Accuracy of gradient diffusion method for susceptibility testing of dalbavancin and comparators

OBJECTIVES

This multicenter study aimed to assess the performances of gradient diffusion (GD) method in comparison to broth microdilution (BMD) method for susceptibility testing of dalbavancin, daptomycin, vancomycin, and teicoplanin.

METHODS

Minimum Inhibitory Concentrations (MICs) were retrospectively determined concomitantly by BMD and GD methods, for 93 staphylococci and enterococci isolated from clinical samples. BMD was considered as the gold standard. Essential (EA) and categorical agreements (CA) were calculated. Discordant categorical results were categorized as major (ME) and very major errors (VME).

RESULTS

EA and CA were 95.7% and 96.8%, 82.8% and 100%, 97.8% and 96.8%, and 94.6% and 95.7% for dalbavancin, daptomycin, vancomycin, and teicoplanin respectively. Concerning dalbavancin, 3 ME without any VME were observed and discrepancies were low (≤ to 2 two-fold dilutions) between both methods. VME were noted in 1 and 3 cases for vancomycin and teicoplanin, respectively, and resulted from 1 two-fold dilution discrepancy in each case. EA was lower for daptomycin. When they were discrepant, BMD MICs were systematically higher than GD ones. Nevertheless, no categorical discrepancy was noted.

CONCLUSIONS

GD appears as an acceptable and convenient alternative for dalbavancin, vancomycin, and teicoplanin MICs determination. Our study also emphasizes how achieving accurate daptomycin MICs remains challenging.

Effect of Tenofovir Disoproxil Fumarate and Emtricitabine on nasopharyngeal SARS-CoV-2 viral load burden amongst outpatients with COVID-19: A pilot, randomized, open-label phase 2 trial

BACKGROUND

Tenofovir and emtricitabine interfere with the SARS CoV-2 ribonucleic acid (RNA)-dependent RNA polymerase (RdRp). Several cohorts reported that people treated by tenofovir disoproxil fumarate and emtricitabine are less likely to develop SARS CoV-2 infection and related severe COVID-19.

METHODS

We conducted a pilot randomized, open-label, controlled, phase 2 trial at two hospitals in France. Eligible patients were consecutive outpatients (aged ≥18 years) with RT-PCR-confirmed SARS-CoV-2 infection and an interval from symptom onset to enrolment of 7 days or less. Patients were randomly assigned in a 1:1 ratio to receive oral tenofovir disoproxil fumarate and emtricitabine (2 pills on day 1 followed by 1 pill per day on days 2-7) or the standard of care. The primary and secondary endpoints were SARS-CoV-2 viral clearance from baseline assessed by cycle threshold (Ct) RT-PCR on nasopharyngeal swab collected at day 4 and day 7, respectively. A higher Ct corresponds to a lower SARS CoV-2 viral burden. Other endpoints were the time to recovery and the number of adverse events. This trial is registered with ClinicalTrials.gov, NCT04685512.

FINDINGS

From November, 20^th 2020 to March, 19^th 2021, 60 patients were enrolled and randomly assigned to a treatment group (30 to tenofovir disoproxil fumarate and emtricitabine and 30 to standard of care). The median number of days from symptom onset to inclusion was 4 days (IQR 3-5) in both groups. Amongst patients who received tenofovir disoproxil fumarate, the difference from standard of care in the increase in Ct RT-PCR from baseline was 2.3 (95% confidence interval [-0.6 to 5.2], p = 0.13) at day 4 and 2.9 (95% CI [0.1 to 5.2], p = 0.044) at day 7. At day 7, 6/30 in the tenofovir disoproxil fumarate and emtricitabine group and 3/30 in the standard of care group reported no COVID-related symptoms. Adverse events included 11 cases of gastrointestinal side effects (grade ≤ 2), three of which leaded to drug discontinuation. Three patients had COVID-19 related hospitalisation, no participant died.

INTERPRETATION

In this pilot study of outpatients adult with recent non-severe COVID-19, tenofovir disoproxil fumarate plus emtricitabine appeared to accelerate the natural clearance of nasopharyngeal SARS-CoV-2 viral burden. These findings support the conduct of larger trials of tenofovir-based therapies for the prevention and early treatment of COVID-19.

FUNDING

No external funding.

High performance of a novel antigen detection test on nasopharyngeal specimens for diagnosing SARS-CoV-2 infection

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has become a major public health issue worldwide. Developing and evaluating rapid and easy-to-perform diagnostic tests is a high priority. The current study was designed to assess the diagnostic performance of an antigen-based rapid detection test (COVID-VIRO®) in a real-life setting. Two nasopharyngeal specimens of symptomatic or asymptomatic adult patients hospitalized in the Infectious Diseases Department or voluntarily accessing the COVID-19 Screening Department of the Regional Hospital of Orléans, France, were concurrently collected. The diagnostic specificity and sensitivity of COVID VIRO® results were compared to those of real-time reverse-transcriptase quantitative polymerase chain reaction (RT-qPCR) results. A subset of patients underwent an additional oropharyngeal and/or saliva swab for rapid testing. A total of 121 patients confirmed to be infected and 127 patients having no evidence of recent or ongoing infection were enrolled for a total of 248 nasopharyngeal swab specimens. Overall, the COVID-VIRO® sensitivity was 96.7% (CI, 93.5%-99.9%). In asymptomatic patients, symptomatic patients having symptoms for more than 4 days and those with an RT-qPCR cycle threshold value ≥ 32, the sensitivities were 100%, 95.8%, and 91.9%, respectively. The concordance between RT-qPCR and COVID VIRO® rapid test results was 100% for the 127 patients with no SARS-CoV-2 infection. The COVID-VIRO® test had 100% specificity and sensitivity greater than 95%, which are better than the recommendations set forth by the WHO (specificity ≥ 97%-100%, sensitivity ≥ 80%). These rapid tests may be particularly useful for large-scale screening in emergency departments, low-resource settings, and airports.

Emerging resistance mutations in PI-naive patients failing an atazanavir-based regimen (ANRS multicentre observational study)

Background

Atazanavir is a PI widely used as a third agent in combination ART. We aimed to determine the prevalence and the patterns of resistance in PI-naive patients failing on an atazanavir-based regimen.

Methods

We analysed patients failing on an atazanavir-containing regimen used as a first line of PI therapy. We compared the sequences of reverse transcriptase and protease before the introduction of atazanavir and at failure [two consecutive viral loads (VLs) >50 copies/mL]. Resistance was defined according to the 2014 Agence Nationale de Recherche sur le SIDA et les Hépatites Virales (ANRS) algorithm.

Results

Among the 113 patients, atazanavir was used in the first regimen in 71 (62.8%) patients and in the first line of a PI-based regimen in 42 (37.2%). Atazanavir was boosted with ritonavir in 95 (84.1%) patients and combined with tenofovir/emtricitabine or lamivudine (n = 81) and abacavir/lamivudine or emtricitabine (n = 22). At failure, median VL was 3.05 log10 copies/mL and the median CD4+ T cell count was 436 cells/mm3. The median time on atazanavir was 21.2 months. At failure, viruses were considered resistant to atazanavir in four patients (3.5%) with the selection of the following major atazanavir-associated mutations: I50L (n = 1), I84V (n = 2) and N88S (n = 1). Other emergent PI mutations were L10V, G16E, K20I/R, L33F, M36I/L, M46I/L, G48V, F53L, I54L, D60E, I62V, A71T/V, V82I/T, L90M and I93L/M. Emergent NRTI substitutions were detected in 21 patients: M41L (n = 2), D67N (n = 3), K70R (n = 1), L74I/V (n = 3), M184V/I (n = 16), L210W (n = 1), T215Y/F (n = 3) and K219Q/E (n = 2).

Conclusions

Resistance to atazanavir is rare in patients failing the first line of an atazanavir-based regimen according to the ANRS. Emergent NRTI resistance-associated mutations were reported in 18% of patients.

Prevalence of HIV-1 drug resistance in treated patients with viral load >50 copies/mL: a 2014 French nationwide study

Background

Surveillance of HIV-1 resistance in treated patients with a detectable viral load (VL) is important to monitor, in order to assess the risk of spread of resistant viruses and to determine the proportion of patients who need new antiretroviral drugs with minimal cross-resistance.

Methods

The HIV-1 protease and reverse transcriptase (RT) and integrase genes were sequenced in plasma samples from 782 consecutive patients on failing antiretroviral regimens, seen in 37 specialized centres in 2014. The genotyping results were interpreted using the ANRS v24 algorithm. Prevalence rates were compared with those obtained during a similar survey conducted in 2009.

Results

The protease and RT sequences were obtained in 566 patients, and the integrase sequence in 382 patients. Sequencing was successful in 60%, 78%, 78% and 87% of patients with VLs of 51-200, 201-500, 501-1000 and >1000 copies/mL, respectively. Resistance to at least one antiretroviral drug was detected in 56.3% of samples. Respectively, 3.9%, 8.7%, 1.5% and 3.4% of patients harboured viruses that were resistant to any NRTI, NNRTI, PI and integrase inhibitor (INI). Resistance rates were lower in 2014 than in 2009. Resistance was detected in 48.5% of samples from patients with a VL between 51 and 200 copies/mL.

Conclusion

In France in 2014, 90.0% of patients in AIDS care centres were receiving antiretroviral drugs and 12.0% of them had VLs >50 copies/mL. Therefore, this study suggests that 6.7% of treated patients in France might transmit resistant strains. Resistance testing may be warranted in all treated patients with VL > 50 copies/mL.

Clinical severity and molecular characteristics of circulating and emerging rotaviruses in young children attending hospital emergency departments in France

Group A rotavirus (RVA) is the leading cause of acute gastroenteritis in young children worldwide. A prospective surveillance network has been set up to investigate the virological and clinical features of RVA infections and to detect the emergence of potentially epidemic strains in France. From 2009 to 2014, RVA-positive stool samples were collected from 4800 children <5 years old attending the paediatric emergency units of 16 large hospitals. Rotaviruses were then genotyped by RT-PCR with regard to their outer capsid proteins VP4 and VP7. Genotyping of 4708 RVA showed that G1P[8] strains (62.2%) were predominant. The incidence of G9P[8] (11.5%), G3P[8] (10.4%) and G2P[4] (6.6%) strains varied considerably, whereas G4P[8] (2.7%) strains were circulating mostly locally. Of note, G12P[8] (1.6%) strains emerged during the seasons 2011-12 and 2012-13 with 4.1% and 3.0% prevalence, respectively. Overall, 40 possible zoonotic reassortants, such as G6 (33.3%) and G8 (15.4%) strains, were detected, and were mostly associated with P[6] (67.5%). Analysis of clinical records of 624 hospitalized children and severity scores from 282 of them showed no difference in clinical manifestations or severity in relation to the genotype. The relative stability of RVA genotypes currently co-circulating and the large predominance of P[8] type strains may ensure vaccine effectiveness in France. The surveillance will continue to monitor the emergence of new reassortants that might not respond to current vaccines, all the more so as all genotypes can cause severe infections in infants.

Zinc oxide nanorod based photonic devices: recent progress in growth, light emitting diodes and lasers

Zinc oxide (ZnO), with its excellent luminescent properties and the ease of growth of its nanostructures, holds promise for the development of photonic devices. The recent advances in growth of ZnO nanorods are discussed. Results from both low temperature and high temperature growth approaches are presented. The techniques which are presented include metal-organic chemical vapour deposition (MOCVD), vapour phase epitaxy (VPE), pulse laser deposition (PLD), vapour-liquid-solid (VLS), aqueous chemical growth (ACG) and finally the electrodeposition technique as an example of a selective growth approach. Results from structural as well as optical properties of a variety of ZnO nanorods are shown and analysed using different techniques, including high resolution transmission electron microscopy (HR-TEM), scanning electron microscopy (SEM), photoluminescence (PL) and cathodoluminescence (CL), for both room temperature and for low temperature performance. These results indicate that the grown ZnO nanorods possess reproducible and interesting optical properties. Results on obtaining p-type doping in ZnO micro- and nanorods are also demonstrated using PLD. Three independent indications were found for p-type conducting, phosphorus-doped ZnO nanorods: first, acceptor-related CL peaks, second, opposite transfer characteristics of back-gate field effect transistors using undoped and phosphorus doped wire channels, and finally, rectifying I-V characteristics of ZnO:P nanowire/ZnO:Ga p-n junctions. Then light emitting diodes (LEDs) based on n-ZnO nanorods combined with different technologies (hybrid technologies) are suggested and the recent electrical, as well as electro-optical, characteristics of these LEDs are shown and discussed. The hybrid LEDs reviewed and discussed here are mainly presented for two groups: those based on n-ZnO nanorods and p-type crystalline substrates, and those based on n-ZnO nanorods and p-type amorphous substrates. Promising electroluminescence characteristics aimed at the development of white LEDs are demonstrated. Although some of the presented LEDs show visible emission for applied biases in excess of 10 V, optimized structures are expected to provide the same emission at much lower voltage. Finally, lasing from ZnO nanorods is briefly reviewed. An example of a recent whispering gallery mode (WGM) lasing from ZnO is demonstrated as a way to enhance the stimulated emission from small size structures.

Spatial fluctuations of optical emission from single ZnO/MgZnO nanowire quantum wells

MgZnO/ZnO quantum wells on top of ZnO nanowires were grown by pulsed laser deposition. Ensembles of spatially fluctuating and narrow cathodoluminescence peaks with single widths down to 1 meV were found at the spectral position of the quantum well emission at 4 K. In addition, the number of these narrow QW peaks increases with increasing excitation power in micro-photoluminescence, thus pointing to quantum-dot-like emission centers. Indeed, laterally strained areas of about 5 nm diameter were identified at the quantum well positions on top of the nanowires by high-resolution transmission electron microscopy.

Comment ponctionner un rein pour réaliser une néphrolithotomie percutanée ?

Obtaining a precise percutaneous calyceal puncture gave way to the development of percutaneous nephrolithotomy, one of the first micro-invasive techniques described in urology. Both radiologist and urologist can perform puncture, sometimes in a collaborative effort. However, being followed by a true surgical procedure, it should be done in the O.R; perfect knowledge of the procedure is mandatory for every urologist. Standard guidance uses a fluoroscopic C-arm device, only able to guide the needle precisely towards the apex of the chosen calyx. Moving the C-arm with cephalad tilting will provide 3-D imaging. Ultrasound guidance is an alternative, but might be difficult with non dilated upper tract. CT guidance and retrograde puncture are rarely used. The access is to be adapted according to the patient (adult or child), type of stone (single or multiple access), or kidney position (eutopic or ectopic). Direct ad stable puncture entering the apex of the chosen calyx is a pre-requisite for easy and efficient subsequent nephrolithotomy.

In vitro effects of diacetoxyscirpenol (DAS) on human and rat granulo-monocytic progenitors

Diacetoxyscirpenol (DAS) is a trichothecene mycotoxin produced by various species of fungi. Trichothecenes are known as major contaminants of cereals and cereal-containing foods. DAS has been detected in agricultural products worldwide and persists in products after processing. In human as well as in animals, DAS consumption has been shown to induce haematological disorders (neutropenia, aplastic anemia). Granulo-monocytic progenitors (CFU-GM) from human umbilical cord blood and rat bone marrow have been cultured in the presence of DAS (from 10(-8) M to 5 x 10(-10) M) for 14 days. Study of concentration and effect relationships have shown a sharp effect of DAS on rat CFU-GM between 10(-7) M and 10(-8) M, while human CFU-GM are able to grow in the presence of 10(-8) M of the toxin. IC50 values on day 14 are respectively, 7.6 x 10(-9) M for human CFU-GM and 6.2 x 10(-9) M for rat CFU-GM.

Effects of graded amounts of duodenal infusions of methionine on the mammary uptake of major milk precursors in dairy cows

Arteriovenous differences in plasma and rate of blood flow were measured across the udder of four lactating dairy cows to examine the effects of increased supplies of a limiting AA on nutrient balance to the mammary gland. Treatment consisted of graded amounts of duodenal infusions of DL-Met (0, 8, 16, and 32 g/d) over 4-d periods according to a 4 x 4 Latin square design. Cows were fed a diet formulated to meet protein and energy requirements and based on 70:30 corn silage:concentrate ratio and dehydrated alfalfa (1.5 kg/d of DM). The basal diet met 70% of Met requirements. Yields of milk, fat, and protein and milk fat content were unaffected by infusions of Met, but milk protein content tended to increase by 5% to a maximum at the third treatment. Surprisingly, the rate of mammary blood flow declined in response to infusions of Met. The mammary uptake remained constant, nevertheless, for oxygen, energy-yielding nutrients, and nonessential AA. In contrast, the quantity of essential AA taken up by the udder decreased. As a result, milk protein yield seemed sustained by an increased efficiency of the mammary gland. In addition, in response to the Met infusions, the arterial supply of Met nearly increased 3-fold, and the mammary uptake of Met was similar across all treatments. The uptake of Met by the udder seems to be more related to the quantity of Met required for milk protein synthesis than to its concentration in the artery.

Effects of graded amounts of duodenal infusions of lysine on the mammary uptake of major milk precursors in dairy cows

Effects of providing a limiting AA on milk secretion and mammary nutrient uptake were investigated using four lactating dairy cows given duodenal infusions of graded amounts of L-Lys-HCl (0, 9, 27, and 63 g/d). Infusions were administered over 4-d periods according to a Latin square design. Diets consisted of a 70:30 corn silage:concentrate ratio supplemented with 1.5 kg of DM/d as dehydrated alfalfa. The basal diet met requirements for energy and protein and was deficient in Lys. Cows were fitted with indwelling catheters inserted into the left carotid and left subcutaneous abdominal veins, and a transit-time flow probe was implanted around the left external pudic artery. Milk, fat, and protein yields were unaffected by infusions of Lys. Milk protein content increased to a maximum with the third treatment, and fat content showed opposite variation. Although arterial concentrations and arteriovenous differences of Lys increased to a plateau with the third treatment, the relationship between arteriovenous differences and arterial concentrations was curvilinear. Infusions of Lys tended to increase the efficiency of N utilization and the mammary extraction rates of AA to synthesize more milk proteins. Initially, Lys was extracted in a direct ratio to its milk output and then taken up in excess by the secretory cells, suggesting that Lys was no longer a limiting factor in milk protein synthesis.

Effect of graded levels of duodenal infusions of casein on mammary uptake in lactating cows. 2. Individual amino acids

The experiment examined patterns of mammary uptake of individual AA when graded amounts of calcium caseinate (0, 177, 362, and 762 g/d) were infused duodenally into four lactating cows. Six blood samples were collected over 12 h from the subcutaneous abdominal vein and the carotid. Mammary blood flow was measured by an ultrasonic flow probe implanted around the external pudic artery. Infusions of casein linearly increased the arterial concentrations of all essential AA and several nonessential AA (Pro, Tyr, Orn, and Cit) and increased, or tended to increase, linearly the mammary arteriovenous differences of all AA except Glu and Ala. Absorption ability of the mammary gland was not reduced in vivo. Relationships between mammary arteriovenous differences and arterial concentrations were positive and linear in every cow for all AA except Asn, Ser, Gly, and Ala. Some essential AA (Lys, Arg, and branched-chain AA) were therefore taken up in excess of their output into milk proteins, but others (His, Thr, Met, and Phe) were almost exclusively extracted by the udder in a direct ratio to their output. As infusions of casein increase, Phe becomes probably the most critical AA for milk synthesis.

Effect of graded levels of duodenal infusions of casein on mammary uptake in lactating cows. 1. Major nutrients

Effects of duodenally infused casein on milk secretion were investigated by coupling measurements of mammary blood flow and arteriovenous differences. Four lactating cows were given a continuous duodenal infusion of 0, 177, 352, and 762 g of calcium caseinate/d according to a Latin square design. Diets, formulated to meet 90% of energy and protein recommendations, consisted of a ratio of corn silage:concentrate of 76:24 supplemented with dehydrated alfalfa. Yields of milk, protein, and fat increased linearly with casein infusions (by up to 2.6 kg/d, 126 g/d, and 133 g/d, respectively) as did milk protein content (by up to 2.2 g/kg). Mammary blood flow and insulin, prolactin, and growth hormone in plasma were not affected by added casein. Concentrations of arterial acetate, glucose, BHBA, and NEFA remained unchanged, but their uptake by the udder increased by 3, 18, 22, and 91%, respectively, between the control and high casein treatments. Plasma arterial concentrations and the mammary uptake of essential and nonessential AA increased linearly with casein infusions. Although arterial concentrations increased to a much greater degree for essential AA than for nonessential AA, the increased udder extraction was higher for nonessential AA. The main part of the added AA (90%) was extracted by the udder. However, a direct transfer of supplementary-extracted AA into milk did not occur, thus increasing AA availability for other metabolic pathways.

[Systematic hip roentgenograms in infants of 4 months of age in the screening for congenital dislocation of the hip (author's transl)]

The authors report the results of a statistical study undertaken for the screening of congenital dislocation of the hip. 961 children born between September 24, 1977 and June 30, 1978 were examined. Congenital dislocation of the hip was diagnosed in 9 (0.9 % of the cases). Out of these, 4 had no clinical sign of dislocatability at birth. The only determination of acetabular angles cannot be relied upon and qualitative criteria such as ilium thickness must be added.

Celiac artery aneurysm

Aneurysms of the celiac axis are rare, since only 50 cases were reported in 1976, 14 of which were operated on successfully. We report here the 15th case. This celiac aneurysm involved the origin of the splenic left gastric and common hepatic arteries. After controlling the aorta by a thoraco-phrenolaparotomy, the celiac artery was ligated at its origin, the anterior wall of the aneurysm was incised and the splenic and the left gastric arteries ligated by an obliterative endoaneurysmorrhaphy. The hepatic vascularization was restored from the gastroduodenal artery with a restorative endoaneurysmorrhaphy. The control arteriogram showed a good arterial revascularization.

[Current indications for barium meal examinations of the small intestine in malabsorption syndromes in children (author's transl)]

The authors study the correlation between the degree of abnormality seen on radiological examination and the extent of atrophy of the villi in 29 children suspected to have had malabsorption syndromes. The radiological signs are valid but at the present time-intestinal biopsy is the only certain diagnostic examination. Based on these observations, an attempt is made to define the indications for barium meal examination of the small intestine.

[The uterine contents (author's transl)]

The technique used for radiological examination of the uterine contents must be adapted to the reason for which it is being carried out. In particular, a study of bony maturation of the foetal knee may be carried out using a localised film, with compression and in lateral view, of the maternal abdomen. The technique of the large scoit film in ventral decubitus is reviewed; the study of the uterine contents, on lateral projection, which localisation and compression is described.

[Pelvimetry (author's transl)]

A simple and precise technique for pelvimetry, delivering only a low dose of irradiation, is described. It includes the usual lateral view, but for the AP uses that of Fernstroëm. The technique and results are described.