Nodular reverse halo sign in active pulmonary tuberculosis: A rare CT feature?

PURPOSE: The purpose of this study was to investigate the prevalence of the nodular reverse halo sign (NRHS) in chest computed tomography (CT) in patients with active pulmonary tuberculosis. MATERIALS AND METHODS: From March 2018 to March 2019, 29 consecutive patients with a culture-confirmed active pulmonary tuberculosis and who underwent chest CT examination during hospital-admission were retrospectively included in the study. There were 24 men and 5 women with a mean age of 40.9±16.7 (SD) years (range: 18-80years). Chest CT examinations of included patients were evaluated for the presence of NRHS and other tuberculosis-related CT signs. RESULTS: CT revealed the NRHS in 5 patients (5/29; 17%). The other CT signs of tuberculosis included consolidations in 18 patients (18/29; 62%), tree-in-bud pattern in 14 patients (14/29; 48%), cavitation in 12 patients (12/29; 41%), sparse nodules in 10 patients (10/29; 34%), and pleural effusion in 8 patients (8/29; 28%). CONCLUSION: CT shows NRHS in 17% of patients with active pulmonary tuberculosis, indicating that the sign is not as rare as previously thought in patients with this condition.

Assessing the benefit of the 72-hour antibiotic therapy reassessment documentation.

OBJECTIVES: To assess the documentation of the 72-hour antibiotic therapy reassessment in medical records. METHODS: One-day prevalence evaluation of curative antibiotic therapies≥72hours. The documentation of the reassessment was defined according to three criteria: (1) "clear" documentation (clinical or microbiological comment associated with a comment on the need to adjust the antibiotic therapy or on the lack of need); (2) "tacit" documentation (only based on a clinical or microbiological comment); (3) no documentation. RESULTS: We assessed 114 antibiotic therapies in 26 hospital departments. A clear reassessment at 72hours was observed in only 45 (39%) records and 31 (27%) records had no reassessment. The planned duration of treatment was written in 63 (55%) records. At 72hours, among the 71 antibiotic therapies with a microbiological documentation, 69 (97%) were active and 44 (62%) had a narrow spectrum. Among the 48 antibiotic therapies with a broad spectrum on day 1, only 21 (44%) benefited from a de-escalation at 72hours. A clearly recorded reassessment at 72hours was associated with de-escalation (P=0.025) and the prescription of a planned duration of treatment was associated with antibiotic therapy compliance with local or national guidelines (P=0.018). CONCLUSION: Although reassessment was observed in 73% of records, it was correctly recorded at 72hours in only 39% of cases. The documentation of the reassessment and the prescription of a planned duration were associated with a better quality of antibiotic prescription (de-escalation, compliance with guidelines) and are relevant indicators for monitoring the proper use of antibiotics.

[Dermatoses and herpes superinfection: A retrospective study of 34 cases]. / Dermatoses et surinfection herpétique : étude rétrospective de 34 cas.

BACKGROUND: Although varicelliform Kaposi eruption is a well-known complication of dermatoses, it has not been widely investigated. AIM: To investigate features of dermatoses and herpes superinfection in patients hospitalized in a dermatology department. PATIENTS AND METHODS: We performed a single-centre, retrospective study between 2008 and 2014 that included cases of Kaposi varicelliform eruptions defined by positive PCR of an unconventional site of herpetic recurrence in a setting of active dermatitis. A record was compiled of each case giving details of the history, clinical and laboratory findings, therapeutic data and outcome. RESULTS: Thirty-four cases of Kaposi varicelliform eruptions in 30 subjects were studied. Mean age at diagnosis was 63.3±24.2 years. The underlying dermatoses were as follows: 7 pemphigus, 6 bullous pemphigoid, 3 cicatricial pemphigoid, 3 atopic dermatitis, 1 Darier disease, and 14 other dermatoses. Patients presented with skin (94.1 %) or mucous membrane lesions (62 %), mostly erosive (79 %), vesicular (27 %) or bullous (41 %), often painful (56 %) or pruritic (29 %). At diagnosis, 41.2 % were undergoing systemic immunotherapy and 24 % were on topical corticosteroids. PCR was positive for HSV1 in 20 cases and for HSV2 in 4 cases, and indeterminate in 10 cases. Lymphocytopenia was seen in 59 % of cases. The majority of patients received treatment. Nine patients experienced at least one relapse. CONCLUSION: Our study confirms the over-representation not only of the expected dermatoses (pemphigus and atopic dermatitis), but also of others such as pemphigoid and acute dermatoses; these results should be investigated in a more systematic prospective study.

The relationship between liver stiffness measurement and outcome in patients with chronic hepatitis C and cirrhosis: a retrospective longitudinal hospital study.

BACKGROUND: There is a relationship between liver stiffness measurement (LSM) and outcome of HCV patients. AIM: To evaluate the performance of LSM to predict outcome of HCV patients at risk of liver-related complication. METHODS: We established a retrospective longitudinal cohort of 341 HCV patients with unequivocal cirrhosis. All underwent LSM and were followed from September 2006 to July 2015. Outcome measure was a composite end-point of end-stage liver disease (ESLD) and/or hepatocellular carcinoma (HCC). Cox models and areas under receiver operating characteristic (AUROC) curves were used to evaluate independent risk factors of outcome. RESULTS: Overall, LSM was below the 12.5 kPa threshold in 129 (37.8%) patients, including three-fourth and one-third of patients with or without a sustained virological response respectively. Liver disease progressed in 136 (39.9%) patients after a median observational period of 23.5 months. Older age, male gender, alcohol use disorders, metabolic syndrome and LSM were independent risk factors of liver disease progression. Age, alcohol use disorders and LSM were independently associated with ESLD. Age, gender and metabolic syndrome, but not LSM, were associated with HCC. The AUROC curves for disease progression, ESLD and HCC were 0.67, 0.70 and 0.58 respectively. Patients with a liver stiffness >12.5 kPa were at the highest risk of liver disease progression; below 12.5 kPa, liver stiffness was not discriminant. CONCLUSION: Liver stiffness measurement is not a surrogate of disease progression of HCV patients with cirrhosis. HCV patients with cirrhosis should undergo the recommended follow-up, regardless of liver stiffness measurement.

Increasing ambulatory surgery potential by non-medicalized accommodation: matched comparison of the 2011 national hospital activity data to 66 local stays.

INTRODUCTION: Several policy and cultural factors still hinder the development of ambulatory surgery (AS) in France. Our surgery unit developed a day-surgery approach with extension of a non-medicalized post-operative stay in a hotel-like structure within the hospital, called an "ambulotel". The present study aims to evaluate the potential of this approach in increasing the possibilities of ambulatory surgery by comparing our stays to those of a nationwide database. PATIENTS AND METHODS: We matched 66 patients according to seven criteria in our one-day ambulotel program to the 2011 DRG national database and then compared their characteristics. RESULTS: Of the 10,428 patients in the database with one-night stays in a traditional surgery unit, more than half (52%) would probably have been eligible for ambulatory surgery with a potential theoretical savings estimated at €12,806,568. CONCLUSION: This estimated amount of savings represents a major medical and economic issue. The savings could contribute to increased ambulatory surgery activity in France by creating new dedicated Ambulatory Units, pooling conventional beds, or using night accommodation in non-hospital nursing homes, for example.

Day surgery: Results after restructuration of a university public general surgery unit.

INTRODUCTION: Nowadays, in France, development of the ambulatory surgery has stalled. This is probably related to the fact that ambulatory surgery is restricted by the law to the "day surgery" in 12 hours, and only 17 procedures are referenced for this surgery. Thus, conventional hospitalization remained the rule after surgery. In January 2010, our university general surgery unit was restructured. It evolved from a conventional unit to a predominantly ambulatory unit. Otherwise, our unit adjoins a hotel, even inside our institution, which accommodates patients, patient visitors and tourists. AIM: The aim of this retrospective study was to compare the postoperative accommodation modalities between two groups of patients. The first group consisted of patients admitted before January 2010, at the time of conventional activity, whereas the second group consisted of patients admitted after January 2010 in a restructured unit. METHODS: Inclusion of patients admitted from April 1, 2008 to March 31, 2009 (conventional hospitalization period) and from April 1, 2010 to March 31, 2011 (ambulatory management period), scheduled for one single surgical procedure excluding emergency. RESULTS: A total of 360 patients were retained: 229 for the conventional period and 131 for the ambulatory period, with a median age of 55 (range 15-87). No statistically significant difference was noted between the two groups as concerned median age, gender or ASA status. The number of postoperative nights varied significantly between the two groups with a mean of 3.8 nights (median three nights, range 0-32) for the conventional period versus 0.4 nights (median 0 night, range 0-10) for the ambulatory period (P<0.0001 by the unadjusted Mann-Whitney test and P<0.0001 by the Wald test [with adjustment]). DISCUSSION: Our results show that it is clearly possible to distinguish the need for care of the need for accommodation and significantly reduce postoperative conventional accommodation. They also raise the question of extending the legal period of 12 hours to 24 hours in order to expand the list of the referenced procedures.

Development of a Web-based clinical information system for surveillance of multiresistant organisms and nosocomial infections.

To optimize the surveillance and control of infections at our hospital, we have developed a clinical information system (CIS) linked to a server providing three kinds of patient-oriented data reports: 1/an automated alert for multiresistant bacteria from a data-driven mechanism; 2/the relevant data for surveillance of hospital-acquired infections; 3/some clinical and educational data for antibiotic prescribing. The new CIS is a Web-based one and now integrated to the Hospital Information System (HIS). In a close collaboration with the experts, we have, first, specified the relevant information for each report. Then, we have linked the system to those HIS DBs containing this information. Finally we have developed a well-secured intranet Web site, on which the concerned practitioners can instantaneously review the latest alerts and/or the summarized/detailed reports. The preliminary results shows that the system is reliable in medical practice and the response time is satisfying.