Pink urine syndrome in an anuric patient during continuous renal replacement therapy: A case report.

INTRODUCTION: Pink urine syndrome is a rare, poorly understood condition, often prompted by obesity, insulin resistance, and the drug propofol. It is characterized by pink urine or urine sediment and occurs in the absence of a heme or food-based pigment. The pathophysiology of this syndrome is not yet fully understood but is linked to a uric acid metabolism disorder. Pink urine syndrome is less familiar to anesthesiologists than other propofol infusion complications. Our case report aims to highlight this rarely encountered syndrome, whose both diagnosis and therapeutic may be challenging. We have reported the first case of this syndrome evidenced by the change in color of the effluent bag during continuous veno-venous hemofiltration (CVVHF). CASE PRESENTATION: A 61-year-old woman was admitted to the intensive care unit following a recovered cardiorespiratory arrest due to ventricular arrhythmia. She was placed in hypothermia, sedated with propofol (300 mg/h), and started on CVVHF for oligo-anuric acute kidney injury associated with severe metabolic acidosis. A few hours after initiation of CVVHF, the effluent bag turned bright pink. Given the pink color of the effluent bag and the hypothesis of propofol-induced pink urine syndrome, propofol was replaced by midazolam. After stopping propofol, the color of effluent bag lightened. Unfortunately, the patient died on the third day of hospitalization due to diffuse cerebral edema. CONCLUSIONS: We report here the first case of pink urine syndrome as revealed by the change in color of the contents of the CVVHF effluent bag in an anuric patient. This syndrome is rare but significant in anesthesia/intensive care settings, where propofol is a frequently used sedative. Knowledge of this syndrome appears to be important to avoid irrelevant additional investigations and to optimize the therapeutic strategy.

Immediate effects of postural repositioning on maximum phonation duration tasks in seated individuals with acquired dysarthria: a pilot study.

PURPOSE: To determine the effectiveness of a single 10-min postural repositioning session on the maximum phonation duration (MPD) of the vowel/a/in individuals with acquired dysarthria. MATERIALS AND METHODS: A pre-post interventional design was implemented; five patients with dysarthria (PWDs) underwent a single 2-hour experimental session. MPD capacities were assessed before and immediately after a 10-min postural repositioning intervention by a physical and occupational therapist. Five age- and sex-matched individuals without dysarthria were recruited as controls. The main outcome measure was the MPD of the vowel/a/at conversational and louder voice levels, with a speech-and-language therapist standing 1 and 6 m away, respectively. Secondary outcome measures were thoracic expansion, manometry, electromyographic recordings of axial muscles and perceived effort. RESULTS: In PWDs, postural repositioning improved the MPD during the/a/-1-m (80.3% increase) and/a/-6-m tasks (18% increase), increased thoracic expansion and manometric measurements, and reduced the perceived effort necessary to perform the tasks. A triphasic electromyographic pattern was observed during both/a/-1-m and/a/-6-m tasks in controls, but was absent in participants with severe dysarthria, even after postural repositioning. Nonetheless, postural repositioning enabled an earlier onset of EMG activity prior to voice production. CONCLUSIONS: These data suggest the efficacy of postural repositioning in improving phonatory capacities essential for voice production in PWDs.

National survey of Canadian residents and program directors regarding parental leave during residency.

BACKGROUND: Despite the advantages of having a child as a medical resident, the transition back to residency after parental leave can be challenging. This study is the first to investigate this issue using a nation-wide Canadian sample of both residents and program directors. METHOD: A questionnaire was developed and made available online. Respondents included 437 female residents, 33 male residents, and 172 residency program directors. The mean length of parental leave was nine months for female residents and six weeks for male residents. Almost all female residents (97.5%) breastfed with an average duration of 12 months. The top challenges reported by residents were feeling guilty for being away from their family, long and unpredictable work hours, sleep deprivation, and finding time to study. When female residents and program directors were matched to both school and program (N = 99 pairs), there was no difference in the total number of challenges reported, but program directors reported offering significantly more accommodations than female residents reported being offered, t(196) = 13.06, p < .001. RESULTS: Our data indicate there is a need for better communication between resident parents and program directors, as well as clear program-specific parental leave policies, particularly for supporting breastfeeding mothers as they return to work.

CONTEXTE: Malgré les avantages d'avoir un enfant au cours d'une résidence en médecine, le retour à la résidence à la suite d'un congé parental peut s'avérer difficile. Cette recherche est la première qui étudie cette question en utilisant un échantillon national comptant à la fois des résidents et directeurs de programmes canadiens. MÉTHODE: Un questionnaire a été préparé et affiché en ligne. Parmi les personnes interrogées, on comptait 437 résidentes, 33 résidents et 172 directeurs et directrices de programmes de résidence. La durée moyenne des congés parentaux était de neuf mois pour les résidentes et six semaines pour les résidents. Presque toutes les résidentes (97,5%) ont allaité en moyenne pendant douze (12) mois. Les plus grands défis que les résidents ont signalés étaient la culpabilité de ne pas être avec leur famille, les longues et imprévisibles heures de travail, le manque de sommeil et la difficulté à trouver le temps pour étudier. Lorsque les résidentes et directeurs et directrices de programme étaient jumelés à l'école et au programme (N = 99 paires), le nombre total de difficultés rapportées est demeuré inchangé. Cependant, les directeurs et directrices de programme ont signalé qu'ils offraient beaucoup plus d'accommodements que ce que les résidentes ont déclaré qu'on leur proposait, t(196) = 13.06, p < .001. RÉSULTATS: Nos données indiquent qu'il est nécessaire d'améliorer la communication entre les résidents parents et les directeurs de programme ainsi que les politiques qui régissent les programmes de congés parentaux, notamment pour aider les mères qui allaitent au moment de retourner au travail.

Early cave art and ancient DNA record the origin of European bison.

The two living species of bison (European and American) are among the few terrestrial megafauna to have survived the late Pleistocene extinctions. Despite the extensive bovid fossil record in Eurasia, the evolutionary history of the European bison (or wisent, Bison bonasus) before the Holocene (<11.7 thousand years ago (kya)) remains a mystery. We use complete ancient mitochondrial genomes and genome-wide nuclear DNA surveys to reveal that the wisent is the product of hybridization between the extinct steppe bison (Bison priscus) and ancestors of modern cattle (aurochs, Bos primigenius) before 120 kya, and contains up to 10% aurochs genomic ancestry. Although undetected within the fossil record, ancestors of the wisent have alternated ecological dominance with steppe bison in association with major environmental shifts since at least 55 kya. Early cave artists recorded distinct morphological forms consistent with these replacement events, around the Last Glacial Maximum (LGM, ∼21-18 kya).

Effect of X-ray irradiation on ancient DNA in sub-fossil bones - Guidelines for safe X-ray imaging.

Sub-fossilised remains may still contain highly degraded ancient DNA (aDNA) useful for palaeogenetic investigations. Whether X-ray computed [micro-] tomography ([µ]CT) imaging of these fossils may further damage aDNA remains debated. Although the effect of X-ray on DNA in living organisms is well documented, its impact on aDNA molecules is unexplored. Here we investigate the effects of synchrotron X-ray irradiation on aDNA from Pleistocene bones. A clear correlation appears between decreasing aDNA quantities and accumulating X-ray dose-levels above 2000 Gray (Gy). We further find that strong X-ray irradiation reduces the amount of nucleotide misincorporations at the aDNA molecule ends. No representative effect can be detected for doses below 200 Gy. Dosimetry shows that conventional µCT usually does not reach the risky dose level, while classical synchrotron imaging can degrade aDNA significantly. Optimised synchrotron protocols and simple rules introduced here are sufficient to ensure that fossils can be scanned without impairing future aDNA studies.

Characterizing the Lower Paleolithic bone industry from Schöningen 12 II: A multi-proxy study.

Although preservation of Paleolithic faunal assemblages from open-air settings is often poor, the Lower Paleolithic sites of Schöningen provide exceptionally well-preserved mammalian faunal material for investigating hominin/animal relationships. Pleistocene fossil assemblages, however, usually reflect a complex taphonomic history in which natural and anthropogenic processes are often superimposed. A number of examples of osseous finds that resemble tools were recently discovered in the MIS 9 deposits of Schöningen 12 II. Non-anthropogenic agents are known to produce surface modifications mimicking human artifacts and the identification of osseous remains used and/or deliberately modified by ancient hominins is often controversial in such old contexts. Multiple lines of evidence are thus useful for distinguishing between osseous artifacts and "eco-facts". In this paper, the recognition of the use of bone for different technological purposes by late Middle Pleistocene hominins is addressed through a multi-proxy study combining geoarcheology, bone taphonomy, zooarcheology, and use-wear analysis. This allowed the identification of the processes and agents responsible for the formation and modification of the different bone assemblages of Schöningen 12 II. Our analysis points to different types of bones having been likely used as tools. These results expand the diversity of the organic technological repertoire of the Middle Pleistocene hominins, making Schöningen 12 II a remarkable new source of information on osseous technology long before the Upper Paleolithic, the period traditionally viewed as the start of the systematic use of bone tools. Together with other observations of bone tools documented during the Lower and Middle Paleolithic, the results from Schöningen show that archeologists may have underestimated the diversity and importance of osseous technology among archaic hominins.

A new approach for deciphering between single and multiple accumulation events using intra-tooth isotopic variations: Application to the Middle Pleistocene bone bed of Schöningen 13 II-4.

It is often difficult to differentiate between archaeological bonebeds formed by one event such as a mass kill of a single herd, and those formed by multiple events that occurred over a longer period of time. The application of high temporal resolution studies such as intra-tooth isotopic profiles on archaeological mammal cohorts offers new possibilities for exploring this issue, allowing investigators to decipher between single and multiple accumulation events. We examined (18)O and (13)C isotopic variations from the enamel carbonate of 23 horse third molars from the Middle Pleistocene archaeological site of Schöningen. We employed a new approach to investigate processes of fossil accumulation that uses both bulk and intra-tooth isotopic variations and takes into account animal behavior, age at death and dental development to test the degree of isotopic affinity of animals from the same fossil assemblage. Oxygen and carbon isotope bulk values indicate that the horses from Schöningen 13 II-4 experienced relatively similar climatic and dietary regimes. Inter-individual differences of the bulk values of the horses sampled in the current study present nevertheless inter-individual variability similar to individuals from multi-layered localities. In addition, the intra-tooth isotopic variation of specimens of the same age at death seems to indicate that the studied cohort corresponds to a mix of individuals that recorded both similar and different isotopic histories. Finally, the conditions recorded in the isotopic signal shortly before death (i.e., for teeth not fully mineralized) varied between sampled individuals, suggesting possible differences in the seasonality of death. Considering those results, we discuss the possibility that the horses from Schöningen 13 II-4 correspond to an accumulation of different death events.

Investigation of equid paleodiet from Schöningen 13 II-4 through dental wear and isotopic analyses: Archaeological implications.

The paleodietary traits of the equid population from Schöningen 13 II-4 were investigated through tooth mesowear and microwear analyses, as well as stable isotopic analyses. The mesowear pattern observed on the upper teeth indicates a low abrasion diet with a significant amount of browse in the diet of the horses. The tooth microwear analysis and the isotopic data confirm that the horses from Schöningen 13 II-4 were mixed feeders, like many populations from other Pleistocene localities in Northern and Eastern Europe. Microwear also provides information on seasonal changes in the diet of the horses and offers the possibility to test hypotheses about the presence of one or several horse populations. Our analysis determined that the assemblage of horse remains from Schöningen 13 II-4 resulted from multiple accumulation events, which took place at different periods of time.

Trunk and neck kinematics during overground manual wheelchair propulsion in persons with tetraplegia.

PURPOSE: To test the hypothesis that movement of the head and trunk increases as a consequence of speed during manual wheelchair propulsion over the ground in individuals with tetraplegia. METHODS: Seven adult participants with tetraplegia who used manual wheelchairs (5 men and 2 women, aged 33.0 ± 10.2) were selected for the study. Participants propelled over the ground at three different speeds while video motion capture methods collected kinematic data. Variables investigated were forward flexion, lateral flexion and axial rotation for both the head and trunk. Repeated measures ANOVA were used to determine effects of speed on head and trunk movements. RESULTS: Both neck and trunk forward flexion significantly increased as a result of speed (p = 0.034, p = 0.031), with a large effect size (r = 0.6, r = 0.6) between slow and fast speeds. Lateral flexion and axial rotation were minimal for the neck and trunk and did not significantly increase with speed. CONCLUSIONS: Results suggest that manual wheelchair users with tetraplegia compensate for trunk muscle weakness by flexing the upper trunk and neck forward during manual wheelchair propulsion and that these movements increase with speed. Further studies should examine if these movements relate to overuse injuries and interventions that focus on improving manual wheelchair biomechanics of individuals with tetraplegia. IMPLICATIONS FOR REHABILITATION: Individuals who use manual wheelchairs utilize their upper extremities almost exclusively for both everyday mobility and participation in daily life activities which can often lead to overuse injuries and pain. Despite having a lack of trunk muscle innervation, manual wheelchair users with tetraplegia are able to compensate for this weakness by using the upper trunk and neck. The way in which force is translated from the trunk through the upper extremities to the pushrim may impact propulsion biomechanics, and ultimately the extent in which upper extremity pain and injury develops. A better understanding of how individuals with trunk impairments propel a manual wheelchair will help clinicians determine optimal wheelchair positioning and training during rehabilitation for individuals with tetraplegia. Clinicians can determine ways in which they can support manual wheelchair users to allow for most efficient biomechanics.

[Management of the yellow fever epidemic in 2010 in Séguéla (Côte d'Ivoire): value of multidisciplinary investigation]. / Gestion de l'épidémie de fièvre jaune en 2010 à Séguéla (Côte d'Ivoire): intérêt d'une investigation pluridisciplinaire.

INTRODUCTION: In August 2010, five positive cases of yellow fever were reported in the region of Séguéla, in the northwest of Côte d'Ivoire, affected by an armed conflict since 2002. In order to evaluate the extent of yellow fever virus circulation and the risk for local people, a multidisciplinary investigation was carried out by the Côte-d'Ivoire Ministry of Health and Public Hygiene. METHODS: Theses investigations were conducted in the villages of confirmed cases and the outpatient and hospitalization centers attended by infected patients, two weeks after the reactive immunization campaign performed in order to stop the spread of the epidemic. The search for suspects identified 16 cases, including 4 cases and 2 deaths in hospital registers and 12 cases during community interviews, including 6 deaths. RESULTS: Stegomyiens indices were relatively low. Aedes aegypti was present among adult mosquitoes. In addition, three wild vectors, varying in number from one locality to another, were detected: Ae. africanus, Ae. luteocephalus and Ae. vittatus with average biting rates of 0.3; 0.1 and 0.05 bite/man/twilight, respectively, at Soba, Ae. africanus and Ae. vittatus with average biting rates of 0.25 and 0.3 bite/man/twilight, respectively, at Yaokro and Ae. luteocephalus with one bite/man/twilight at Kaborékro. DISCUSSION: Unfortunately, the vaccine response conducted before investigations did not stop progression of the epidemic which broke out three months later in the Worofla health area, close to the Magrékros encampment.

Middle Pleistocene ecology and Neanderthal subsistence: insights from stable isotope analyses in Payre (Ardèche, southeastern France).

The Middle Palaeolithic site of Payre in southeastern France yields abundant archaeological material associated with fossil hominid remains. With its long sequence of Middle Pleistocene deposits, Payre is a key site to study the Middle Palaeolithic chronology of this region. This study is the first to investigate carbon and oxygen isotope contents of Neanderthal tooth enamel bioapatite, together with a wide range of herbivorous and carnivorous species. The aim is to contribute to the understanding of hunting behaviour, resource partitioning, diet and habitat use of animals and Neanderthals through a palaeoecological reconstruction. Local topography had a visible influence on carbon and oxygen stable isotope values recorded in herbivore tooth enamel. This was used to investigate possible habitats of herbivores. The different herbivorous species do not show large variations of their carbon and oxygen isotope values through time, indicating niche conservatism from OIS 8-7 to OIS 6-5, i.e., independently of palaeoclimatic and palaeoenvironmental variations. Based on these new observations, we conclude that Neanderthals employed a stable subsistence strategy over time, using a variety of local resources, with resource partitioning visible between humans and carnivores, especially wolves. A comparison of the results of stable isotopic investigation with the results of tooth wear analyses previously conducted on the same teeth allowed us to demonstrate that grazing and browsing do not bind animals to a specific habitat in a C3 environment as reflected in the isotopic values.

Species composition and population dynamics of Aedes mosquitoes, potential vectors of arboviruses, at the container terminal of the autonomous port of Abidjan, Côte d'Ivoire.

An entomological survey of Aedes mosquitoes was initiated at the container terminal of the Autonomous Port of Abidjan in 2009 following the occurrence of two outbreaks of yellow fever in less than 10 years and dengue cases reported in 2008 among expatriates returning from Côte d'Ivoire (Ivory Coast). It was based on regular monitoring of ovitraps from July 2009 to June 2010. A total of 4,739 adult mosquitoes represented by four species of Aedes (97% of total) and one unexpected species of Culex (3%) were obtained. Aedes aegypti was dominant with 98% of total Aedes (n = 4,594). Its density variation was closely related to the amount of rainfall. The other species of Aedes were collected in the second half of the major rainy season including Ae. albopictus (1.17% of Aedes) and Ae. angustus (0.13%) whose presence was discovered for the first time in Côte d'Ivoire.

Decreased motivation in the use of insecticide-treated nets in a malaria endemic area in Burkina Faso.

BACKGROUND: The use of insecticide-treated nets (ITN) is an important tool in the Roll Back Malaria (RBM) strategy. For ITNs to be effective they need to be used correctly. Previous studies have shown that many factors, such as wealth, access to health care, education, ethnicity and gender, determine the ownership and use of ITNs. Some studies showed that free distribution and public awareness campaigns increased the rate of use. However, there have been no evaluations of the short- and long-term impact of such motivation campaigns. A study carried out in a malaria endemic area in south-western Burkina Faso indicated that this increased use declined after several months. The reasons were a combination of the community representation of malaria, the perception of the effectiveness and usefulness of ITNs and also the manner in which households are organized by day and by night. METHODS: PermaNet 2.0 and Olyset were distributed in 455 compounds at the beginning of the rainy season. The community was educated on the effectiveness of nets in reducing malaria and on how to use them. To assess motivation, qualitative tools were used: one hundred people were interviewed, two hundred houses were observed directly and two houses were monitored monthly throughout one year. RESULTS: The motivation for the use of bednets decreased after less than a year. Inhabitants' conception of malaria and the inconvenience of using bednets in small houses were the major reasons. Acceptance that ITNs were useful in reducing malaria was moderated by the fact that mosquitoes were considered to be only one of several factors which caused malaria. The appropriate and routine use of ITNs was adversely affected by the functional organization of the houses, which changed as between day and night. Bednets were not used when the perceived benefits of reduction in mosquito nuisance and of malaria were considered not to be worth the inconvenience of daily use. CONCLUSION: In order to bridge the gap between possession and use of bednets, concerted efforts are required to change behaviour by providing accurate information, most particularly by convincing people that mosquitoes are the only source of malaria, whilst recognising that there are other diseases with similar symptoms, caused in other ways. The medical message must underline the seriousness of malaria and the presence of the malaria vector in the dry season as well as the wet, in order to encourage the use of bednets whenever transmission can occur. Communities would benefit from impregnated bednets and other vector control measures being better adapted to their homes, thus reducing the inconvenience of their use.

Sources of clostridia in raw milk on farms.

A PCR-denaturing gradient gel electrophoresis (DGGE) method was used to examine on-farm sources of Clostridium cluster I strains in four dairy farms over 2 years. Conventional microbiological analysis was used in parallel to monitor size of clostridial populations present in various components of the milk production chain (soil, forage, grass silage, maize silage, dry hay, and raw milk). PCR amplification with Clostridium cluster I-specific 16S rRNA gene primers followed by DGGE separation yielded a total of 47 operational taxonomic units (OTUs), which varied greatly with respect to frequency of occurrence. Some OTUs were found only in forage, and forage profiles differed according to farm location (southern or northern Québec). More clostridial contamination was found in maize silage than in grass silage. Milk represented a potential environment for certain OTUs. No OTU was milk specific, indicating that OTUs originated from other environments. Most (83%) of the OTUs detected in raw milk were also found in grass or maize silage. Milk DGGE profiles differed according to farm and sampling year and fit into two distinct categories. One milk profile category was characterized by the presence of a few dominant OTUs, the presence of which appeared to be more related to farm management than to feed contamination. OTUs were more varied in the second profile category. The identities of certain OTUs frequently found in milk were resolved by cloning and sequencing. Clostridium disporicum was identified as an important member of clostridial populations transmitted to milk. Clostridium tyrobutyricum was consistently found in milk and was widespread in the other farm environments examined.

Changes in suicide methods in Quebec between 1987 and 2000: the possible impact of bill C-17 requiring safe storage of firearms.

This study presents the changes in the overall and firearm suicide rates for Québec (Canada) before and after Bill C-17, which was implemented to secure safe storage of firearms. It covers 20,009 suicide cases reported to the coroner's office. Interrupted time series analysis is used to compare suicide rates in the two periods. Firearm suicide rates have dropped among males and females, but the downward trends were not significant when compared to those prior to the law. Hanging suicide rates have risen considerably among men and women, but those upward trends did not increase significantly when compared with those preceding the law. The decline in suicide rates involving firearms has not resulted in a parallel decline in overall suicide rates. The analyses suggest that Bill C-17 neither improved the downward trend in firearm suicide, which had already begun before the enactment of the law, nor reduced the upward trend of the overall suicide rate. Correlation analyses between firearm suicide, hanging suicide, and the overall suicide rate suggest that firearm suicide is replaced by hanging suicide among males.