Does type of immunosupression influence the course of Covid-19 infection?

Coronavirus disease 19 (Covid-19) is a new emerging virus responsible for pandemic and death. High blood pressure, diabetes, obesity have been described as poor prognosis factors. Few data have been reported in patient with immunocompromised status (solid tumor, hematological malignancy, rheumatoid conditions or organ transplant). We evaluated the characteristics of patients, including the outcome, with immunodepression hospitalized in Besancon University hospital (East of France). We wanted to identify if a type of immunosupression influences the course of Covid-19. In a cohort of 80 patients with immunosupression (42 solid tumors, 20 hematological malignancy and 18 non neoplastic immunosupression), poor outcomes (Intensive care unit hospitalization and or deaths) was frequent (38%) and tended to be more frequent in patients with hematological malignancy.

Clinical Predictive Model of Multidrug Resistance in Neutropenic Cancer Patients with Bloodstream Infection Due to Pseudomonas aeruginosa.

We aimed to assess the rate and predictive factors of bloodstream infection (BSI) due to multidrug-resistant (MDR) Pseudomonas aeruginosa in neutropenic cancer patients. We performed a multicenter, retrospective cohort study including oncohematological neutropenic patients with BSI due to P. aeruginosa conducted across 34 centers in 12 countries from January 2006 to May 2018. A mixed logistic regression model was used to estimate a model to predict the multidrug resistance of the causative pathogens. Of a total of 1,217 episodes of BSI due to P. aeruginosa, 309 episodes (25.4%) were caused by MDR strains. The rate of multidrug resistance increased significantly over the study period (P = 0.033). Predictors of MDR P. aeruginosa BSI were prior therapy with piperacillin-tazobactam (odds ratio [OR], 3.48; 95% confidence interval [CI], 2.29 to 5.30), prior antipseudomonal carbapenem use (OR, 2.53; 95% CI, 1.65 to 3.87), fluoroquinolone prophylaxis (OR, 2.99; 95% CI, 1.92 to 4.64), underlying hematological disease (OR, 2.09; 95% CI, 1.26 to 3.44), and the presence of a urinary catheter (OR, 2.54; 95% CI, 1.65 to 3.91), whereas older age (OR, 0.98; 95% CI, 0.97 to 0.99) was found to be protective. Our prediction model achieves good discrimination and calibration, thereby identifying neutropenic patients at higher risk of BSI due to MDR P. aeruginosa The application of this model using a web-based calculator may be a simple strategy to identify high-risk patients who may benefit from the early administration of broad-spectrum antibiotic coverage against MDR strains according to the local susceptibility patterns, thus avoiding the use of broad-spectrum antibiotics in patients at a low risk of resistance development.

Turning a conventional camera into a 3D camera with an add-on.

We propose to add an optical component in front of a conventional camera to improve depth estimation performance of depth from defocus (DFD), an approach based on the relation between defocus blur and depth. The add-on overcomes ambiguity and the dead zone, which are the fundamental limitations of DFD with a conventional camera, by adding an optical aberration to the whole system that makes the blur unambiguous and measurable for each depth. We look into two optical components: the first one adds astigmatism and the other one chromatic aberration. In both cases, we present the principle of the add-on and experimental validations on real prototypes.

[Congenital mucocele of the ventral face of the tongue]. / Mucocèle congénitale de la face ventrale de la langue.

BACKGROUND: Congenital cystic lesions of the oral cavity are an extremely rare occurrence. Their prenatal diagnosis is essential since they can impede respiratory and swallowing functions. We describe a case that was detected prenatally and discuss its management. CASE REPORT: A 21-year-old primigravida patient who was 23 weeks pregnant was referred to our obstetrics and gynecology center after fetal ultrasonography showed a cystic lesion of the oral cavity. She had no family history of any congenital anomalies. Ultrasonography showed a male fetus with an anechoic mass measuring 21×11 mm encompassing the entire oral cavity, evoking either a mucocele or a cystic hygroma. Magnetic resonance imaging (MRI) showed a fetus with a wide-open mouth, due to a well-demarcated protruding cystic mass with no solid component, suggestive of a mucocele. A prenatal sonographically guided percutaneous needle aspiration of mucous fluid was performed at 33 gestational weeks. Although the mucocele decreased significantly in size, it nevertheless continued to expand progressively. After an uncomplicated pregnancy, the patient had spontaneous onset of labor at 39 weeks of gestation. An iterative aspiration was performed in the same manner in utero, resulting in a complete collapse of the mucocele. If needed, intubation could be considered. A 3030-g male was born by vaginal delivery, without respiratory distress. Clinical examination showed the extremely opened mouth and confirmed the presence of a large cystic mass approximately 4 cm in diameter, of sublingual origin and encompassing the entire oral cavity. The continuous protrusion of the tongue was responsible for the infant's inability to close the mouth and be breastfed. After insertion of a feeding tube, the newborn had maxillofacial surgery consisting in marsupialization of the cyst at 2 days of age. The mucocele decreased in size and the postoperative course was uneventful. No recurrence was observed at 6 months' follow-up. DISCUSSION AND CONCLUSION: Congenital mucoceles of the tongue are very rare benign lesions of the oral cavity, resulting from extravasation or retention of mucus from minor salivary glands. Their prevalence is unknown and, to our knowledge, less than ten cases of prenatal diagnosis have been previously reported. Such cystic lesions can cause respiratory distress and swallowing disorders in newborns. They are usually suspected on ultrasonography. MRI highlights the nature of the lesion and its locoregional connections with muscles and blood vessels. It provides a good analysis of the soft tissues and can distinguish between the muscles of the tongue and the pathologic mass. However, the use of CT has been reported when the diagnosis was made after childbirth or in adulthood. Given the risks of interference of the lesion with respiratory and swallowing functions, intrauterine decompression of the mucocele can be an option to prevent respiratory distress at birth and the need for neonatal intubation. Mucoceles provide somewhat confusing and disturbing ultrasonographic appearances, which can be stressful for the medical team and parents. Prenatal diagnosis and early surgical intervention (marsupialization, complete excision of the cyst or the salivary gland) can prevent risks of breathing distress and breastfeeding problems. Therefore, this strategy is essential to offer fast and satisfactory management of this rare but anxiety-producing congenital situation.

Diagnosing pelvic osteomyelitis beneath pressure ulcers in spinal cord injured patients: a prospective study.

There is no consensus on a diagnostic strategy for osteomyelitis underlying pressure ulcers. We conducted a prospective study to assess the accuracy of multiple bone biopsies and imaging to diagnose pelvic osteomyelitis. Patients with clinically suspected osteomyelitis beneath pelvic pressure ulcers were enrolled. Bone magnetic resonance imaging (MRI) and surgical bone biopsies (three or more for microbiology and one for histology per ulcer) were performed. Bacterial osteomyelitis diagnosis relied upon the association of positive histology and microbiology (at least one positive culture for non-commensal microorganisms or three or more for commensal microorganisms of the skin). From 2011 to 2014, 34 patients with 44 pressure ulcers were included. Bacterial osteomyelitis was diagnosed for 28 (82.3%) patients and 35 (79.5%) ulcers according to the composite criterion. Discrepancy was observed between histology and microbiology for 5 (11.4%) ulcers. Most common isolates were Staphylococcus aureus (77.1%), Peptostreptococcus (48.6%) and Bacteroides (40%), cultured in three or more samples in 42.9% of ulcers for S. aureus and ≥20% for anaerobes. Only 2.8% of ulcers had three or more positive specimens with coagulase-negative staphylococci, group B Streptococcus, and nil with enterococci and Pseudomonas aeruginosa. Staphylococcus aureus, Proteus and group milleri Streptococcus were recovered from one sample in 22.8%, 11.4% and 11.4% of ulcers, respectively. Agreement was poor between biopsies and MRI (κ 0.2). Sensitivity of MRI was 94.3% and specificity was 22.2%. The diagnosis of pelvic osteomyelitis relies on multiple surgical bone biopsies with microbiological and histological analyses. At least three bone samples allows the detection of pathogens and exclusion of contaminants. MRI is not routinely useful for diagnosis.

[The access of independent midwives to maternity ward technical facilities: the experimentation of a level-1 department]. / Accès des sages-femmes libérales au plateau technique: l'expérimentation d'une maternité de type 1.

OBJECTIVES: The first aim of this study was to evaluate the access of independent midwives to the technical facilities of a level-1 maternity hospital, with a follow-up of 2 years. The second aim was to evaluate the transfer of clinical responsibility, when a patient stops being managed by the independent midwife to be taken care of by the hospital team. PATIENTS AND METHODS: A retrospective study including 51 patients. Analysis of maternal and perinatal data. RESULTS: Of the 51 births, there were 42 vaginal deliveries without intervention (82.35%), 3 instrumental deliveries (5.88%), 6 caesarean sections (11.76%). The midwife-led care was completed in 70.59% of cases. The rate of transfer of clinical responsibility during labor was 25.49%. We conducted a neonatal transfer due to a respiratory distress syndrome. DISCUSSION AND CONCLUSION: The access to technical support appears as an opportunity for independent midwives to establish a special relationship with their patients. However, this device preserves the possibility of a traditional hospital care when needed. This way, access to the technical support is a safe alternative that has the consent of the users (patients and midwives) as well as of the entire hospital team. Moreover, such device allowed an increase of 5% per year of our obstetrical activity with an estimated increase of 10% per year.

[The obstetrics and gynaecology departments in the French public hospitals: an updated overview]. / État des lieux des services de gynécologie-obstétrique dans les centres hospitaliers publics français.

Restructuring the surgery and gynecology-obstetrics departments taking place now raise many interrogations. It appears as a mandatory necessity to some people and as a tribute to financial strategies to others to the detriment of quality and accessibility of care. Its effect is to clarify a good amount of socioeconomical and medical indicators. The plans of perinatality for the obstetrical aspect and the thresholds of activity for the surgical aspect constitute the major lines of these restructurings. A survey soliciting all the French public hospitals was used to assess the state of obstetrics and gynecology departments in the light of these recent restructurings. Medical demography, preserving and improving the quality and continuity of care, efficiency of the technical supports are discriminating criteria of the involved challenges. Such restructurings have an impact on the doctor's lives, which looks globally positive and a good omen to complete this remodeling process. The activity was safeguarded by a redistribution and a refocusing of institutions. One should not minimize the social impact of these changes, with a potential deterioration of working conditions (internal professional reclassifications, mobility obligation towards other sites). It thus appears that the deep changes which affect the small size institutions will be able to achieve well only if they are clearly done (information) and truly integrated in their medical project.

[Original presentation of relapsing polychondritis: four cases]. / Manifestations originales au cours de la polychondrite atrophiante: à propos de quatre cas.

INTRODUCTION: The diagnosis of relapsing polychondritis is difficult as various manifestations may be encountered aside the characteristic episodes of recurrent chondritis. CASE REPORTS: From the retrospective analysis of the medical charts of patients presenting with relapsing polychondritis seen at Nîmes hospital between 1995 to 2006, four were selected for their original extra-cartilaginous manifestations. Case 1: relapsing polychondritis was diagnosed at the time of a thromboembolic event associated with a right uveitis, left temporomandibular arthritis and bilateral sensorineural deafness. Case 2: relapsing polychondritis occurred in a patient with history of bilateral sensorineural deafness with punctuated keratitis followed by a relapsing cutaneous leucocytoclastic vasculitis. Case 3: relapsing polychondritis associated with recurrent thromboembolic disease and a Sweet's syndrome and case 4: relapsing polychondritis presenting with a febrile erythema. CONCLUSION: The reported observations highlight the difficulty of the initial diagnosis of relapsing chondritis and the variety of the extra-chondritis manifestations that could be observed in this disease.

Host manipulation by Ligula intestinalis: a cause or consequence of parasite aggregation?

Previous investigations suggest that the infection of the cyprinid roach, Rutilus rutilus, with the larval plerocercoid forms of the cestode, Ligula intestinalis, creates behavioural and morphological changes in the fish host, potentially of adaptive significance to the parasite in promoting transmission to definitive avian hosts. Here we consider whether these behavioural changes are important in shaping the distribution of parasite individuals across the fish population. An examination of field data illustrates that fish infected with a single parasite were more scarce than expected under the negative binomial distribution, and in many months were more scarce than burdens of two, three or more, leading to a bimodal distribution of worm counts (peaks at 0 and >1). This scarcity of single-larval worm infections could be accounted for a priori by a predominance of multiple infection. However, experimental infections of roach gave no evidence for the establishment of multiple worms, even when the host was challenged with multiple intermediate crustacean hosts, each multiply infected. A second hypothesis assumes that host manipulation following an initial single infection leads to an increased probability of subsequent infection (thus creating a contagious distribution). If manipulated fish are more likely to encounter infected first-intermediate hosts (through microhabitat change, increased ingestion, or both), then host manipulation could act as a powerful cause of aggregation. A number of scenarios based on contagious distribution models of aggregation are explored, contrasted with alternative compound Poisson models, and compared with the empirical data on L. intestinalis aggregation in their roach intermediate hosts. Our results indicate that parasite-induced host manipulation in this system can function simultaneously as both a consequence and a cause of parasite aggregation. This mutual interaction between host manipulation and parasite aggregation points to a set of ecological interactions that are easily missed in most experimental studies of either phenomenon.

Immunoregulatory effects of a nutritional preparation containing bovine lactoferrin taken orally by healthy individuals.

The aim of this study was to monitor several immune parameters in 17 healthy volunteers taking orally commercially available capsules containing bovine lactoferrin (BLFT) for 10 days (40 mg of BLFT daily). We determined leukocyte number and content of main blood cell types, spontaneous and phytohemagglutinin A (PHA)-induced proliferation of lymphocytes, plasma levels of interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) as well as spontaneous and lipopolysaccharide (LPS)-induced production of these cytokines in peripheral blood cell cultures. All measurements were performed before, one day and 14 days following cessation of BLFT treatment. We established some, transient drop in the percentage of neutrophils accompanied by an opposite phenomenon with regard to lymphocyte levels. More profound changes were registered in the percentage of other cell types, for example a 100% increase in the level of immature cell forms (bands) was noted. At the same time the percentages of eosinophils and monocytes declined significantly. All these changes were, however, more individual and regulatory, the direction of these changes depended on initial picture of blood cells. Although the proliferative response of lymphocytes showed, on average, a transient decrease, differentiated effects of BLFT treatment were observed depending on initial ability of lymphocytes to proliferate. TNF-alpha serum levels showed a tendency to decrease during the monitoring time, the changes of IL-6 levels were, however, not significant. As in the case of the proliferative response, the treatment with BLFT was regulatory with respect to serum TNF-alpha levels. When we analyzed spontaneous and LPS-induced cytokine production in cell cultures we found that mainly the mean spontaneous response was affected (inhibition). We also observed a typical, regulatory action of BLFT on the level of spontaneously produced IL-6. This kind of regulatory action of BLFT was also found in the case of spontaneously produced TNF-alpha in cell cultures. The influence of other ingredients such as selenium or vitamins, contained in the capsules, cannot be excluded, although our latest data showed that orally taken bovine lactoferrin alone can induce identical changes as BLFT. Taken together, we revealed regulatory effects of oral treatment with commercially available capsules, containing BLFT. The results indicate that oral administration on BLFT-containing capsules may regulate some immune parameters in healthy individuals. In addition, the data suggest that bovine lactoferrin may be applied in clinic to improve the immune status of patients.

Influence of the destabilisation of the maternal digestive microflora on that of the newborn rat.

By destabilising the digestive flora of pregnant rats by antibiotic treatment, it was shown that part of the digestive microflora of the neonate originated from the maternal faeces. A mixture of ampicillin, bacitracin neomycin and streptomycin associated with nystatin were administered ad libitum at three different times, 1-3, 3-5, and more than 5 days before the estimated date of littering. For each treatment, samples were taken from the faeces, teats, and vagina of dams and from the digestive tracts of neonates aged between 6 and 120 h, and analysed for the presence of staphylococci, enterococci, lactobacilli and coliform bacteria. Antibiotic treatment reduced digestive flora populations to levels lower than 10(2) g-1 but had less effect on the vaginal and cutaneous mammary flora. In the digestive microflora of the neonate, the enterococci were unevenly affected, whereas the staphylococci were considerably decreased and the lactobacilli almost completely eliminated; coliform bacteria were found sporadically and in small numbers. The traces of antibiotics found in milk are not sufficient to explain these modifications. Counts made in control animals on media fed the same antibiotic concentrations were not modified. This work underlined the awful consequences for the newborn of a serious perturbation of the mother flora and the necessity of its presence for a normal installation of the digestive microflora of the newborn.

[Decrease of the intestinal microflora without consequences for the morphometry and topography of the distal ileum in the mouse treated with antibiotics]. / Diminution de la microflore intestinale sans conséquences sur la morphométrie et la topographie de l'iléon distal chez la souris traitée aux antibiotiques.

The aim of this study was to assess the possible modifications in the conventional intestine when deprived of its symbiotic microflora. The experiment was designed to study the effect of a heavy antibiotic dose on fecal microflora during the 33-d treatment period as well as its effects upon the intestinal wall. Conventional adult mice received either a casein-starch diet (conventional controls) or an antibiotic-supplemented (0.66% dry matter, DM) diet (treated conventionals); Furthermore, germ-free (axenic) mice taken from isolators to the open animal room received the same antibiotic-supplemented diet (treated axenics) Fecal microbial population remained around 10(8)/g in the conventional mice while it decreased to 10(3)/g in the treated conventional mice. Fecal microbial population of the treated axenic mice dropped to 10(2)/g. At the end of the 33-d treatment period, no significant difference in ileal villus height between the treated or control groups no difference either was seen in the aspects of the villus and cell surface as shown by scanning electron microscopy. In the control group, however, development of bacterial colonies exhibiting various shapes were observed on the intestinal mucus. Although it was found that antibiotic treatment was followed by significant changes in microbial population and biochemical composition of digestive contents, this study concluded that the structure of the distal ileal epithelium was not impaired.

Intestinal microflora of the newborn rat as related to mammary, faecal, and vaginal Staphylococci strains isolated from the dam.

To determine the relative importance of maternal microflora (faeces, vagina, and teats) in the contamination of newborn rats, strains of staphylococci from six different families (dam + litter) were isolated. These strains were identified, and by means of numerical profiles analyzed for their degree of similarity for each litter and (or) biotope. The staphylococci strains found in the gut of the newborn rat originated first from the teats and thereafter from the faeces. Concomitant observation of some identical strains, however, suggested a certain degree of similarity between these two maternal biotopes in this animal.

Relationship between the digestive microflora of the newborn and maternal microflora in rodents as evidenced by a transit marker.

The cutaneous and digestive microflora of the dam, constitute the main sources of bacteria likely to colonize the digestive tract of the newborn. Our objective was to study the conditions (delay, level) in relation to the maternal microflora. Spores of Bacillus stearothermophilus were used as a tracer. They were spread on the mother's udder or given per os to the mother. In our study, we used holoxenic rats and axenic mice. The tracer was then followed in newborn rats and newborn mice. Transfer of the spore from the dam to the digestive tract of the newborn were generally observed very shortly after the contact between the dam and the newborn (2 or 3 h). This transfer requires a minimal concentrations of spores 1.5 x 10(6) spores/g feces and 3 x 10(6) spores/udder for the rat; 10(6) spores/g feces and 1.5 x 10(6) spores/udder for the mouse). Transfer of spores in the digestive tract of neonates is proportional to the level of spores on the udder. But only a hundredth or less of the initial inoculum is transferred. The transfer of spores via the udder or via the maternal feces led to very similar levels of implantation of spores in the digestive tract of neonates. These results emphasize the important role of the maternal fecal and mammary microflora in the colonization of the digestive tract of the newborn.

Kinetics of the establishment of gastrointestinal microflora in the conventional new-born rat.

The kinetics of the establishment of gastrointestinal flora in the conventional new-born rat aged 5 h to 8 days was studied. Anaerobic species were counted by the method of Hungate in an anaerobic glove box, in the stomach and the whole of the intestine. In both organs, staphylococci and micrococci were the first bacteria to settle, along with a few unidentified aerobic bacilli. Counts levelled off after the first day. Streptococci and enterococci settled somewhat later, and their numbers too levelled off after the first day. The appearance of Escherichia coli was sometimes early and always very irregular. Permanent implantation of this species only began to occur after the first day. Actinobacilli were observed at 20 h, but irregularly. Lactobacilli (mainly Lactobacillus murinus and L. leichmanii) were initially very low in number, but later multiplied rapidly towards the end of the first day to become the dominant genus. No strictly anaerobic bacteria, sporing or not, were ever found in animals younger than 4 days. Inoculation of axenic mice with gut contents from rats aged up to 1 day confirmed the above results. Analysis of superficial mammary flora of suckling parent females consistently showed staphylococci and micrococci during the first day post partum. By the 15th day post partum, lactobacilli had progressively become implanted alongside these two other genera. On the other hand, the vaginal flora of parent females immediately post partum was found to be quite different from that observed in the gut of the new-born rat. Possible origins for the early colonizing genera, including suckling, are discussed.