16 research outputs found
Electroencephalographic Abnormalites in SARS-CoV-2 Patients
No full textInternational audienceViral infection with SARS-CoV-2 has a neurological tropism that may induce an encephalopathy. In this context, electroencephalographic exploration (EEG) is indicated as a diagnostic argument correlated with lumbar puncture, biology, and imaging. We performed a retrospective analysis of 42 patients explored by EEG and infected by COVID-19, according to the EEG abnormalities and clinical signs that motivated the examination. Confusion and epileptic seizures were the most common clinical indications, with 64% of the patients displaying these symptoms. The EEG was altered in 85% of the cases of confusion, in 57% of the cases of epileptic symptoms (general or focal seizure or prolonged loss of contact) and 20% of the cases of malaise or brief loss of consciousness. Nine EEG (21%) were in favor of an encephalopathy, two had alterations in persistent consciousness and two had alterations in general states of confusion; one was very agitated and without history of epilepsy and combined eyelids clonia while a second one exhibited unconsciousness with left hemicorpus clonus. Two were being investigated for delayed awakening without sedation for more than 24 h. All of these patients were diagnosed COVID-19, some of them with associated mild to severe respiratory disorders. This work shows the interest of the EEG in exploring COVID-19 patients suffering from neurological or general symptoms looking for cerebral alteration
Cognitive impairment and brain metabolic changes in post-acute sequelae of COVID-19
No full textInternational audiencePurpose: Neurological symptoms often prominent in post-acute sequelae of COVID-19 (PASC) necessitate deeper understanding. Our objective was to investigate brain metabolism in PASC and examine correlations with neurological symptoms during both the acute and chronic stages. Methods: Eighty-seven adults experiencing PASC with neurocognitive symptoms were recruited in the PERSICOR prospective study and examined using brain [ 18 F]FDG PET/CT. Comprehensive clinical variables including neurocognitive symptoms were evaluated. PET images were compared voxel-wise with SPM12 software (P < 0.05, false discovery rate corrected) and volume-of-interest basis (BrainVisa software) with those of 55 healthy controls recruited before COVID-19 pandemic. We also investigated differences in brain metabolism according to the time interval after acute COVID-19. The correlation between brain metabolism and neurocognitive symptoms was assessed. Results: Frequently reported neurological symptoms included concentration difficulties (79%) and immediate/working memory impairments (66%). Significant hypometabolism was identified in regions previously identified in PASC: left fusiform gyrus (33% of patients), amygdala (23% on left, 28% on right), parahippocampal area (25% left, 24% right), and vermis (22%). The most substantial metabolism decreases were observed in the pons (5.5% decrease in the whole patient group vs controls) and right amygdala (-4.2%). Concentration and memory impairments correlated with decreased metabolism in prefrontal and mesial/inferior temporal areas, respectively (P < 0.01 for both). A shorter interval between PET imaging and the acute phase of COVID-19 correlated with reduced glucose metabolism in the brainstem, thalamus, mesiotemporal lobe, frontobasal cortex, and olfactory bulb (P < 10 ).Conclusions: This study underscores the links between neurological symptoms and cerebral hypometabolism in specific regions in PASC. These findings illuminate the complex neuropathophysiological mechanisms of PASC and pave the way for potential therapeutic interventions
Cerebrovascular complications in patients with community-acquired bacterial meningitis: occurrence and associated factors in the COMBAT multicenter prospective cohort
No full textAbstract Background Community-acquired bacterial meningitis is a rare but severe central nervous system infection that may be associated with cerebrovascular complications (CVC). Our objective is to assess the prevalence of CVC in patients with community-acquired bacterial meningitis and to determine the first-48 h factors associated with CVC. Methods We analyzed data from the prospective multicenter cohort study (COMBAT) including, between February 2013 and July 2015, adults with community-acquired bacterial meningitis. CVC were defined by the presence of clinical or radiological signs (on cerebral CT or MRI) of focal clinical symptom. Factors associated with CVC were identified by multivariate logistic regression. Results CVC occurred in 128 (25.3%) of the 506 patients in the COMBAT cohort (78 (29.4%) of the 265 pneumococcal meningitis, 17 (15.3%) of the 111 meningococcal meningitis, and 29 (24.8%) of the 117 meningitis caused by other bacteria). The proportion of patients receiving adjunctive dexamethasone was not statistically different between patients with and without CVC (p = 0.84). In the multivariate analysis, advanced age (OR = 1.01 [1.00-1.03], p = 0.03), altered mental status at admission (OR = 2.23 [1.21–4.10], p = 0.01) and seizure during the first 48 h from admission (OR = 1.90 [1.01–3.52], p = 0.04) were independently associated with CVC. Conclusions CVC were frequent during community-acquired bacterial meningitis and associated with advanced age, altered mental status and seizures occurring within 48 h from admission but not with adjunctive corticosteroids
Additional file 1 of Cerebrovascular complications in patients with community-acquired bacterial meningitis: occurrence and associated factors in the COMBAT multicenter prospective cohort
No full textSupplementary Material
Additional file 2 of Cerebrovascular complications in patients with community-acquired bacterial meningitis: occurrence and associated factors in the COMBAT multicenter prospective cohort
No full textSupplementary Material
MR imaging of adult acute infectious encephalitis
No full textInternational audienceBackground. – Imaging is a key tool for the diagnosis of acute encephalitis. Brain CT scan must be urgently performed to rule out a brain lesion with mass effect that would contraindicate lumbar puncture. Brain MRI is less accessible than CT scan, but can provide crucial information with patients presenting with acute encephalitis.Method. – We performed a literature review on PubMed on April 1, 2015 with the search terms " MRI " and " encephalitis ".Results. – We first described the various brain MRI abnormalities associated with each pathogen of acute encephalitis (HSV, VZV, other viral agents targeting immunocompromised patients or travelers; tuberculosis, listeriosis, other less frequent bacterial agents). Then, we identified specific patterns of brain MRI abnomalies that may suggest a particular pathogen. Limbic encephalitis is highly suggestive of HSV; it also occurs less frequently in encephalitis due to HHV6, syphillis, Whipple's disease and HIV primary infection. Rhombencephalitis is suggestive of tuberculosis and listeriosis. Acute ischemic lesions can occur in patients presenting with severe bacterial encephalitis, tuberculosis, VZV encephalitis, syphilis, and fungal infections. Conclusion. – Brain MRI plays a crucial role in the diagnosis of acute encephalitis. It detects brain signal changes that reinforce the clinical suspicion of encephalitis, especially when the causative agent is not identified by lumbar puncture; it can suggest a particular pathogen based on the pattern of brain abnormalities and it rules out important differential diagnosis (vascular, tumoral or inflammatory causes).Introduction. – L'imagerie cérébrale est essentielle au diagnostic d'encéphalite aiguë. Le scanner cérébral doit être réalisé en urgence afin d'exclure une lésion cérébrale avec effet de masse qui contre-indiquerait la ponction lombaire. L'IRM cérébrale est moins accessible que le scanner, mais peut apporter des informations importantes en cas d'encéphalite aiguë.Méthode. – Revue de la littérature sur PubMed le 1 er avril 2015 avec les mots clés « IRM » et « encéphalite ».Résultats. – Nous décrivons les différentes anomalies IRM associées à chaque agent pathogène de l'encéphalite aiguë (HSV, VZV, autres virus ciblant les patients immunodéprimés ou voyageurs ; tuberculose, listériose, autres agents bactériens moins fréquents). Nous identifions des patterns spécifiques d'anomalies IRM qui peuvent orienter vers un pathogène particulier. L'encéphalite limbique est très évocatrice de l'HSV ; elle survient aussi moins fréquemment dans les encéphalites dues au HHV6, à la syphilis, à la maladie de Whipple et à la primo-infection par le VIH. Une rhombencéphalite doit fait rechercher la tuberculose et la listériose. Des lésions ischémiques aiguës peuvent survenir chez des patients atteints d'encéphalite bactérienne grave, de tuberculose, d'encéphalite à VZV, de syphilis et d'infections fongiques
Do Education Decisions Respond to Returns by Field of Study?
No full textWe utilize the 2000 cohort of university graduates from the National Graduate Survey (NGS) to estimate the extent to which the choice of field of study is influenced by expected returns to those fields of study. The expected returns are based on earnings equations estimated from the earlier 1990 NGS cohort for the years 1992 and 1995 -- years that are around the time when the 2000 cohort would be applying to university and forming expectations of their expected returns by field of study. We estimate those expected returns using conventional OLS earnings equations as well as IV estimates to account for the potential endogeneity of the returns by field of study since selection effects may bias the expected returns. Our IV estimates utilize measures of skill-biased technological change as instruments. Overall, our results suggest that prospective students do choose fields of study in part at least on the basis of earnings they can expect to receive in those fields. Furthermore, earnings expectations formed around the time they are applying are more influential than earnings expectations based on years further away from that time, although both generally have an impact on the choice of field of study.Education decisions; field of study; returns to education; multi-nomial logits; National Graduate Survey (NGS)
Stiffness in human joints
No full textArticular stiffness is an important symptom in most arthritic diseases and appears to be a useful marker of disease activity in rheumatoid arthritis. Attempts to obtain a reliable objective measure of articular stiffness span the last 30 years but a meaningful measure
of this symptom remains elusive. A number of reasons have been suggested to explain the discrepancy between objective and subjective stiffness in arthritis and these can be
summarised as: a semeiological confusion, aberrant mechano-receptor thresholds and concurrent muscle wasting. This thesis examines each of these hypotheses.
Some patients may confuse pain and stiffness or may wish to use other words to describe their joint symptoms. A questionnaire was developed which enabled patients
to express their joint symptomatology using a wide range of descriptors. No differences were found between health professionals and patients in their definition of each of the descriptors. The questionnaire discriminated clearly between groups of patients with rheumatoid arthritis, ankylosing spondylitis and non-articular rheumatism.
Movement perception threshold was measured in the finger but it was found that subjects relied on cutaneous information. Vibration perception threshold was used as
an alternative measure of mechano-receptor thresholds: no abnormalities were found in 50 patients with rheumatoid arthritis.
Muscle cross-sectional area was calculated from anthropometric data and the results compared with measurements obtained from computed tomographic scans. A
significant decrease in forearm muscle cross-sectional area was found in rheumatoid arthritis but the decrease was not sufficient to explain the reduction in grip strength
observed, some of the variation being explained by deformity and pain in the joints. From this study it was possible to make a correction for muscle wasting in previously published stiffness data, revealing significant increases in metacarpo-phalangeal joint stiffness in rheumatoid arthritis. This result was confirmed in new data based on the resonant frequency of the wrist. Further data on the qualitative aspects of muscle were obtained by relating dynamic angular wrist stiffness to level of contraction of forearm muscles. Although arthritic subjects differed significantly from normals at maximum activation, when the results were expressed in terms of absolute grip strength no differences were found, suggesting inhibition of muscle activation in rheumatoid arthritis.
It is concluded that symptomatic stiffness is objectively quantifiable in arthritis providing measurements are made in relationship to the equilibrium position of the joint
and providing a correction is made for muscle wasting
Cefiderocol resistance genes identified in environmental samples using functional metagenomics
No full textAntibiotic resistance poses a global public health threat, which can originate from the transfer of environmental antibiotic resistance genes to pathogenic bacteria, as highlighted by the “One Health” framework. Cefiderocol is a siderophore cephalosporin recently introduced in clinical practice which displays a “Trojan Horse” mechanism, utilizing bacterial iron transportation systems for cell entry. Although it is only used as a last-line antibiotic, resistance has already been observed in clinical isolates. Yet, cefiderocol resistance genes are difficult to monitor as resistance mechanisms remain mostly undescribed in antibiotic resistance gene databases and therefore uncharacterized in the environment. To address this critical gap, we applied functional metagenomics to diverse environmental samples (wastewater, freshwater, and soil) from France, Germany, Sweden, and Pakistan. Four antibiotic resistant genes were identified as responsible for increased cefiderocol minimum inhibitory concentrations to clinically-relevant levels (ranging from 1 to 4 mg/l), including ꞵ-lactamases (VEB-3, OXA-372 homolog, and YbxI homolog) and a partial penicillin-binding protein homolog. None of these genes had been previously reported as a cefiderocol resistance gene. Three out of four had their closest homologs in pathogenic bacteria. The bla(VEB-3) gene was associated with a mobile genetic element and distributed across all wastewater metagenomes analyzed in this study. We therefore highlight the critical need for functional metagenomics, to characterize previously uncharacterized last-line antibiotic resistance mechanisms which will be used to enrich antibiotic resistance gene databases and thereby improving antibiotic resistance surveillance in all One Health compartments
Comparative effectiveness of teriflunomide vs dimethyl fumarate in multiple sclerosis
No full textInternational audienceObjective: In this study, we compared the effectiveness of teriflunomide (TRF) and dimethyl fumarate (DMF) on both clinical and MRI outcomes in patients followed prospectively in the Observatoire Français de la Sclerose en Plaques.Methods: A total of 1,770 patients with relapsing-remitting multiple sclerosis (RRMS) (713 on TRF and 1,057 on DMF) with an available baseline brain MRI were included in intention to treat. The 1- and 2-year postinitiation outcomes were relapses, increase of T2 lesions, increase in Expanded Disability Status Scale score, and reason for treatment discontinuation. Propensity scores (inverse probability weighting) and logistic regressions were estimated.Results: The confounder-adjusted proportions of patients were similar in TRF- compared to DMF-treated patients for relapses and disability progression after 1 and 2 years. However, the adjusted proportion of patients with at least one new T2 lesion after 2 years was lower in DMF compared to TRF (60.8% vs 72.2%, odds ratio [OR] 0.60, p< 0.001). Analyses of reasons for treatment withdrawal showed that lack of effectiveness was reported for 8.5% of DMF-treated patients vs 14.5% of TRF-treated patients (OR 0.54, p< 0.001), while adverse events accounted for 16% of TRF-treated patients and 21% of DMF-treated patients after 2 years (OR 1.39, p< 0.001).Conclusions: After 2 years of treatment, we found similar effectiveness of DMF and TRF in terms of clinical outcomes, but with better MRI-based outcomes for DMF-treated patients, resulting in a lower rate of treatment discontinuation due to lack of effectiveness
