Ultra-sensitive troponin-I and incident coronary heart disease, stroke, heart failure, cardiac arrhythmias, arterial aneurysms and venous thromboembolism hospitalizations

Background

Cardiac troponin I (cTnI) as measured by high-sensitive assays has been related to incident cardiovascular disease events (CVD) in the community. With the advent of ultra-sensitive assays, it is now possible to detect troponin I at very low concentration, far below the classical threshold of 1.9 pg/mL. However, the clinical relevance of these low concentrations for predicting CVD is largely unknown.

Purpose

To examine the association of cTnI as low as 0.013 pg/mL with incident cardiovascular disease events (CVDs) in the primary prevention setting.

Methods

cTnI was analyzed in the baseline plasma (2008–2012) of CVD free volunteers from the Paris Prospective Study III using for the first time a novel ultra-sensitive immunoassay (Simoa Troponin-I 2.0 Kit, Quanterix, Lexington) with a limit of detection (LOD) of 0.013 pg/mL. Incident CVD hospitalizations for coronary heart disease, stroke, arrhythmias, venous thromboembolism, arterial aneurysms and heart failure were validated by critical review of the hospital records. Hazard ratios were estimated per log-transformed standard deviation (SD) increase of cTnI in Cox models using age as the time scale. The added value (gain in discriminatory capacity) of cTnI for CVD risk prediction was examined by calculating the Harell's C-index boostraped difference of the SCORE 2 risk model with and without cTnI.

Results

There were 9503 CVD free participants (40% women) aged 59.6 (6.3) years at baseline. cTnI was detected in 99.6% of the participants (median value = 0.63 pg/mL, interquartile range [IQR] 0.39–1.09). After a median follow-up of 8.34 years (IQR, 8.0–10.07), 516 participants suffered 612 events. In fully-adjusted analysis, higher cTnI (per 1 SD increase of log cTnI) was significantly associated with CVD events combined (n=516, HR= 1.21; 1.06; 1.39). In univariate Cox analysis and compared to each single established risk factor, cTnI had the highest discrimination capacity for incident CVD events (C-index=0.6349) (Figure 1). Adding log cTnI to the SCORE 2 algorithm increased significantly albeit moderately discriminatory capacity (C-index 0.698 vs. 0.685; boostraped C index difference: 0.0135 (95% CI: 0.0131; 0.0138)).

Conclusion

cTnI concentrations as measured by a novel ultra-sensitive immunoassay is associated with a significant increased risk of incident CVD events in the primary prevention setting.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): ANR: French National Research AgencyEurope: Horizon 2020

Infection à SARS-CoV-2 et biomédicaments : une étude multicentrique française de 7808 patients

Introduction

Les formes sévères d’infection à COVID-19 sont liées à une importante réponse inflammatoire. Certains biomédicaments (BM) sont en cours d’évaluation dans des essais thérapeutiques avec pour rationnel cet orage cytokinique. À l’inverse, nous pouvons nous interroger sur le risque d’infections à COVID-19 chez les patients sous BM au long cours. L’objectif principal de notre étude était de déterminer l’impact de la prise d’un BM sur le taux d’hospitalisation, de passage en réanimation (ICU) et de décès chez les patients sous BM atteints d’une infection à COVID-19.

Matériels et méthodes

Étude de cohorte rétrospective multicentrique à partir des données médico-administratives de l’Entrepôt de Données de Santé (EDS) de l’APHP. L’ensemble des patients recevant un BM (anti-TNF, anti-IL-12/23, anti-IL-17 ou anti-intégrine) étaient inclus. Les événements d’intérêt étaient la survenue d’une hospitalisation, d’un séjour en ICU ou d’un décès dans le cadre d’une infection à COVID-19 (confirmée par RT-PCR ou TDM thoracique) entre le 01/02 et le 22/04/20. Le risque d’hospitalisation/ICU/décès était évalué selon la méthodologie du Ratio de Morbidité/Mortalité Standardisé (SMR) en calculant le rapport entre le nombre observé et le nombre attendu. Le nombre attendu d’hospitalisation/ICU/décès était calculé en appliquant le taux d’hospitalisation/ICU/décès à COVID-19 de la population d’Ile-de-France (par tranche d’âge de 20 ans et par sexe) au nombre de personnes sous BM dans la sous-classe correspondante de la même source de données (données EDS de l’APHP).

Résultats

Un total de7808 patients (âge médian 45 ans, 51 % de femmes) étaient inclus ; dont 48 avec un diagnostic d’infection à COVID-19 : 19 (40 %) hospitalisés, 4 (8 %) en ICU et 1 décès. En comparaison avec la population d’Ile-de-France, les taux d’hospitalisation et d’ICU étaient significativement élevés chez les patients sous BM avec SMR 2,19, IC95 % 1,32-3,42, p < 0,001 et SMR 6,04, IC95 % 1,62-15,45, p < 0,001 respectivement, significativement observés chez les [20-40[. Cependant, une analyse post-hoc suggérait que les SMR d’hospitalisation et d’ICU étaient surestimés, un retour aux compte-rendus mettant en évidence une poussée de la pathologie sous-jacente comme principal motif d’hospitalisation chez les [20-40[et non une infection à COVID-19 nécessitant une hospitalisation ou un passage en ICU. Aucun sur-risque de mortalité était mis en évidence.

Discussion

À partir d’une large base de données, notre étude a permis de confirmer que les taux d’hospitalisation, de passage en réanimation et de mortalité n’étaient pas augmentés chez les patients sous BM. Nos résultats sont concordants avec les différentes études publiées dans la littérature (Haberman et al., Favalli et al. ou Sanchez-Piedra et al.).

Conclusion

Ces résultats plaident pour un maintien des BM en période d’épidémie du virus COVID-19 pour éviter la rechute des pathologies inflammatoires de fond.

Direct 24-Hour Presumptive Enumeration of Escherichia coli 0157:H7 in Foods Using Hydrophobic Grid Membrane Filter Followed by Serological Confirmation: Collaborative Study

Fifteen laboratories took part in a collaborative study to validate a method for enumerating Escherichia coli 0157:H7. The method is based on use of a hydrophobic grid membrane filter and consists of 24 h presumptive enumeration on SD-39 Agar and serological confirmation to yield a confirmed E. coli 0157:H7 count. Six food products were analyzed: pasteurized apple cider, pasteurized 2% milk, cottage cheese, cooked ground pork, raw ground beef, and frozen whole egg. The test method produced significantly higher confirmed count results than did the reference method for milk, pork, and beef. Test method results were numerically higher than but statistically equivalent to reference method results for cheese, cider, and egg. The test method produced lower repeatability and reproducibility values than did the reference method for most food/inoculation level combinations and values very similar to those of the reference method for the remaining combinations. Overall, 94% of presumptive positive isolates from the test method were confirmed serologically as E. coli 0157:H7, and 98% of these were also biochemically typical of E. coli 0157:H7 (completed test). Corresponding rates for the reference method were 69 and 98%, respectively. On the basis of the results of this collaborative study and the precollaborative study that preceded it, it is recommended that this method be adopted official first action for enumeration of E. coli 0157:H7 in meats, poultry, dairy foods, infant formula, liquid eggs, mayonnaise, and apple cider

Rappaport-Vassiliadis Medium for Recovery of Salmonellaspp. from Low Microbial Load Foods: Collaborative Study

Twenty-three laboratories participated in a collaborative study to compare the relative effectiveness of Rappaport-Vassiliadis (RV) medium incubated at 42°C, selenite cystine (SC) broth (35°C), and tetrathionate (TT) broth (35 and 43°C) for recovery of Salmonella from the following foods with a low microbial load: dried egg yolk, dry active yeast, ground black pepper, guar gum, and instant nonfat dry milk. For dry active yeast, lauryl tryptose (LT) broth, incubated at 35°C, was used instead of SC broth. All of the foods were artificially inoculated with single Salmonella serovars, that had been lyophilized before inoculation, at high and low target levels of 0.4 and 0.04 colony forming units/g food, respectively. For analysis of 870 test portions, representing all of the foods except yeast, 249 Salmonella-positive test portions were detected by RV medium, 265 by TT broth (43°C), 268 by TT broth (35°C), and 269 by SC broth (35°C). For analysis of 225 test portions of yeast, 79 Salmonella-positive test portions were detected by RV medium, 79 by TT broth (43°C), 84 by TT broth (35°C), and 68 by LT broth (35°C). RV medium was comparable to, or even more effective than, the other selective enrichments for recovery of Salmonella from all of the foods except guar gum. It is recommended that RV (42°C) and TT (35°C) be used with foods that have a low microbial load, except for guar gum for which SC (35°C) and TT (35°C) are recommended.

Anal dilatation versus left lateral sphincterotomy for chronic anal fissure: a prospective randomized study

BACKGROUND: Several surgical methods are accepted for the treatment of chronic anal fissure. The most popular are anal dilatation (AD) and left lateral sphincterotomy (LLS). The objective of the current study was to prospectively evaluate the results of these two procedures in terms of recurrence rate, complications and patient satisfaction. METHODS: The study enrolled all patients who required operation for chronic anal fissure in the Division of General Surgery, Campus Golda, Rabin Medical Center, between the years 1997 and 2001. Exclusion criteria were acute anal fissure or inflammatory bowel disease. RESULTS: A total of 108 patients participated in the study, at an average age of 42.4 years (SD=12.5). The patients were randomly assigned to two groups; one for LLS (53 patients, 49.1%) and one for AD (55 patients, 50.9%). The study protocol included a questionnaire and a physical examination performed 1, 2, 3, 6 and 12 months after operation. The questionnaire contained questions about pain, bloody stool, incontinence for gas, fluid or hard feces, during the day or night, and soiling. The patients were also asked about their satisfaction on an analog scale from 1 to 10. The average follow-up was 11.2 months (SD=4.1). Minor incontinence occurred in 8 patients of AD group and in 2 patients of LLS group (p<0.005). Recurrence occurred in 6 cases of the AD group and in one case of the LLS group (p<0.003). Satisfaction score was insignificantly higher in the LLS group (9.1+/-0.8 in the LLS group and 7.4+/-2.0 in the AD group). CONCLUSIONS: These results suggest that LLS is the preferred method for the treatment for chronic anal fissure.

Rappaport-Vassiliadis medium for recovery of Salmonella spp. from low microbial load foods: collaborative study

Twenty-three laboratories participated in a collaborative study to compare the relative effectiveness of Rappaport-Vassiliadis (RV) medium incubated at 42 degrees C, selenite cystine (SC) broth (35 degrees C), and tetrathionate (TT) broth (35 and 43 degrees C) for recovery of Salmonella from the following foods with a low microbial load: dried egg yolk, dry active yeast, ground black pepper, guar gum, and instant nonfat dry milk. For dry active yeast, lauryl tryptose (LT) broth, incubated at 35 degrees C, was used instead of SC broth. All of the foods were artificially inoculated with single Salmonella serovars, that had been lyophilized before inoculation, at high and low target levels of 0.4 and 0.04 colony forming units/g food, respectively. For analysis of 870 test portions, representing all of the foods except yeast, 249 Salmonella-positive test portions were detected by RV medium, 265 by TT broth (43 degrees C), 268 by TT broth (35 degrees C), and 269 by SC broth (35 degrees C). For analysis of 225 test portions of yeast, 79 Salmonella-positive test portions were detected by RV medium, 79 by TT broth (43 degrees C), 84 by TT broth (35 degrees C), and 68 by LT broth (35 degrees C). RV medium was comparable to, or even more effective than, the other selective enrichments for recovery of Salmonella from all of the foods except guar gum. It is recommended that RV (42 degrees C) and TT (35 degrees C) be used with foods that have a low microbial load, except for guar gum for which SC (35 degrees C) and TT (35 degrees C) are recommended.

MAG3-F0 scintigraphy in decision making for emergency intervention in renal colic after helical CT positive for a urolith

Patients with renal colic are evaluated with clinical, laboratory, and imaging methods for stratification for emergency decompression, medical treatment, or discharge and follow up. The current standard practice is heavily based on unenhanced helical CT for detecting uroliths. However, the presence of a urolith does not necessarily mean that the kidney is obstructed and requires emergency decompression. In this study, technetium-mercaptoacetyltriglycine (MAG3) diuretic scintirenography was used to detect obstruction in patients with renal colic. The contribution of this test to patient management after positive findings from helical CT was also studied.

METHODS

Diagnostic criteria were established on the basis of previous experience with 60 patients who had renal colic and had undergone radiography of the kidneys, ureters, and urinary bladder (KUB) and diuretic Tc-MAG3 scintirenography and were followed up to correlate scintigraphic findings with clinical outcome. Subsequently, 80 patients with renal colic underwent scintigraphy within 12 h of presentation in the emergency room, after abdominal helical CT showed findings positive for calculus and suggestive of obstruction. After therapeutic oral or intravenous hydration and analgesics, diuretic dynamic renal scintigraphy (flow, function, delayed imaging) was performed after intravenous injections of 10 mCi (370 MBq) 99mTc-MAG3 and 40 mg furosemide (at zero time, or F0). Results were available soon after completion of the study and were considered in patient management. Four characteristic patterns of scintirenography, essential in patient stratification and treatment, had been standardized and were used for interpretation of the studies: the unobstructed kidney; the partially obstructed kidney, proximally or distally obstructed, with mild to severe obstruction and impairment of function; the totally obstructed kidney, with arrested renal function; and the unobstructed but dysfunctioning kidney after decompression, or stunned kidney.

RESULTS

Among the 80 patients with positive helical CT findings, 56.5% were found to have obstruction by scintigraphy (32.5% partially, 24% completely); the remaining 43.5% did not have obstruction (21% without an indication of recent obstruction and 22.5% with stunned kidneys after spontaneous decompression). Occasionally, findings of preexistent urine extravasation or infection were present. Patients who, by scintigraphy, never had obstruction or had experienced spontaneous decompression did not require admission or emergency intervention; those with complete or severe obstruction required admission and decompression for relief of pain or restoration of function, whereas those with mild obstruction were treated variably with forced fluids, analgesics, or, less frequently, elective surgery. Outcome information from clinical examination, imaging, and interventional findings indicated that this stratification was successful. The test caused no side effects.

CONCLUSION

For renal colic, clinical selection, KUB radiography, and even positive helical CT findings were all found to have a low positive predictive value for obstruction (in this study, 35%, 32%, and 56% respectively). Anatomic studies, including helical CT, should be followed by diuretic MAG3-F0 scintirenography to diagnose and quantify or exclude obstruction, detect spontaneous decompression, and appropriately stratify patients for emergency intervention, observation and medical therapy, or further work-up and discharge with referral to the clinic.

Twenty-four-hour direct presumptive enumeration of Listeria monocytogenes in food and environmental samples using the ISO-GRID method with LM-137 agar

A new culture medium, LM-137 agar, was developed for use with the ISO-GRID hydrophobic grid membrane filter system for direct presumptive enumeration of Listeria monocytogenes in 24 h. The method was validated against three-replicate, three-dilution most probable number procedures based on enrichment methods specified by the U.S. Department of Agriculture, the Association of Official Analytical Chemists International and the U.S. Food and Drug Administration. The study encompassed meats, dairy products, egg, produce, seafood, and environmental samples. The ISO-GRID filter method produced significantly higher recovery of L. monocytogenes from fermented sausage, hot dogs, pasteurized and raw milk, raw shrimp, and environmental swab samples (P < 0.05). The reference methods yielded significantly higher counts from frozen raw pork and cole slaw (P < 0.05). Confirmation rates of presumptive positive isolates from the filter method ranged from a low of 92% (frozen raw pork) to 100% (most other products). Neither the recovery efficiency nor the confirmation rate were affected by the presence of competing aerobic flora.

Enumeration of beta-glucuronidase-positive Escherichia coli in foods by using the ISO-GRID method with SD-39 agar

A study was undertaken to compare beta-glucuronidase-positive Escherichia coli counts produced by the ISO-GRID hydrophobic grid membrane filter method using SD-39 agar (test method) with those produced by AOAC Official Method 990.11, an existing ISO-GRID method using lactose monensin glucuronate agar and buffered MUG agar (reference method). The methods were evaluated using 21 food products, with three independent lots of five replicate samples analyzed per product by both methods. The test and reference methods were statistically equivalent for 19 of the 21 products; frozen, raw ground lamb produced significantly higher counts using the reference method, whereas counts obtained from cottage cheese were significantly higher using the SD-39 agar-based method.

Two-Day Hydrophobic Grid Membrane Filter Method for Yeast and Mold Enumeration in Foods Using YM-11 Agar: Collaborative Study

Twenty laboratories participated in a collaborative study to validate a 2-day hydrophobic grid membrane filter method using YM-11 agar for enumeration of yeast and mold in foods. Six naturally contaminated food products were included in the study: garlic powder, raw ground beef, walnuts, flour/meal, orange juice, and yogurt. The test method produced significantly higher results than the 5-day pour plate reference method for orange juice and significantly lower, though numerically similar, results for walnuts and yogurt. Differences between the test and reference methods were not significant for garlic powder, raw ground beef, or flour/meal. Repeatability and reproducibility were similar for both the test and reference methods in all cases. The hydrophobic grid membrane filter method for enumeration of yeast and mold in foods has been adopted by AOAC INTERNATIONAL.

Decrease in canine corneal endothelial cell density and increase in corneal thickness as functions of age

Fifty-nine normal dogs, ranging in age from 6 weeks to 132 months were examined with contact specular microscopy to determine the relationship of age to corneal endothelial cell density, morphology, and corneal thickness. Canine corneal endothelial cells appear quite similar to those of other species studied, including man. The hexagonally shaped canine endothelial cells tend to enlarge with age, with the population in young animals averaging around 2500 cells/mm2 and the number of cells in older dogs being frequently below 2100 cells/mm2. A significant increase in corneal thickness was observed with age. Healthy canine corneal endothelial cells appear to maintain a functional monolayer by enlargement and migration and represent a reasonable model for future endothelial cell study.