Severe acute malnutrition (SAM)

Top PDF Severe acute malnutrition (SAM):

Clinical evidence of the role of Methanobrevibacter smithii in severe acute malnutrition

Clinical evidence of the role of Methanobrevibacter smithii in severe acute malnutrition

Amadou Hamidou Togo 1,2,3 , Sebastien Cortaredona 4 , Bernard Henrissat 5 , Mahamadou Ali Thera 3 , Ogobara K. Doumbo 3 , Didier Raoult 1,2,6* & Matthieu Million 1,2* Gut microbial dysbiosis has been shown to be an instrumental factor in severe acute malnutrition (SAM) and particularly, the absence of Methanobrevibacter smithii, a key player in energy harvest. Nevertheless, it remains unknown whether this absence reflects an immaturity or a loss of the microbiota. In order to assess that, we performed a case–control study in Mali using a propensity score weighting approach. The presence of M. smithii was tested using quantitative PCR on faeces collected from SAM children at inclusion and at discharge when possible or at day 15 for controls. M. smithii was highly significantly associated with the absence of SAM, detected in 40.9% controls but only in 4.2% cases (p < 0.0001). The predictive positive value for detection of M. smithii gradually increased with age in controls while decreasing in cases. Among children providing two samples with a negative first sample, no SAM children became positive, while this proportion was 2/4 in controls (p = 0.0015). This data suggests that gut dysbiosis in SAM is not an immaturity but rather features a loss of M. smithii. The addition of M. smithii as a probiotic may thus represent an important addition to therapeutic approaches to restore gut symbiosis.
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Gut Bacteria Missing in Severe Acute Malnutrition, Can We Identify Potential Probiotics by Culturomics?

Gut Bacteria Missing in Severe Acute Malnutrition, Can We Identify Potential Probiotics by Culturomics?

Streptococcus gallolyticus was the only bacterial species to be associated with kwashiorkor in the present African study both by culturomics and metagenomics. This finding is not random as S. gallolyticus was one of the three species enriched in SAM while 31 other species were enriched in controls in the largest metagenomics study to date performed in Asia ( Subramanian et al., 2014 ). This is clinically relevant as S. gallolyticus is one of the human pathogenic bacteria with the strongest association with colon cancer and endocarditis ( Rusniok et al., 2010; Amado et al., 2015; Butt et al., 2016 ). Among the 117 Streptococcus validated species (http://www.bacterio.net/ streptococcus.html), only S. gallolyticus has such a pathogenic potential. The species-level resolution of the characterization of the gut microbiota alteration associated with SAM is also critical as a species and strain specificity of probiotics effect on weight regulation has previously been demonstrated ( Million et al., 2012; Million and Raoult, 2013 ). As S. gallolyticus strains are always susceptible to amoxicillin, this is a new argument to confirm the inclusion of amoxicillin in the standard protocols for severe acute malnutrition as recently demonstrated by a meta-analysis ( Million et al., 2017a ). This also suggests that future probiotic mixtures to treat SAM should inhibit S. gallolyticus.
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Biomedical Investigations for the Optimized Diagnosis and Monitoring of Severe Acute Malnutrition : The OptiDiag Study

Biomedical Investigations for the Optimized Diagnosis and Monitoring of Severe Acute Malnutrition : The OptiDiag Study

Clinical and biochemical markers of functional severity in severe acute malnutrition (SAM): comparative analysis of anthropometric phenotypes from the OptiDiag study Trenton Dailey-Chwalibóg, 1 , 2 , 3 , * Michael Freemark, 4 Dominique Roberfroid, 5 Issa A. Kemokai, 6 Md. Rayhan Mostak, 7,8 Md. Abdul Alim, 9 Murad Md. Shamsher Tabris Khan, 9 Md. Abdul Hashem Khan, 10 Luke Bawo, 11 Nelson K. Dunbar, 11 Curtis H. Taylor, 12 Hélène Fouillet, 2 Jean-François Huneau, 2 Patrick Kolsteren, 3 Benjamin Guesdon 1

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Increased Gut Redox and Depletion of Anaerobic and Methanogenic Prokaryotes in Severe Acute Malnutrition

Increased Gut Redox and Depletion of Anaerobic and Methanogenic Prokaryotes in Severe Acute Malnutrition

Gut microbiota maturation is associated with an enrichment in obligate anaerobes. After iden- tifying the recruiting center bias and the need for meta-analysis, we sought to identify whether age has a signifi- cant impact on the enrichment or depletion of anaerobic bacteria in the digestive tract. Meta-regression appeared as the most suitable approach to identify whether age (gut microbiota maturation) was associated with enrich- ment or depletion of obligate anaerobes independently of nutritional status and recruiting center. We also decided to only include children with severe acute malnutrition (SAM) and healthy controls (CTL), strictly based on the WHO anthropometric criteria 2,3 , in order to improve the consistency among studies and to increase the power of
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Critical Illness - Related Corticosteroïd Insufficiency after Non-severe Acute Aneurysmal Subarachnoid Haemorrhage : impact on complications and early outcome

Critical Illness - Related Corticosteroïd Insufficiency after Non-severe Acute Aneurysmal Subarachnoid Haemorrhage : impact on complications and early outcome

Assessment of endocrine function Endocrine evaluation in the acute stage included blood samples drawn in the morning (8:00 am). We measured plasma levels of cortisol T0 and adrenocorticotropic hormone (ACTH). Blood samples for cortisol and ACTH analyses were collected within 48 hours of admission at 8:00 am, immediately after a stimulation test (intravenous administration of 250 µg of corticotrophin hormone (Synacthène ®, ALFASIGMA, France)) was performed. A second blood sample for cortisol T1 analysis was collected one hour later (9:00 am). Unfortunately, there has been a temporary shortage of Synacthène® in France from December 2014 to February 2015 explaining the prolonged period of inclusion of the study (June 2013 to March 2016).
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Severe acute respiratory syndrome coronavirus 2 may be an underappreciated pathogen of the central nervous system

Severe acute respiratory syndrome coronavirus 2 may be an underappreciated pathogen of the central nervous system

Potential neuropathological effects of current COVID-19 therapies At this time, there are no therapeutics or vaccines approved by the US Food and Drug Administration (FDA) to specifically cure, treat or prevent COVID- 19. However, the FDA continues to issue emergency approvals for ‘off-label’ drugs to treat severe COVID- 19 patients. These drugs include antiviral drugs (remdesivir, chloroquine and hydroxychloroquine) and immunomodulators (tocilizumab, canakinumab and anakinra), and some of them may contribute to neu- rological dysfunction. For example, chloroquine and hydroxychloroquine, which were commonly used ear- lier in the pandemic, could potentially increase the likelihood of neurological disorders, especially in the elderly [114]. The use of hydroxychloroquine has been associated with neuropsychiatric manifestations including irritability, nervousness and psychosis, possi- bly by its ability to cross the BBB [115]. Corticos- teroids, another common group of medications used to treat severe cases of COVID-19, have also been associated with psychiatric symptoms, especially when administered at high doses [116]. The use of immunomodulators, such as tocilizumab (monoclonal antibody to IL-6 receptor), canakinumab (monoclonal antibody to IL-1b) and anakinra (IL-1 receptor antag- onist), is in clinical trials to dampen cytokine responses in severely ill COVID-19 patients; however, they have poor BBB penetration into the CNS [117].
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Virtual screening identification of novel severe acute respiratory syndrome 3C-like protease inhibitors and in vitro confirmation

Virtual screening identification of novel severe acute respiratory syndrome 3C-like protease inhibitors and in vitro confirmation

Severe acute respiratory syndrome (SARS) is a severe febrile respiratory illness caused by SARS-associated coronavirus (SARS-CoV). 1,2 A global outbreak of SARS between March 2003 and July 2003 caused over 8 000 probable or confirmed cases and 774 deaths. 3 A mortality rate as high as 10% has been estimated by the World Health Organization. 3,4 The possibility of the re- emergence of SARS is a serious threat, since efficient therapy and a vaccine are not currently available. 5 The SARS-CoV genome con- tains 14 functional open reading frames (ORFs). 6 Two large 5 0 -ter- minal ORFs, designated 1a and 1b, encode two overlapping polyproteins, respectively designated pp1a and pp1b, which have to be cleaved extensively to produce proteins necessary for viral RNA synthesis and genome replication. 6,7 SARS-CoV 3C-like prote- ase (3CL pro ) plays a major role in the processing of the viral poly- proteins and control of the activity of the replicase complex. 8 The enzymatic activity of 3CL pro is essential for the viral life cycle and, therefore, represents an attractive target for the development
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Intranasal sufentanil versus intravenous morphine for acute severe trauma pain: A double-blind randomized non-inferiority study

Intranasal sufentanil versus intravenous morphine for acute severe trauma pain: A double-blind randomized non-inferiority study

This randomized and double-blinded study should minimize most of the common biases. Nevertheless, our study has a number of limitations. Despite the random assignment, there was imbalance between the study arms in the male/female ratio and in the concomitant anal- gesics used. Allowing co-analgesia only after 30 minutes could have avoided this bias. On the other hand, opioid drugs are generally used as co-analgesics, in combination with acetamino- phen in particular. From this point of view, the chosen methodology was closer to what hap- pens in real clinical practice. As co-analgesia was more often used in the IVM group, this imbalance might have reduced the observed efficacy of INS compared to IVM but does not call into question the interpretation of non-inferiority. Although recruitment was lower than expected over the planned duration of the study, the power remained above 80%, with an effective standard deviation in reduction in pain lower than planned. The relatively low rate of participant inclusion was due to the difficulty of implementing a randomized trial during tri- age of patients experiencing intense pain. Finally, the study was not powered to answer the question of safety. Although the number of severe events observed was not statistically differ- ent between the 2 treatment groups, we observed an imbalance between the groups. The con- firmation of safety would require a much larger trial. Future studies will also need to ensure that the use of INS is effective and safe in other emergency settings, such as pre-hospital or in difficult situations, such as in mountain rescue.
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Consensus definitions of 14 severe acute toxic effects for childhood lymphoblastic leukaemia treatment: a Delphi consensus.

Consensus definitions of 14 severe acute toxic effects for childhood lymphoblastic leukaemia treatment: a Delphi consensus.

Although there are high survival rates for children with acute lymphoblastic leukaemia, their outcome is often counterbalanced by the burden of toxic eff ects. This is because reported frequencies vary widely across studies, partly because of diverse defi nitions of toxic eff ects. Using the Delphi method, 15 international childhood acute lymphoblastic leukaemia study groups assessed acute lymphoblastic leukaemia protocols to address toxic eff ects that were to be considered by the Ponte di Legno working group. 14 acute toxic eff ects (hypersensitivity to asparaginase, hyperlipidaemia, osteonecrosis, asparaginase-associated pancreatitis, arterial hypertension, posterior reversible encephalopathy syndrome, seizures, depressed level of consciousness, methotrexate-related stroke-like syndrome, peripheral neuropathy, high-dose methotrexate-related nephrotoxicity, sinusoidal obstructive syndrome, thrombo embolism, and Pneumocystis jirovecii pneumonia) that are serious but too rare to be addressed comprehensively within any single group, or are deemed to need consensus defi nitions for reliable incidence comparisons, were selected for assessment. Our results showed that none of the protocols addressed all 14 toxic eff ects, that no two protocols shared identical defi nitions of all toxic eff ects, and that no toxic eff ect defi nition was shared by all protocols. Using the Delphi method over three face-to-face plenary meetings, consensus defi nitions were obtained for all 14 toxic eff ects. In the overall assessment of outcome of acute lymphoblastic leukaemia treatment, these expert opinion-based defi nitions will allow reliable comparisons of frequencies and severities of acute toxic eff ects across treatment protocols, and facilitate international research on cause, guidelines for treatment adaptation, preventive strategies, and development of consensus algorithms for reporting on acute lymphoblastic leukaemia treatment.
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Production agricole et malnutrition : le paradoxe de Musanze au Rwanda

Production agricole et malnutrition : le paradoxe de Musanze au Rwanda

63 Le modèle de régression utilisé explique 72% de la variabilité de la malnutrition à Musanze (R 2 =0,72). Cela dit, les résultats de notre modèle de régression montrent que pour la région de Musanze, sur 27 variables considérées, il y en a seulement douze qui sont significativement associées au retard de croissance (risque de se tromper < 5 %). Parmi ces douze variables, il y en a cinq dont le coefficient a un signe positif et sept dont le coefficient a un signe négatif. Celles dont le coefficient a un signe positif sont : « Enfants pas laissés seuls », « Enfants n’ayant pas de fièvre », « pouvoir de décision des femmes », « Mères ne souffrent pas d’anémie » et « Diversité alimentaire moyenne ». En d’autres termes, le fait que l’enfant ne soit pas laissé seul pendant au moins une heure au cours d’une semaine précédant l’enquête améliore le z-score de 0,521 unité, que l’enfant n’ait pas eu de fièvre pendant au moins 24 h sur une période de deux semaines précédant l’enquête augmente le z-score de 0,353 unité, que les femmes aient un pouvoir dans la prise de décisions fait grimper le z-score de 0,408 unités, que les mères ne souffrent pas d’anémie augmente le z-score de 1 166 unités et que le score de diversité alimentaire du ménage passe de faible à moyen augmente la valeur du Z-score de 0,711 unités. En ce sens, ces facteurs, en améliorant la valeur du z-score, causent une amélioration de l’état nutritionnel des enfants à Musanze.
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La prévalence de la malnutrition chez les enfants et adolescents hospitalisés

La prévalence de la malnutrition chez les enfants et adolescents hospitalisés

l'évaluation du statut nutritionnel : l'IMC et la mesure de la composition corporelle par DXA. Les chercheurs ont conclu qu'il existait une bonne corrélation entre ces méthodes et que la CB s'avérait un moyen utile de déterminer l'état nutritionnel des enfants (161). De plus, dans la population atteinte de fibrose kystique, des changements au niveau de l'état nutritionnel sembleraient être plus rapidement détectables par les mesures de la composition corporelle que par les mesures de poids ou de stature (153). Cela dit, la CB et le PCT auraient la capacité de détecter des proportions plus élevées de malnutrition que les mesures de poids (154, 155). L'avantage de ces deux indices est que ce sont des méthodes relativement simples, non invasives et peu coûteuses (133). Ces techniques sont d'autant plus intéressantes lorsque les mesures de poids et de la taille sont difficiles à obtenir, notamment chez les enfants très malades qui sont incapables de se lever. Malgré le fait que les mesures au niveau du bras sont particulièrement utiles dans la population pédiatrique, elles présentent un certain nombre de limites et d'inconvénients. Afin d'éviter les variabilités intra et inter-observateur et d'optimiser l'exactitude du pli cutanée, il est essentiel de suivre les recommandations qui suivent. D'abord, la précision et la reproductibilité des mesures dépendront de la formation et de l'entraînement de l'examinateur. Ceci étant dit, le praticien doit être bien formé et bénéficier d'une technique appropriée. Entre autres, lors de la mesure du pli cutané, il est important de bien distinguer la peau et les tissus sous-cutanés du muscle. Ceci est spécialement difficile chez les bébés, car leur plus grand ratio de masse grasse rend la détection du muscle plus difficile. Aussi, afin d'éviter des biais de variation dans les données, il est important que les mesures soient évaluées par le même individu en plus d'être répétées à plusieurs reprises (133, 162, 163). Enfin, le clinicien doit s'assurer de la fiabilité de la pince à plis cutanée en la calibrant de façon adéquate et régulièrement. De toute évidence, l'analyse de la composition corporelle constitue un élément plus complet qui fournit des informations détaillées sur l'état nutritionnel.
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Malnutrition, VIH et traitement antirétroviral dans les pays à ressources limitées

Malnutrition, VIH et traitement antirétroviral dans les pays à ressources limitées

17 al., 2012, Calder, 2013). Bien que l’organisme puisse générer lui-même certains substrats nécessaires au maintien et à la fonction du système immunitaire, certains autres sont obligatoirement d’origine extrinsèque comme les acides aminés et gras essentiels (Calder, 2013). L’apport protéique est aussi central à la synthèse des médiateurs tels que les cytokines protéines d’adhésion, immunoglobulines, complément, et protéines de la phase aigüe (Galhardo et al., 2001). Un déclin dans la production de ces molécules entrainera une diminution des mécanismes de signalisation et la dérégulation de la réponse immunitaire (Hughes and Kelly, 2006, Honda et al., 2011). Une carence protéino-énergétique peut aussi entrainer une atrophie du thymus et des tissus lymphoïdes nécessaires pour la maturation des lymphocytes contribuant ainsi à la lymphopénie. Certaines carences en acides aminés spécifiques ont récemment été associées à l’écologie et l’inflammation du tractus intestinal (Hashimoto et al., 2012). En effet, comme observé dans Hashimoto et al. 2012, le tryptophane semble agir comme régulateurs du microbiota et conséquemment de la vulnérabilité à l’inflammation. De même, des conséquences de la MPE, comme l’atrophie du tissu lymphoïde associé au tractus intestinal et la dégradation des muqueuses, entrainent aussi un dérèglement de l’écologie intestinale. En combinaison avec certaines carences, ceci a pour effet de permettre une translocation accrue de produits bactériens intestinaux dans la circulation sanguine, contribuant ainsi à une activation des processus inflammatoires, un affaiblissement de l’immunité épithélial, une altération composition de la flore intestinale et une augmentation des risques de troubles gastro-intestinaux, comme des diarrhées, qui peuvent exacerber l’état de malnutrition (Cunningham-Rundles et al., 2011, Hashimoto et al., 2012, Brestoff and Artis, 2013). Finalement, de nouvelles données suggèrent que le mécanisme des macrophages et monocytes, cellules impliquées dans l’immunité, est modifié en présence de MPE. En effet, ces cellules sécrèteraient plus d’arginase, une substance entrainant l’immunosuppression, lorsqu’exposées à une carence protéino-énergétique (Corware et al., 2014).
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Risk factors and high-risk subgroups of severe acute maternal morbidity in twin pregnancy: A population-based study

Risk factors and high-risk subgroups of severe acute maternal morbidity in twin pregnancy: A population-based study

The second multivariate model included factors identified over the course of pregnancy; placenta praevia (aRR, 3.5, 95% CI, 2.3–5.3), non-severe preeclampsia (aRR, 2.5, 95% CI, 1.9– 3.2), and macrosomia for either twin (aRR, 1.7, 95% CI, 1.3–2.1) were then risk factors for severe acute maternal morbidity ( Table 2 ). The second CART analysis, including the risk fac- tors identified during pregnancy, showed that non-severe preeclampsia was the most discrimi- nating factor (position A, Fig 2 ). In the absence of non-severe preeclampsia, the severe acute maternal morbidity rate was 5.2% (95% CI, 4.7–5.7) (position B), while with non-severe pre- eclampsia, it reached 15.2% (95% CI, 12.8–17.6) (position C). As we followed the "non-severe preeclampsia" branch to the terminal leaves of the tree, the highest risk of severe acute mater- nal morbidity was found in two subgroups of women with non-severe preeclampsia: those with oocyte donation (28.9%; 95% CI, 19.9–37.9) (position D) and those nulliparas born in sub-Saharan Africa (26.9%; 95% CI, 9.9–43.9) (position E); these subgroups accounted respec- tively for 1.1% and 0.3% of the women in the JUMODA cohort. Conversely, the women at low- est risk (3.8%; 95% CI, 3.2–4.4) were multiparous with none of the following events: non- severe preeclampsia, placenta praevia, or macrosomia (position F).
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Moderate to severe acute pain disturbs motor cortex intracortical inhibition and facilitation in orthopedic trauma patients : a TMS study

Moderate to severe acute pain disturbs motor cortex intracortical inhibition and facilitation in orthopedic trauma patients : a TMS study

Results:  Reduced SICI and ICF were found in IULF patients with moderate to severe pain, whereas mild pain was not associated with M1 alterations. Age, sex, and time since the accident had no influence on TMS measures.   Discussion:  These findings show altered M1 in the context of acute moderate to severe pain, suggesting early signs of altered GABAergic inhibitory and glutamatergic facilitatory activities.

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Malnutrition périnatale et programmation métabolique - Le tissu adipeux en ligne de mire

Malnutrition périnatale et programmation métabolique - Le tissu adipeux en ligne de mire

Le tissu adipeux de la descendance présente un état pro-inflammatoire Chez les rongeurs et le mouton, la descendance ayant subi, durant la période périnatale, une malnutrition présente une augmentation de cytokines pro-inflammatoires (TNF-D [tumor necrosis factor], IL[interleukine]6) circulantes et dans le tissu adipeux blanc, due, en partie, à une infiltration accrue de macrophages dans ce tissu. Cet état pro-inflammatoire participerait à la mise en place d’une résistance à l’insuline avant même l’établissement d’une obésité avérée [6] .

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Heterogeneity of Cause, Care, and Prognosis in Severe Acute Kidney Injury in Hospitalized Patients: A Prospective Observational Study

Heterogeneity of Cause, Care, and Prognosis in Severe Acute Kidney Injury in Hospitalized Patients: A Prospective Observational Study

Acute kidney injury cause was defined according to stan- dard nephrology definitions 13 and the clinical context, as suggested by Kellum and Prowle. 4 If a kidney biopsy was done for AKI, we used the results to specify the precise cause. The different causes considered were prerenal kidney injury with a clinical context of real hypovolemia and rapid reversibility of AKI after fluid administration; obstructive kidney failure with documented urinary tract obstruction; and renal kidney injury including acute tubular necrosis (ATN), glomerulopathy, vascular or acute interstitial nephri- tis, as assessed by a nephrologist based on medical history, clinical presentation, kidney imaging, and urine analysis. Acute tubular necrosis was diagnosed in cases of sustained renal ischemia, drug direct tubular injury, rhabdomyolysis, cast nephropathy, or persistent AKI more than 72 hours after hemodynamic correction. Acute kidney injury in the context of type I cardiorenal syndrome was defined by acute heart
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Prone positioning monitored by electrical impedance tomography in patients with severe acute respiratory distress syndrome on veno-venous ECMO

Prone positioning monitored by electrical impedance tomography in patients with severe acute respiratory distress syndrome on veno-venous ECMO

4. Terragni PP, Del Sorbo L, Mascia L, Urbino R, Martin EL, Birocco A, et al. Tidal volume lower than 6 ml/kg enhances lung protection: role of extra‑ corporeal carbon dioxide removal. Anesthesiology. 2009;111(4):826–35. 5. Fan E, Del Sorbo L, Goligher EC, Hodgson CL, Munshi L, Walkey AJ, et al. An official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: mechanical ventilation in adult patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2017;195(9):1253–63.

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Outcomes and survival prediction models for severe adult acute respiratory distress syndrome treated with extracorporeal membrane oxygenation

Outcomes and survival prediction models for severe adult acute respiratory distress syndrome treated with extracorporeal membrane oxygenation

Characteristics and management of respiratory failure Management of mechanical ventilation and adjuvant ther- apies for severe ARDS have greatly evolved during the last decade [18–20, 22, 23]. Amongst the patient cohorts from which scores have been developed, there was evidence of variation in pre-ECMO management, which influenced survival. For instance, only 49% of patients received pre- ECMO neuromuscular blockade in the RESP study [27] compared with all patients in Roch et al.’s cohort [28]. Pre-ECMO nitric oxide and prone positioning were used, respectively, in 16 and 29% of patients in the ECMOnet study [53] vs 90 and 60% in the PRESERVE cohort [6]. Despite the variation in reported use of pre-ECMO adjuvant therapies, where these have been reported, the studies have demonstrated both prone positioning and provision of neuromuscular blockade to be associated with improved survival. These findings are consistent with non-ECMO literature [6, 27]. Duration of mechanical ventilation pre ECMO over 7 days has been significantly associated with a poor outcome in the RESP, the PRE- SERVE and the VV-ECMO mortality scores [6, 27, 56]. Interestingly, although hypoxemia is a major factor, which influences the decision to start VV-ECMO, no predictive score has shown it to be predictive of survival. Potential reasons for this include a direct effect of ECMO which re- verses the adverse effects of hypoxia, bias induced by lack of information on “equally hypoxic” patients who do not receive ECMO or a type II statistical error as a result of the studies being underpowered to detect a small adverse effect from hypoxia. On the other hand, pre-ECMO direct and indirect markers of reduced compliance (e.g. high PaCO 2 , high peak inspiratory pressure, plateau
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Cumul de la malnutrition et de l'obésité dans les ménages des zones urbaines en Haïti

Cumul de la malnutrition et de l'obésité dans les ménages des zones urbaines en Haïti

Les objectifs de cette étude sont d’évaluer le profil nutritionnel des ménages, de déterminer la prévalence du cumul «enfant mainutri mère en surpoids» en milieu urbain pauvre en Haïti e[r]

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ECMO for severe acute respiratory distress syndrome: systematic review and individual patient data meta-analysis.

ECMO for severe acute respiratory distress syndrome: systematic review and individual patient data meta-analysis.

37. World Health Organization: Clinical management of severe acute respiratory infection when COVID-19 disease is suspected. . Last accessed July, 10 2020: https://www.who.int/ publications/i/item/clinical-management-of-covid-19 38. Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, Oczkowski S, Levy MM, Derde L, Dzierba A, Du B, Aboodi M, Wunsch H, Cecconi M, Koh Y, Chertow DS, Maitland K, Alshamsi F, Belley-Cote E, Greco M, Laundy M, Morgan JS, Kesecioglu J, McGeer A, Mermel L, Mammen MJ, Alexander PE, Arrington A, Centofanti JE, Citerio G, Baw B, Memish ZA, Hammond N, Hayden FG, Evans L, Rhodes A, (2020) Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med 46: 854-887
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