Sharing Digital Health Educational Resources in a One-Stop Shop Portal: Tutorial on the Catalog and Index of Digital Health Teaching Resources (CIDHR) Semantic Search Engine

BACKGROUND

Access to reliable and accurate digital health web-based resources is crucial. However, the lack of dedicated search engines for non-English languages, such as French, is a significant obstacle in this field. Thus, we developed and implemented a multilingual, multiterminology semantic search engine called Catalog and Index of Digital Health Teaching Resources (CIDHR). CIDHR is freely accessible to everyone, with a focus on French-speaking resources. CIDHR has been initiated to provide validated, high-quality content tailored to the specific needs of each user profile, be it students or professionals.

OBJECTIVE

This study's primary aim in developing and implementing the CIDHR is to improve knowledge sharing and spreading in digital health and health informatics and expand the health-related educational community, primarily French speaking but also in other languages. We intend to support the continuous development of initial (ie, bachelor level), advanced (ie, master and doctoral levels), and continuing training (ie, professionals and postgraduate levels) in digital health for health and social work fields. The main objective is to describe the development and implementation of CIDHR. The hypothesis guiding this research is that controlled vocabularies dedicated to medical informatics and digital health, such as the Medical Informatics Multilingual Ontology (MIMO) and the concepts structuring the French National Referential on Digital Health (FNRDH), to index digital health teaching and learning resources, are effectively increasing the availability and accessibility of these resources to medical students and other health care professionals.

METHODS

First, resource identification is processed by medical librarians from websites and scientific sources preselected and validated by domain experts and surveyed every week. Then, based on MIMO and FNRDH, the educational resources are indexed for each related knowledge domain. The same resources are also tagged with relevant academic and professional experience levels. Afterward, the indexed resources are shared with the digital health teaching and learning community. The last step consists of assessing CIDHR by obtaining informal feedback from users.

RESULTS

Resource identification and evaluation processes were executed by a dedicated team of medical librarians, aiming to collect and curate an extensive collection of digital health teaching and learning resources. The resources that successfully passed the evaluation process were promptly included in CIDHR. These resources were diligently indexed (with MIMO and FNRDH) and tagged for the study field and degree level. By October 2023, a total of 371 indexed resources were available on a dedicated portal.

CONCLUSIONS

CIDHR is a multilingual digital health education semantic search engine and platform that aims to increase the accessibility of educational resources to the broader health care-related community. It focuses on making resources "findable," "accessible," "interoperable," and "reusable" by using a one-stop shop portal approach. CIDHR has and will have an essential role in increasing digital health literacy.

Anti-SARS-CoV-2 (COVID-19) vaccination efficacy in patients with severe neuromuscular diseases

INTRODUCTION

Patients with severe neuromuscular disease (sNMD) are considered at high risk of severe COVID-19. Muscle tissue is often replaced by fibroadipose tissue in these diseases whereas the new mRNA-based vaccines are injected intramuscularly. We aimed at evaluating the efficacy of two injections associated with a booster injection of mRNA vaccine in these patients.

METHODS

We performed an observational, prospective, single-centre study to investigate the level of anti-S antibodies (Abs) and their neutralization activity at weeks 6 (W6) and 24 (W24) after two injections of mRNA-1273 vaccine and at weeks 12 (BW12) and 29 (BW29) after a booster injection of BNT162b2 vaccine in patients with sNMD.

RESULTS

Thirty-three patients with sNMD were included. At W6, 30 patients (90.1%) showed a protective serum level of specific anti-S Abs with a strong neutralization capacity. We observed a decline over time: only 12 patients (36.3%) retained anti-S Abs levels considered as protective at W24. The neutralization activity remained above the cut off in 23 (69.7%). The booster vaccination restored robust neutralization activity for all analysed 22 patients (100%) at BW12, which was maintained without any significant drop at BW29 (16). No severe adverse event was reported in this cohort and none of the 33 patients developed symptomatic COVID-19 over one year.

CONCLUSIONS

This study provides evidence that most sNMD patients receiving two injections of COVID-19 mRNA-based vaccines develop a strong humoral response after vaccination. A decline over time was observed but a single booster injection restores a long-term immunity. Moreover, no safety issues were observed.

A multiparametric approach to assessing residual pain experienced by dairy cows undergoing digestive tract surgery under multimodal analgesia

This study assessed residual pain responses of dairy cows undergoing fistulation surgery under multimodal analgesia using a multiparametric method combining behavioural and physiological indicators. A longitudinal study was conducted on five dairy cows, each acting as her own control. The surgery consisted of implanting a ruminal and a duodenal cannula in each cow. The multimodal drug protocol consisted of a combination of N-Methyl-D aspartic Acid antagonists, α2-agonists, and local anaesthetic during surgery, and non-steroidal anti-inflammatory drugs (NSAIDs) and opioid treatment postsurgery. Cow responses to surgery were monitored by direct behavioural observation, physiological assay indicators, and milk production from day (D) -6 days before surgery (D-6) to D13 postsurgery. From the data recorded, the variables that contributed most to the discrimination of days pre- and postsurgery were identified using factorial discriminant analysis. Components 1 and 2 of the factorial discriminant analysis explained 68.2% and 17.9%, respectively, of the total variance. Component 1 was mainly explained by haptoglobin (contribution to axis: 0.885), oxidative stress (ratio of oxidized gluthatione to reduced glutathione (GSH/GSSG), -0.746; vitamin E, -0.683; vitamin A, -0.597; malondialdehyde (MDA), 0.416), and behavioural indicators (general attitude, 0.594). On this axis, the higher the score, the higher were the apathy and haptoglobin and MDA concentrations, and the lower were the GSH/GSSG ratio and concentrations of vitamins A and E. This axis opposed cows on D-6 to cows on D3 and D5; cows on D1 and D13 were intermediate. Component 2 was mainly explained by the Hypothalamic-pituitary-adrenal axis (non-esterified fatty acid (NEFA), 0.686; cortisol, 0.669), milk yield (-0.725), oxidative stress (MDA, -0.584; nitric oxide (NO), 0.454), and behavioural indicators of pain (ear position, 0.467; leg postures, 0.431). On this axis, the higher the score, the higher the NEFA, cortisol, and nitric oxide concentrations; the more the ear and leg pain postures; and the lower the milk production and MDA concentrations. This axis opposed cows on D13 to cows on D1. These results suggest that cows may experience some pain only on D1, whereas on subsequent days, the inflammatory response and oxidative stress did not seem to be associated with pain. Our results should be considered for different surgeries to improve analgesia immediately after surgery, and to provide antioxidants along with NSAIDs to promote recovery.

[Eosinophilic pneumonia: A rare complication of sodium divalproate]

INTRODUCTION

Eosinophilic pneumonias are characterized by an increase in lung eosinophils. These disorders can be induced by drug reactions.

CASE REPORT

A 57-year-old woman suffering from bipolar disorder and treated by sodium divalproate for more than 2 years was hospitalised in the department of respiratory medicine for dyspnoea and cough. The investigations showed severe hypoxaemia, airflow limitation, multiple ground-glass opacities and crazy paving on the chest CT-scan and a blood eosinophilia. A significant alveolar eosinophilia was found in the broncho-alveolar lavage. A complete assessment of possible causes was made. Finally, we made the diagnosis of eosinophilic pneumonia secondary to sodium divalproate. The treatment was stopped and systemic corticosteroid therapy was not introduced. The patient showed an improvement of her dyspnoea in a few days. Lung function and the CT-scan were normal within a few months.

CONCLUSIONS

Sodium divalproate, frequently used in the treatment of bipolar disorder, is a rare cause of eosinophilic lung disease, even years after its introduction. Rapid diagnosis and withdrawal of treatment led to complete resolution in the reported case.

[Evaluation of cardiac MRI in the follow up assessment of patients with pulmonary arterial hypertension]

Haemodynamic follow up in pulmonary arterial hypertension (PAH) is currently based on right heart catheterisation (RHC). The primary objective of the EVITA study is to compare the use of cardiac magnetic resonance imaging (cMRI) with RHC in the identification of an unfavourable hemodynamic status. The secondary objectives are to determine the role of cMRI in the follow up process. Patients will undergo at diagnosis and at follow up visits both RHC and cMRI. Patients will be followed and treated according to the current guidelines. The primary endpoint will be an unfavourable haemodynamic status defined by cardiac index<2.5L/min/m² or a right atrial pressure≥8mm Hg measured with RHC compared with a cardiac index<2.5L/min/m² or right ventricle ejection fraction<35% or an absolute decrease of 10% from the previous measurement with cMRI. Exact values of sensitivity, specificity and 95% confidence intervals will be computed. A population of 180 subjects will have a power of 90% with an α risk of 5%. Univariate and multivariate Cox analysis will allow answering to the secondary objectives. We expect to demonstrate that cMRI could be partly used instead of RHC in the follow up of patients with PAH.

[Tunnelled central venous catheter infection during treatment with epoprostenol]

INTRODUCTION

Pulmonary arterial hypertension is a pulmonary vascular disease with a poor prognosis. Continuous intravenous treatment with prostacyclin analogues requires the placement of a tunnelled catheter. The occurrence of catheter-related infections in this context is unusual due to the alkaline pH of the prostacyclin analogue solutions.

OBSERVATION

A 50-year-old patient with inherited pulmonary artery hypertension, treated with bosentan, sildenafil and epoprostenol, experienced generalized malaise associated with a weight loss of 9kg over a 12-month period without evidence of a source of infection or malignancy. There was no evidence of hemodynamic disturbance. The diagnosis was made after 1 year of follow-up, when the patient presented with a 38° fever and a biological inflammatory syndrome. Repeated peripheral blood cultures were positive for Dietzia, an alkalophilic coryneform bacillus. The patient's condition responded favourably to antibiotic therapy.

CONCLUSION

Infection of a tunneled intravenous catheter should be considered in the case of non-specific symptoms or where there is evidence of sepsis, in patients treated with intravenous prostacyclin analogues administered intravenously. In this context, the laboratory should be warned to search for slow-growing organisms.

[Malignant transformation of an eccrine spiradenoma]

INTRODUCTION

Malignant eccrine spiradenoma is a rare and aggressive tumor, developed on the epithelium of eccrine sweat glands. Typically, it occurs after malignant transformation of benign eccrine spiradenoma, but sometimes it happens de novo.

OBSERVATION

We report a case of malignant eccrine spiradenoma in a 62-year-old woman. The patient presented a rapid increase in size of a long-standing tumoral lesion of her forearm. There was no secondary lesion on the chest, abdomen or pelvis at the CT-scanner. Cutaneous biopsy of the lesion was performed and showed a carcinoma with no contact with epidermis. On this biopsy, we could not affirm if the tumor was a metastatic process or a primary tumor of the skin. Histologic examination of the surgical removal of the tumor showed an undifferentiated carcinoma with adjacent nodules of eccrine spiradenoma. Immunohistochemical assessment of Ki67 expression showed a weak expression (5%) in the benign spiradenoma nodules and a high rate expression (80%) in the malignant neoplasm. The final diagnosis was an undifferentiated carcinoma arising from preexisting benign spiradenoma.

DISCUSSION

Malignant eccrine spiradenoma is not frequent and is rarely described in the international literature that may lead to diagnostic difficulties.

The insulin sensitiser metformin regulates chicken Sertoli and germ cell populations

Metformin, an insulin sensitiser from the biguanide family of molecules, is used for the treatment of insulin resistance in type 2 diabetes individuals. It increases peripheral glucose uptake and may reduce food intake. Based on the tight link between metabolism and fertility, we investigated the role of metformin on testicular function using in vitro culture of Sertoli cells and seminiferous tubules, complemented by in vivo data obtained following metformin administration to prepubertal chickens. In vitro, metformin treatment reduced Sertoli cell proliferation without inducing apoptosis and morphological changes. The metabolism of Sertoli cells was affected because lactate secretion by Sertoli cells increased approximately twofold and intracellular free ATP was negatively impacted. Two important pathways regulating proliferation and metabolism in Sertoli cells were assayed. Metformin exposure was not associated with an increased phosphorylation of AKT or ERK. There was a 90% reduction in the proportion of proliferating germ cells after a 96-h exposure of seminiferous tubule cultures to metformin. In vivo, 6-week-old chickens treated with metformin for 3 weeks exhibited reduced testicular weight and a 50% decrease in testosterone levels. The expression of a marker of undifferentiated germ cells was unchanged in contrast to the decrease in expression of ‘protamine’, a marker of differentiated germ cells. In conclusion, these results suggest that metformin affects the testicular energy content and the proliferative ability of Sertoli and germ cells.

Reproduction (2016) 151 527–538

Shopper cards data and storage practices for the investigation of an outbreak of Shiga-toxin producing Escherichia coli O157 infections

INTRODUCTION

An outbreak of shiga-toxin producing Escherichia coli infections occurred in southwest France in June 2012. The outbreak was investigated to identify the source of infection, and guide control measures.

METHODS

Confirmed outbreak cases were patients who developed bloody diarrhoea or haemolytic uremic syndrome (HUS) between 28 May and 6 July 2012, with E. coli O157 isolates showing indistinguishable patterns on pulse field gel electrophoresis (PFGE). A standardized questionnaire was administered to patients to document food consumption and other risk exposures. Their purchase was checked through their supermarket shopper card data.

RESULTS

Six patients (four with HUS and two with bloody diarrhea) were confirmed outbreak cases. Fresh ground beef burgers from one supermarket were the only common food exposure, identified by interviews and shopper card data. The PFGE profile of shiga toxin-producing E. coli O157 isolated from the suspected beef burgers was identical to those from the human cases. The suspected beef burgers were no longer on sale at the time of investigation but three patients confirmed as outbreak cases had deep-frozen some at home.

CONCLUSION

Shopper card data was particularly useful to obtain precise and reliable information on the traceability of consumed food. Despite the expired use-by date, a recall was issued for the beef burgers. This contributed to preventing other cases among consumers who had deep-frozen the beef burgers.

Photocatalytic conversion of gaseous nitrogen trichloride into available chlorine--experimental and modeling study

In water, chlorine reacts with nitrogen-containing compounds to produce disinfection byproducts such as nitrogen trichloride which induces ocular and respiratory irritations in swimming pool workers. A technical solution has been used to reduce NCl3 exposure to acceptable levels, by adding a stripping step to the water recycling loop. The pollutants extracted are currently rejected into the atmosphere without treatment. However, the physical properties of NCl3 could be harnessed to induce its controlled degradation by direct or indirect light. This paper describes the way to transform NCl3 into oxidizing chlorine by photocatalysis under laboratory conditions. Photocatalytic oxidation efficiently degrades gaseous nitrogen trichloride, producing compounds such as HClO. About 60% of NCl3 decomposed was converted into HClO which could be used as a disinfection compound. A kinetic model is proposed for the photocatalytic process based on a convection/diffusion model. The Langmuir-Hinshelwood model was applied to the chemical part of the mechanism. The apparent quantum yield was also estimated to assess the optimal irradiance for NCl3 transformation. The results show that photocatalysis performs much better than photolysis alone for NCl3 removal, i.e. at least 25 times more efficient.

Caspase-1 activity affects AIM2 speck formation/stability through a negative feedback loop

The inflammasome is an innate immune signaling platform leading to caspase-1 activation, maturation of pro-inflammatory cytokines and cell death. Recognition of DNA within the host cytosol induces the formation of a large complex composed of the AIM2 receptor, the ASC adaptor and the caspase-1 effector. Francisella tularensis, the agent of tularemia, replicates within the host cytosol. The macrophage cytosolic surveillance system detects Francisella through the AIM2 inflammasome. Upon Francisella novicida infection, we observed a faster kinetics of AIM2 speck formation in ASC^KO and Casp1^KO as compared to WT macrophages. This observation was validated by a biochemical approach thus demonstrating for the first time the existence of a negative feedback loop controlled by ASC/caspase-1 that regulates AIM2 complex formation/stability. This regulatory mechanism acted before pyroptosis and required caspase-1 catalytic activity. Our data suggest that sublytic caspase-1 activity could delay the formation of stable AIM2 speck, an inflammasome complex associated with cell death.

Re-emergence of brucellosis in cattle in France and risk for human health

A case of human brucellosis was diagnosed in France in January 2012. The investigation demonstrated that the case had been contaminated by raw milk cheese from a neighbouring dairy farm. As France has been officially free of bovine brucellosis since 2005, veterinary investigations are being conducted to determine the origin of the infection and avoid its spread among other herds. Hypotheses about the source of this infection are discussed.

Re-emergence of brucellosis in cattle in France and risk for human health

A case of human brucellosis was diagnosed in France in January 2012. The investigation demonstrated that the case had been contaminated by raw milk cheese from a neighbouring dairy farm. As France has been officially free of bovine brucellosis since 2005, veterinary investigations are being conducted to determine the origin of the infection and avoid its spread among other herds. Hypotheses about the source of this infection are discussed.

Health-related quality of life of patients 12 months following surgical intensive care discharge

Health  related  quality  of  life  (HRQoL)  and  the  effect  of  selected  socio-demographic  and  clinical  intensive  care  variables  on  HRQoL of  patients  12  months  following  adult  surgical  intensive  care  unit  discharge in  the  Western  Cape  was  evaluated.  A  prospective  observational  study  was conducted.  The  sample  comprised  46  patients  who  had  survived  12  months following discharge. Structured telephonic interviews were conducted using a self-developed  and  SF-36v2  HRQoL  questionnaire.  Data  was  analyzed  using Stastica 7 and values were accepted as significant at the 5% level. Low mean HRQoL  domain  scores  (43%  -  53%)  were  found  implying  a  poor  HRQoL outcome. Physical functioning [43.5%], Role Play [44.5%] and Role Emotion [43.1%] scores were specifically lower than the other HRQoL domain scores. Age and severity of illness scores (APACHE II) were significantly associated with the social functioning (p=0.01) and physical functioning (p=0.02) scores  respectively. APACHE  II  may  be  a  useful  contributor  in  predicting  long-term  physical  functioning  outcomes  in  patients  following  surgical  ICU  discharge.  The  HRQoL  outcomes  are  slightly  lower  than  that  found  for  inter-national ICU populations however responses in the domains affected are comparable. Low physical functioning, role play  and  role  emotion  scores  indicate  a  need  for  further  physical  and  emotional  rehabilitation  following  surgical  ICU discharge.

From public to occupational health: towards an inverse push-pull paradigm in nanotechnologies innovation

Nanotechnologies are an important set of new technologies no longer at a very early stage in their development. The financial support for R&D in this domain is greater than a few Giga Euros/year for innovation and considerably lower (less than 1-2%) for risk management. At the factory level, As Low As Reasonably Achievable (ALARA) methods have to be used in order to protect workers against possible exposure. New "short-term" toxicological studies show that nano-particles are seldom exempt of effects in humans... Thus, for the general population, more and more anxious about the future, nanotechnologies are the object of numerous debates. Ultimately, the population is asking governmental bodies to take the required preventive measures. Social pressure is now initiated by the public towards innovative industries, which have to prove, before the marketing stage, the absence of any risk for the users and demonstrate a safety driven governance.