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Coma chez un nourrisson : les amphétaminiques en cause
No full textInternational audienceObjectifsDocumenter une intoxication pédiatrique à des dérivés amphétaminiques ayant conduit à un état de mal épileptique généralisé et un coma chez un nourrisson.MéthodesAlertés par un brusque mouvement de révulsion oculaire chez leur enfant de sept mois, les parents contactent rapidement les secours. À son arrivée, l’équipe médicale constate une crise convulsive tonicoclonique généralisée non fébrile nécessitant l’administration d’une dose de Valium® ainsi que deux doses de charge de Gardénal® et de Rivotril®. La crise convulsive qui a duré quarante minutes, associée à une absence de reprise de conscience, un score de Glasgow à 3 et une mydriase bilatérale réactive, conduit à un transfert urgent de l’enfant au service de réanimation pédiatrique. Des analyses toxicologiques comprenant des dépistages par immunochimie et un criblage large recherchant médicaments et stupéfiants par LC-MS/MS, sont demandés afin d’écarter une cause toxicologique. À l’issue des premiers résultats rendus dans un cadre hospitalier, un signalement judiciaire est réalisé et une demande de prise en charge sociale par l’unité d’accueil pédiatrique enfants en danger (UAPED) est initiée. Une expertise toxicologique de référence est ainsi demandée, incluant un dosage sanguin des alcools par HS-GC-FID, un criblage toxicologique par LC-MS/MS ainsi qu’une quantification des molécules retrouvées par LC-MS/MS.RésultatsLes explorations menées sur les prélèvements réalisés à l’admission n’ont mis en évidence ni alcools, ni cannabinoïdes, ni opiacés, ni dérivés cocaïniques dans le sang et les urines de l’enfant. En revanche, il a été retrouvé au criblage toxicologique les médicaments administrés, des stupéfiants de la famille des amphétaminiques, de la méthylènedioxyméthamphétamine (MDMA) et son métabolite la méthylènedioxyamphétamine (MDA) ainsi qu’une cathinone, la méthylone présente uniquement dans les urines. Les concentrations sanguines étaient de 770 ng/mL pour la MDMA et de 52 ng/mL pour la MDA. Dans les urines, les concentrations étaient supérieures à notre limite de quantification pour la MDMA et la MDA et de 86 ng/mL pour la méthylone. Les concentrations sanguines des médicaments administrés dans le cadre de la prise en charge étaient conformes aux valeurs mesurées dans un contexte thérapeutique (diazépam et métabolites, midazolam et métabolites, phénobarbital).ConclusionAprès une prise en charge ayant nécessité une ventilation invasive et une intubation orotrachéale pendant 3 jours, aucune récidive de crise convulsive n’est observée et l’état de l’enfant n’a montré aucune autre complication. Une autorisation de sortie de l’enfant du service de réanimation est émise en accord avec le Parquet, après une hospitalisation de 6 jours. Les parents réfutent toute consommation de drogue au domicile et s’interrogent également sur l’origine de cette exposition inattendue de leur enfant. Ainsi, les circonstances de cette intoxication aux dérivés amphétaminiques demeurent inconnues. Les analyses toxicologiques réalisées, montrent que l’enfant était sous l’emprise des stupéfiants au moment des prélèvements. Les concentrations de la MDMA et de son métabolite sont élevées et compatibles avec des valeurs pouvant entraîner les effets toxiques observés, à savoir une crise convulsive, une rhabdomyolyse et un coma. La détection de la méthylone uniquement dans les urines, soulève des interrogations quant au moment de l’exposition de l’enfant à cette drogue par rapport à celle de la MDMA et de ce fait, à l’environnement dans lequel vit cet enfant de 7 mois. Par ailleurs, la maturation encore incomplète des cytochromes hépatiques pourrait avoir contribué à l’intoxication à la MDMA en retardant son élimination. Bien que d’évolution favorable, cette intoxication grave, dénonce un phénomène émergent et préoccupant, qu’est l’intoxication pédiatrique aux stupéfiants. Ce cas souligne également l’importance des explorations toxicologiques dans un contexte de détérioration neurologique, même en l’absence d’indications fournies par les parents
Early bacterial co-infections and ventilator-associated lower respiratory tract infections among intubated patients during the first and second COVID-19 waves: a European comparative cohort study
No full textInternational audienceBackground: The management of severe SARS-CoV-2 pneumonia, alongside logistical constraints, evolved between the first and subsequent COVID-19 waves. This study aimed to compare the prevalence of early bacterial pulmonary co-infections and the incidence of ventilator-associated lower respiratory tract infections (VA-LRTI) across the first and second waves of the pandemic, and to characterize their microbiology.Methods: Latter part of a multicenter retrospective European cohort analysis conducted in 35 ICUs. Adult patients admitted for SARS-CoV-2 pneumonia and requiring invasive mechanical ventilation ≥ 48 h were consecutively included from both waves (February-May 2020 for period 1, October 2020-April 2021 for period 2). Co-infections were defined by bacterial isolation in respiratory secretions or blood cultures, or a positive pneumococcal urinary antigen test, within 48 h after intubation. VA-LRTI, including ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP), were diagnosed using clinical, radiological and quantitative microbiological criteria. The 28-day cumulative incidence of first VA-LRTI episodes was estimated using the Kalbfleisch and Prentice method, with co-infection prevalence and VA-LRTI incidence compared using multivariable logistic regression and Fine-and-Gray models, respectively.Results: The study included 1,154 patients (558 in period 1 and 596 in period 2). Co-infection prevalence significantly rose from 9.7% in period 1 to 14.9% in period 2 (adjusted odds ratio (95% confidence interval) 1.52 (1.04-2.22), p = 0.03). Gram-positive cocci dropped from 59 to 48% of co-infections between periods 1 and 2. The overall incidence of VA-LRTI was similar across periods (50.4% and 53.9%, adjusted sub distribution hazard ratio (sHR) 1.14 (0.96-1.35), p = 0.11), with a significant increase in VAP incidence in period 2 (36% to 44.8%, adjusted sHR 1.37 (1.12-1.66), p = 0.001), predominantly occurring within the initial 14 days after intubation, and a concurrent significant decrease in VAT incidence (14.3% to 9.1%, adjusted sHR 0.61 (0.42-0.88), p = 0.007). Gram-negative bacilli, led by Pseudomonas aeruginosa, Enterobacter spp., and Klebsiella spp., were responsible for 89% and 84% of VA-LRTI in periods 1 and 2, respectively.Conclusions: Between the first and second COVID-19 waves, the prevalence of early bacterial pulmonary co-infections significantly increased among intubated patients. Although the overall incidence of VA-LRTI remained stable, there was a significant shift from VAT to VAP episodes
Australian compilation of seismic-derived bathymetry
No full textInternational audienceThis article presents a national seismic-derived bathymetric compilation based on the integration of 253 3D seismic surveys. Individual surveys were combined to produce four regional compilations covering an area of 267,000 km 2 , with a spatial resolution of 30 × 30 m and a vertical accuracy of 5 m + 5%d. The production of the dataset is based on the integration of seismic survey first returns with seismic vessel echosounder measurements. Following the extraction of the depth soundings, all data points were converted from time to depth using synthetic velocity profiles and filtered to remove erroneous records. The seismic survey’s first returns were corrected using navigation depth soundings to account for geometric distortions. All depth values were reduced to WGS84 and EGM2008 datum. A comparison of the seismic-derived bathymetry with multibeam echosounder surveys suggests that where a thin layer of loose sediments overlies a lithified substratum, the seismic first return captures the top of the substratum
Industry 5.0 for Sustainable Supply Chains: A Fuzzy AHP Approach for Evaluating the adoption Barriers
No full textInternational audienceCurrently, the adoption of industry 5.0 (I5.0) in supply chain management (SCM) emphasizes human-centric, sustainable, and resilient practices by implementing digital technologies including collaborative robots, Internet of Things (IoT) and Artificial Intelligence (AI). These advancements aim to enhance performance and sustainability in SCs. However, the adoption of I5.0 introduces several barriers, including technological integration challenges, high implementation costs, and organizational resistance. This paper aims to identify and prioritize I5.0 integration barriers in sustainable supply chains (SSC). This study presents a comprehensive literature review to understand I5.0’s implications for sustainability. By applying the fuzzy Analytical Hierarchy Process (FAHP) model, the authors analyze and prioritize the identified barriers. The proposed approach is beneficial for both academics and practitioners, as it prioritizes the critical barriers to I5.0 adoption, offering strategic insights for facilitating this integration. The findings aim to support organizations in overcoming these challenges and advancing towards more sustainable and efficient SC practices
Improv as Cognitive Activity
No full textInternational audienceBackground: Engaging in regular cognitive activity has been associated with cognitive function, yet the field of aging research has limited choices of cognitive activity programs to implement in clinical trials.As the field of aging research works to operationalize healthy habits, the potential role of improvisational theater (improv) to improve the lives of older adults has emerged. Given the limitations of existing cognitive training programs and the promise of improv, we sought to establish the feasibility of creating a cognitive training program based on improv exercises. Methods: We engaged 13 neuropsychologists and trainees in 15 improv exercises and asked them to rate the extent to which each exercise engaged or required one of 20 distinct cognitive abilities or cognitive subdomains. We then examined the mean ratings of the highest and the lowest rated subdomains to provide evidence that different exercises could be mapped onto different cognitive subdomains, thereby providing evidence of concept.Results: Our results demonstrated that these informed participants deemed the improv exercises as engaging cognitive processes. We found consensus among raters via higher-than-average means for specific abilities across the 15 exercises. Ratings from participants were broadly consistent with the prestudy groupings of the authors.Discussion: Our study provides the initial steps of establishing construct validity of improv exercises as a meaningful form of cognitive activity. This set of exercises can be examined as a cognitive training program in future clinical trials in order to determine if it has a significant influence on the cognitive function of older adults
The Two Faces of Pediatric SCA2
No full textInternational audienceIntroduction Spinocerebellar ataxia type 2 (SCA2) is an autosomal dominant neurological disease usually described in adults. Expanded CAG repeats in the ATXN2 gene can lead to pediatric onset. This study aims to describe the natural history of SCA2 in children. Methods We analyzed clinical and genetic data from 22 children with SCA2 across 17 institutions and compared them to 20 previously reported cases. Results The phenotype of pediatric SCA2 can be divided into two distinct groups based on CAG repeat size and age. In the infantile group ( n = 9), developmental delay and seizures were prominent features, along with cerebellar and cerebral atrophy. In the juvenile group ( n = 13), the disease was a cerebellar degeneration similar to adults. A threshold of 88 ± 4 CAG repeats distinguished the infantile group from the juvenile group. Pediatric SCA2 type was independent of parental origin; SCA2 was maternally inherited in 22%, including three infantile presentations. Discussion This large cohort of pediatric SCA2 disease provides the first comprehensive description of its characteristics, which differ from those of SCA7. Indeed, the phenotypic spectrum of SCA7 in children is continuous, while that of SCA2 is bimodal. Although pediatric SCA2 can be difficult to diagnose by genome‐wide sequencing, it is a recognizable disease that can be easily diagnosed with a targeted study of the number of CAGs in ATXN2 . Genetic counseling for families should consider the significant proportion of maternal transmission
Towards more personalized management of pneumonia: recent progress and outstanding issues
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Modified surgical procedures that facilitate endoscopic and radiologic management of postoperative complications
No full textInternational audienceThe development of endoscopy and interventional radiology has reduced the need for repeat surgery to manage postoperative complications, thereby reducing morbidity and mortality. Surgical set-ups modify the anatomy and are sometimes difficult for gastroenterologists and radiologists to understand. To improve multidisciplinary management, certain surgical techniques can be adapted to facilitate morphological identification and endoscopic access to the various anastomoses that are a source of complications, particularly at the supra-mesocolic level. The aim of this update is to provide a non-exhaustive list of surgical procedures that can be used to anticipate the endoscopic and radiological management of possible postoperative complications
Development and Clinical Interpretation of an Explainable AI Model for Predicting Patient Pathways in the Emergency Department: A Retrospective Study
No full textInternational audienceBackground: Overcrowded emergency departments (EDs) create significant challenges for patient management and hospital efficiency. In response, Amiens Picardy University Hospital (APUH) developed the “Prediction of the Patient Pathway in the Emergency Department” (3P-U) model to enhance patient flow management. Objectives: To develop and clinically validate an explainable artificial intelligence (XAI) model for hospital admission predictions, using structured triage data, and demonstrate its real-world applicability in the ED setting. Methods: Our retrospective, single-center study involved 351,019 patients consulting in APUH’s EDs between 2015 and 2018. Various models (including a cross-validation artificial neural network (ANN), a k-nearest neighbors (KNN) model, a logistic regression (LR) model, and a random forest (RF) model) were trained and assessed for performance with regard to the area under the receiver operating characteristic curve (AUROC). The best model was validated internally with a test set, and the F1 score was used to determine the best threshold for recall, precision, and accuracy. XAI techniques, such as Shapley additive explanations (SHAP) and partial dependence plots (PDP) were employed, and the clinical explanations were evaluated by emergency physicians. Results: The ANN gave the best performance during the training stage, with an AUROC of 83.1% (SD: 0.2%) for the test set; it surpassed the RF (AUROC: 71.6%, SD: 0.1%), KNN (AUROC: 67.2%, SD: 0.2%), and LR (AUROC: 71.5%, SD: 0.2%) models. In an internal validation, the ANN’s AUROC was 83.2%. The best F1 score (0.67) determined that 0.35 was the optimal threshold; the corresponding recall, precision, and accuracy were 75.7%, 59.7%, and 75.3%, respectively. The SHAP and PDP XAI techniques (as assessed by emergency physicians) highlighted patient age, heart rate, and presentation with multiple injuries as the features that most specifically influenced the admission from the ED to a hospital ward. These insights are being used in bed allocation and patient prioritization, directly improving ED operations. Conclusions: The 3P-U model demonstrates practical utility by reducing ED crowding and enhancing decision-making processes at APUH. Its transparency and physician validation foster trust, facilitating its adoption in clinical practice and offering a replicable framework for other hospitals to optimize patient flow
Shallow Water models for viscoplastic flows
No full textInternational audienceThis was one of the plenary talks of the 10th Meeting on Numerical Analysis of PDEs in Chile.In this talk, we provided an overview of some yield stress fluid models in the context of geophysical simulations. As a case study, we described recent events (La Bérarde 2024. Blatten 2025.). We briefly described various types of debris flows and avalanches. Then, we focused specifically on viscoplastic flows. A first approach was presented, based on a monolayer + variational inequality model. Recent results from the PhDs of C. Ginot and M. Wallon were presented, showing a comparison between new experimental configurations and simulations for 3D dambreaks. A second approach was then motivated and presented, based on a shallow multilayer method. It was compared with the 1D experiments of Ancey's group. The mathematical description of discretizations relevant to such models was outlined. Finally, perspectives and future work required were outlined