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The Resilience of Senegal’s Hospitals to the First Waves of the COVID-19 Pandemic
No full textInternational audienc
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Aspirin dosing after acute coronary syndrome with suspected aspirin resistance: the ANDAMAN trial
No full textInternational audienceBackground and Aims Despite current antithrombotic treatments, the recurrence of ischaemic events remains high in patients with diabetes mellitus (DM) or aspirin resistance after acute coronary syndrome (ACS). Whether twice-daily aspirin dosing reduces major adverse cardiovascular events (MACE) in this population remains unknown. Methods In this prospective multicentre, randomized trial, patients with ACS and DM or high-risk of aspirin resistance (HRAR) defined as: (i) an index event occurring while on aspirin; (ii) body mass index ≥27 kg/m2; or (iii) increased waist circumference were assigned to receive enteric-coated aspirin once daily (100 mg/day) or twice daily (100 mg morning and evening). The primary outcome was MACE, a composite of any death, myocardial infarction, stroke, urgent coronary revascularization, stent thrombosis, or acute arterial thrombotic event assessed using a time-to-first-event analysis. The main secondary outcome was major bleeding (Bleeding Academic Research Consortium type 3–5). Results In total, 2484 participants were enrolled (77.2% with DM, 55.5% with ST-elevation segment myocardial infarction). The median follow-up duration was 18 (interquartile range: 17.6–18.3) months. The primary outcome occurred in 95 of 1228 participants (7.7%) in the twice-daily aspirin group, and 110 of 1256 (8.8%) in the once-daily group (hazard ratio [HR] 0.90; 95% confidence interval [CI] 0.69–1.19; P = .42). Major bleeding rates were similar between the groups (1.9% vs 2.1%; HR 0.88; 95% CI 0.50–1.55). Conclusions In patients with ACS and DM or HRAR, twice-daily aspirin did not significantly reduce the risk of MACE compared to once-daily dosing. No significant difference was observed in major bleeding between groups. Trial Registration NCT02520921/EUDRACT No: 2015-000947-18
Degenerative cervical myelopathy: timing of surgery
No full textInternational audienceBackground Despite the growing burden of degenerative cervical myelopathy (DCM), consensus on the optimal timing of surgical intervention remains lacking, especially for patients with mild symptoms or asymptomatic cord compression or in the context of recent trauma. Different scores, such as the mJOA, Nurick scale and NDI are commonly used to classify disease severity, but guidelines for managing these patients do not provide a clear framework for intervention timing. Materials and methods We conducted a narrative review of the literature on the optimal timing of surgical intervention for DCM, using PubMed to identify relevant studies. The search was focused on surgical and non-operative management, clinical and radiological assessments, biomarkers and emerging technologies. The selected papers were reviewed for relevance and quality, with guidance from a senior author. Results The initial search identified 6,705 articles, which were narrowed down to 136 relevant studies after applying filters for study type and clinical focus. A final selection of 87 papers was categorized by topics and the findings were synthesized to highlight trends, challenges and knowledge gaps in surgical timing for DCM. Focus of the study This review article examines strategies for determining the optimal timing for surgery in DCM. It explores how radiological signs, clinical indicators and other markers may help identify patients at risk of rapid neurological deterioration, particularly in the ‘grey-zone’ population (mild symptoms or asymptomatic disease), enabling clinicians to assess correctly different clinical scenarios and to indicate timely surgical intervention
Study protocol and statistical plan for the ICRAKI trial: Intermittent haemodialysis versus continuous renal replacement therapy for severe acute kidney injury in critically ill patients
No full textInternational audienceBackground: The effect of intermittent haemodialysis (IHD) vs continuous renal replacement therapy (CRRT) on mortality and/or renal function recovery in adults with acute kidney injury (AKI) and a recognised indication for renal replacement therapy (RRT) remains controversial.Objective: To summarise the protocol and statistical analysis plan for the ICRAKI trial.Design, settings and participantsICRAKI is a non-inferiority multicentre randomised controlled trial comparing IHD and CRRT. We will include 1000 patients with AKI receiving (or who have received) invasive mechanical ventilation and/or catecholamine infusion and who have at least one recognised criterion for initiating RRT.Intervention: The study compares IHD with CRRT.Main outcomes measures: The primary endpoint is the proportion of patients who will meet one or more criteria for a major adverse kidney event (composite of death, RRT dependence and/or more than a 25 % increase in serum creatinine from baseline value) 90 days after randomisation. Secondary endpoints are time to death; mortality at day (D)28, D60 and D90; number of patients with RRT dependency at D28, D60 and D90; number of patients with more than a 25 % increase in serum creatinine from baseline value at D28, D60 and D90; intensive care unit (ICU) and hospital length of stay; time until cessation of RRT; catecholamine-free days, ventilator-free days and RRT-free days through day 28; estimated glomerular filtration rate at hospital discharge; the number of episodes of adverse events.Conclusion: The ICRAKI trial will inform the choice of RRT modalities in critically ill patients with severe AKI. More than 300 patients were already included
La fabrique d'une spatialité des jeux d'argent au Sénégal: Dynamique d'un maillage territorial par le bas de la LONASE à Dakar.
No full textInternational audienceCONTENTS1. Research background2. Methodology3. Overview of the gambling market in Senegal4. The creation of a new territorial networkSOMMAIRE1. Contexte de la recherche2. Méthodologie3. Retour sur le marché des jeux d'argent au Sénégal4. La fabrique d'un nouveau maillage du territoir
Discharge dynamics in a cylindrical SDBD prototype reactor under ns-pulsed and sinusoidal AC operation
No full textWe developed a prototype reactor generating surface dielectric barrier discharges (SDBDs) in ambient air, designed for consistent operation while preventing constructive material degradation. It features detachable stainless steel electrodes and quartz dielectric to ensure precise fabrication. The grounded electrode is fully immersed into transformer oil drastically suppressing undesired parasitic discharges. The device efficiently sustains ns-pulsed and AC discharges at 10 kHz, enabling fundamental studies of their electrical characteristics (applied voltage, induced current, electric power) and spatiotemporal dynamics (morphology, propagation length and velocity). The electric power (P) consumed exhibits a dissimilar non-linear increase with the rising peak voltage (Vp) in each case: P≈0.8-2.5 W for ns-pulsed (Vp=7-9 kV) and P≈0.9-5.3 W (Vp=7-10 kV) for AC operation. Using ICCD imaging, distinct ionization channels are recorded in the rising part of the pulsed voltage being detached from the driven electrode; during the voltage decrease, a glow-like discharge is formed remaining anchored on the driven electrode. The rising part of the AC voltage is characterized by erratic, elongated ionization channels in a filamentary form, the voltage drop featuring a glow-like behavior. During the rising and falling parts of the AC voltage, the discharge reaches maximum propagation lengths (Lmax) of ≈12 mm and ≈7 mm, respectively, while remaining attached to the driven electrode. The corresponding maximum discharge velocities (vmax) are about 5×10 2 m/s and 3×10 2 m/s. For the ns-pulsed operation, Lmax≈5 mm (vmax≈5×10 5 m/s) and Lmax≈3.5 mm (vmax≈1.5×10 5 m/s) during the rising and falling parts of the voltage pulse, respectively. The SDBD dynamics generated with a ns-pulsed voltage is more reproducible than for the AC case allowing for the use of a 500 times smaller ICCD gate width (2 ns) and a more accurate description of the discharge's spatiotemporal development. This reactor is suitable for performing fundamental studies and understanding key SDBD features for various applications such as flow control, biomedicine and agriculture
Is Diet Perceived as a Cancer Risk Factor? Lay Perceptions in a Representative French Sample
No full textInternational audienceBackgroundThe French Cancer Barometer is a survey performed at five-year intervals investigating awareness of cancer risk factors, including dietary factors. The aims of this study were (1) to report the results of the survey concerning participants' awareness of diet/foods as cancer risk factors, (2) to describe the determinants of this awareness, and (3) to compare the results of the 2010, 2015, and 2021 surveys.MethodsA randomly selected representative sample of participants aged from 15 to 85 years (n = 4938) was surveyed in 2021. Questions concerned awareness of diet, specific foods, and behaviors as cancer risk factors.ResultsMore than 40% of the participants spontaneously identified diet as a cancer risk factor, and almost 92% considered it to be a cancer risk factor in a closed-ended question. Some foods were considered by most participants to increase cancer risk (ultra-processed food, processed meats, and red meat), whereas others (fruit and vegetables) were perceived as decreasing cancer risk or were thought either to decrease risk or to have no effect (organic foods and pulses). Demographic factors were found to be associated with risk factor perceptions and specific perceptions of cancer (i.e., having a cancer someday, being well informed) and behaviors (i.e., having consulted a general practitioner recently). Interestingly, the perception of diet/food as risk factors was greater in 2021 than in previous surveys.ConclusionIn addition to continuing efforts to target interventions for individuals with lower educational levels, efforts should also be made to target individuals who consult their general practitioner infrequently