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In hospitalized patients, staphylococcal blood infection is common and mortality is high. Rapid diagnosis using molecular assay aims to identify the presence of Staphylococcus aureus and its resistance to methicillin as soon as the blood culture is positive. We evaluate performance of GeneXpert MRSA/SA Blood Culture assay (Cepheid®) before and after interpretation of the positivity levels of the various probes estimated by the Cycle threshold (Ct), as well as its contribution to the characterization of coagulase-negative staphylococci blood cultures not offered by the supplier. The study involved 145 samples with gram-positive cocci bacteremias. Ct analysis of the different probes revealed a few positive results with very high Ct values distants from the mean. The reclassification of these results as negative improves the specificity of the probes (spa: 100% vs. 96,8% and mec 100% vs. 91,9%) without degrading the sensitivity (spa: 98,1% vs. 100% and mec 98,6% vs. 98,6%). Then, based on an algorithm integrating the amplification results of each target, we extrapolated the results to the coagulase-negative staphylococci. In the end, reclassifying probes with extreme Ct values as negative and using the algorithm for coagulase-negative staphylococci resulted in a 97,9% (142/145) agreement between the molecular assay conclusion and conventional culture.

"In current practice, what is the best test to detect the presence of blood in faeces? Testing for the presence of blood in faeces is still widely performed in France, although the uptake in the national colorectal cancer screening programme is less than desirable, as is use in routine practice to guide diagnosis when patients present with gastrointestinal or general symptoms. Guaiac-based tests (Hemoccult) are obsolete and have been replaced by faecal immunochemical tests (FITs), both quantitative (OC-Sensor), currently reserved for the screening programme, and qualitative, performed by all medical laboratories. However, qualitative FITs should be abandoned: their visual reading is subjective, their positivity rate is highly variable, around 50%, and their diagnostic sensitivity for colorectal cancer has not been well determined. In contrast, quantitative FITs are reliable and their performance has been well evaluated. Several neighbouring countries use these tests in general practice to assess the risk of colorectal cancer in symptomatic patients and to determine the indication for colonoscopy. In this context, the decision thresholds are very different from those of organised screening: a faecal haemoglobin concentration below 4-10 µg/g is associated with a very low risk of cancer, a concentration above 4-10 µg/g should be investigated by colonoscopy, and a concentration above 150 µg/g requires an urgent colonoscopy.""En pratique courante, quel est le meilleur test pour rechercher du sang dans les selles ? La recherche de sang dans les selles, malgré son caractère quelque peu désuet, est, à juste titre, encore très prescrite en France, insuffisamment dans le programme national de dépistage organisé du cancer colorectal et en pratique courante pour guider une conduite diagnostique en cas de symptômes digestifs ou généraux. Les tests au gaïac (Hemoccult), obsolètes, ont été remplacés par des tests immunochimiques, quantitatifs (OC-Sensor) réservés au programme de dépistage, et qualitatifs réalisés par tous les laboratoires de biologie médicale. Pourtant les tests qualitatifs sont obsolètes et devraient être abandonnés : leur lecture est subjective, leur taux de positivité très variable, proche de 50 %, et leur sensibilité diagnostique pour le cancer colorectal non évaluée. Au contraire, les tests quantitatifs sont fiables et leurs performances parfaitement évaluées. Plusieurs pays voisins utilisent ces tests en médecine générale pour évaluer le risque de cancer colorectal chez les patients symptomatiques et poser l’indication d’une coloscopie. Dans ce contexte, les seuils décisionnels sont très différents de ceux du dépistage organisé : un taux d’hémoglobine fécale inférieur à 4-10 µg/g de selles est associé à un risque infime de cancer, un taux supérieur à 4-10 µg/g doit être exploré par coloscopie, et un taux supérieur à 150 µg/g relève d’une coloscopie urgente."

Flow cytometry is the gold standard for the detection of paroxysmal nocturnal hemoglobinuria (PNH) clones. Several antibody panels have been used with varying sensitivities and specificities. The CD157 is one of the glycosylphosphatidylinositol-anchored molecules tested and widely used. The CD157 deficiency is rare. We report a case of an isolated CD157 deficiency discovered during the search for the PNH clone in a patient with a plastic anemia. The interpretation of the results in this case poses a problem of false positive. We discuss how to deal with these difficulties encountered by the biologist, detailing the various possible causes. This observation also underlines the importance of following international guidelines before making the diagnosis of the PNH clone which has significant implications.

The prediction model M6 classifies pregnancy of unknown location (PUL) into a low-risk or a high-risk group in developing ectopic pregnancy (EP). The aim of this study was to validate the two-step M6 model's ability to classify PUL in French women.All women with a diagnosis of PUL over a year were included in this single center retrospective study. Patients with a diagnosis of EP at the first consultation of with incomplete data were excluded. For each patient, the M6 model calculator was used to classified them into "high risk of EP" and "low risk of EP" group. The reference standard was the final diagnostic: failed PUL (FPUL), intrauterine pregnancy (IUP) of EP. The statistical measures of the test's performance were calculated.Over the period, 255 women's consulted for a PUL, 197 has been included in the study. Final diagnosis were: 94 FPUL (94/197; 47.7%), 74 IUP (74/197; 37.6%) et 29 EP (29/197; 14.7%). The first step of the M6 model classified 16 women in the FPUL group of which 15 (15/16; 93.7%) correctly. The second step of the M6 model classified 181 women: 90 (90/181; 49.7%) in the "high risk of EP" group of which 63 (63/90; 70%) were FPUL/IUP and 27 (27/90; 30%) were EP. 91 (91/181; 50.3%) was classified in the "low risk of EP" group of which 90 (90/91; 98.9%) were FPUL/IUP and 1 (1/91; 1.1%) were EP. EP were correctly classified with sensitivity of 96.4%, negative predictive value of 98.9%, specificity of 58.8% and positive predictive value of 30.0%.The prediction model of PUL M6 classified EP in "high risk of EP group" with a sensitivity of 96.4%. It classified 50.3% of PUL in a "low risk of EP" group with a negative predictive value of 98.9%.

In current practice, the use of circulating oncological biomarkers by clinicians is almost inseparable from cancer patients management. However, the interpretation of the results is not always easy because it is more specific to laboratory medicine and involves notions of peri-analytical orders as well as analytical sensitivity and specificity. In the past, the development of new analytical techniques improved the analytical sensitivity or allowed the implementation of new biomarkers; this observation would still be true today. Mass spectrometry, microRNA assay, or Single Molecule Array (SiMoA) are recent analytical developments with very good analytical performances that could contribute to the improvement of cancer patient management.Dans la pratique courante, le recours des cliniciens aux biomarqueurs circulants oncologiques est presque indissociable de la prise en charge des patients cancéreux. Cependant, l’interprétation des résultats n’est pas toujours aisée. Elle est, en effet, plus spécifique à la médecine de laboratoire faisant intervenir des notions d’ordres péri-analytiques ainsi que celles de sensibilité et spécificité analytiques. Comme il a été démontré par le passé, le développement de nouvelles techniques d’analyses a permis d’abaisser le seuil de sensibilité analytique, ou encore, l’implémentation de nouveaux biomarqueurs; cette observation se vérifierait encore aujourd’hui. La spectrométrie de masse, le dosage des microARN, ou encore le Single Molecule Array (SiMoA) sont des méthodes d’analyse récentes présentant de très bonnes performances analytiques qui pourraient contribuer à l’amélioration de la prise en charge des patients cancéreux.

High-sensitivity troponin has become an essential emergency biomarker for diagnosing or ruling out an ACS. The establishment of a point of care biology related to the reorganization and fusion of laboratories raise a question about transferability of results between techniques. In this study, we propose to compare the bioclinical performances of high-sensitivity troponin measured by two different techniques on laboratory immunoanalyzer (Siemens Advia Centaur XPT) and on point of care device (Mitsubishi Pathfast). The assay of high-sensitivity troponin (n = 90 patients), according to our study, show consistent clinical results with both method.

Ophthalmology care has been growing for several years. Since ophthalmic technicians have the opportunity to perform delegated procedures, it is important to evaluate their training.To evaluate the ability of 3rd year ophthalmic technician students and graduates to assess the normality of an ophthalmological examination and to determine a proposed time delay for seeing an ophthalmologist.One hundred records including ophthalmology examinations were shown to 8 ophthalmic technician students in their third year of study and to 3 graduated technicians. Three ophthalmologists determined the content of the files, the pathological nature or not of the case, as well as the proposed time for seeing an ophthalmologist. We calculated the sensitivity and specificity to recognize the normality of the case, as well as the concordance between the proposed time for seeing an ophthalmologist.For recognition of a normal case, the sensitivity was 80%, and the specificity was 83% in the group of technician students, and 81% versus 80% respectively in the group of graduated technicians. For the proposed time of consultation for seeing an ophthalmologist, the kappa agreement coefficient was 0.30 in the group of students and 0.41 in the group of graduates (low and moderate agreement respectively).The study showed a good ability of technicians to recognize the normality or not of clinical cases, but their ability to judge the appropriate timing of treatment by an ophthalmologist remains insufficient.

The objective of this study is to evaluate the diagnostic accuracy of high-sensitivity (hs) troponin I to predict cardiac origin after syncope. The secondary objective is to determine the causes of elevated troponin.Were included hospitalized patients with syncope/near syncope diagnosed in ED. The diagnostic accuracy to predict cardiac origin was evaluated and compared to the "high risk" group, defined by the 2018 European Society of Cardiology guidelines.A total of 163 patients were enrolled, 26% had a cardiac origin. Positive troponin I hs predict a cardiac origin with a sensitivity of 31%, a specificity of 80%, positive predictive value of 35% and negative value of 77%. These diagnostic performances are not discriminating and lower than the ESC classification. A positive troponine I hs level is associated with 5 times more cardiac failure during the hospitalization.A positive troponin I hs level after syncope/near syncope is not predictive of cardiac origin. It appears to be an early marker of ventricular remodeling in heart failure.

Acute mesenteric ischemia is a rare diagnosis with a very high mortality rate. It is often suspected in case of severe abdominal pain, disproportional to the findings of physical examination. The definite diagnosis is confirmed by CT-angiography and surgical exploration, but the measurement of blood L-lactate often takes place during the diagnostic work-up when this pathology is suspected. This review shows that there is no biological marker with sufficient sensitivity and specificity to confirm or rule out acute mesenteric ischemia. L-lactate measurement is easy to perform, but its diagnostic performance is insufficient to avoid a CT-angiography, whatever the pre-test clinical probability of acute mesenteric ischemia. These conclusions are supported by the current recommendations of the World Society of Emergency Surgery.L’ischémie mésentérique aiguë est un diagnostic rare au taux de mortalité très élevé. Elle est souvent suspectée en cas de douleurs abdominales sévères et disproportionnelles aux résultats de l’examen physique. Le diagnostic définitif s’obtient par angio-CT et exploration chirurgicale, mais le dosage du L-lactate intervient fréquemment lors de la stratégie diagnostique au moment de la suspicion clinique. Cet article met en évidence qu’il n’existe pas de marqueur biologique unique suffisamment sensible et spécifique pour confirmer ou exclure une ischémie mésentérique aiguë. Le dosage du L-lactate est rapide, mais sa performance diagnostique ne permet pas de surseoir à l’angio-CT, et ce quelle que soit la probabilité clinique prétest d’ischémie mésentérique. Ces conclusions sont soutenues par les recommandations des sociétés de chirurgie.

The diagnosis of heart failure can sometimes be challenging for the clinician because presentation circumstances and heart failure phenotypes are varied. The identification and validation of sensitive and specific biomarkers for this condition are still a subject of intensive research. Among them, natriuretic peptides (ANP, BNP, NTproBNP) are widely used and validated as markers of heart failure. Their appropriate use and correct interpretation, however, require knowledge of their indications, specificities and limitations. The European Society of Cardiology has recently issued recommendations in this regard. This article summarizes them in order to facilitate the understanding and the use of natriuretic peptides in clinical practice. It also discusses their use in the etiological diagnosis of pleural effusions caused by heart failure.Le diagnostic d’insuffisance cardiaque peut parfois mettre en difficulté le clinicien tant les circonstances de présentation et les phénotypes de cette pathologie sont variés. L’identification et la validation de biomarqueurs sensibles et spécifiques à cette condition particulière font toujours l’objet d’une recherche intensive. Parmi eux, les peptides natriurétiques (ANP, BNP, NTproBNP) sont largement utilisés et validés comme marqueurs de l’insuffisance cardiaque. Leur usage approprié et leur interprétation correcte requièrent, toutefois, la connaissance de leurs indications, spécificités et limitations. La Société Européenne de Cardiologie a récemment publié des recommandations à cet égard. Cet article propose d’en résumer les lignes principales afin de faciliter l’utilisation des peptides natriurétiques en pratique clinique. Il aborde, aussi, leur utilisation dans le diagnostic étiologique des épanchements pleuraux.

The Covid-19 pandemic imposes new diagnostic strategies in order to optimize the medical care of our patients. The current biblio-graphy, although of low quality, shows a sensitivity of 56 to 83 % for the Covid-19 PCR. Even though one negative test can exclude a Covid-19 in the majority of cases, the NPV (Negative Predictive Value) decreases with increasing prevalence (pre-test probability). This finding suggests the need for strict auto-isolation of patients until the resolution of their symptoms. For patients that present with typical symptoms, who have a presumed Covid-19 prevalence of -40-50 %, a negative test should be interpreted with caution and a repeat test may be needed.La pandémie actuelle du Covid-19 impose une stratégie diagnostique pour la prise en charge des patients. La performance du frottis nasopharyngé avec analyse par PCR peut être estimée sur la base des premières données bibliographiques. Celles-ci, certes de qualité faible, montrent une sensibilité de 56 à 83 % pour la PCR Covid-19. Un seul test négatif permet d’infirmer un Covid-19 dans la majorité des situations. Cependant, comme la valeur ­prédictive négative du test se situe entre 88 et 95 % en cas de ­probabilité prétest de 30 %, il est indispensable d’assurer le suivi de ces patients. Pour ceux qui présentent des symptômes typiques, qui auraient une probabilité prétest présumée à 40-50 %, un test négatif doit être interprété avec précaution et un deuxième test peut être indiqué.

The Covid-19 pandemic imposes new diagnostic strategies in order to optimize the medical care of our patients. The current biblio-graphy, although of low quality, shows a sensitivity of 56 to 83 % for the Covid-19 PCR. Even though one negative test can exclude a Covid-19 in the majority of cases, the NPV (Negative Predictive Value) decreases with increasing prevalence (pre-test probability). This finding suggests the need for strict auto-isolation of patients until the resolution of their symptoms. For patients that present with typical symptoms, who have a presumed Covid-19 prevalence of -40-50 %, a negative test should be interpreted with caution and a repeat test may be needed.

International audience; Molecular biology or immunochromatographic tests are conventionally offered as aids in the routine diagnosis of malaria. However, the interpretation of their results requires a precise knowledge of their limits, both by the biologist and the physician. It is in particular conditioned by thorough interview of the patient in order to seek a history of recent or even older malaria disease. We discuss herein the different usages and how to interpret such diagnostics, through a concrete example of a malaria case which was particularly tough to investigate.; Des tests de biologie moléculaire ou de détection d’antigènes par immunochromatographie (tests de diagnostic rapide ou TDR) sont classiquement proposés comme aides au diagnostic du paludisme en routine. Cependant, l’interprétation de leurs résultats nécessite une connaissance précise de leurs limites, aussi bien par le biologiste que par le clinicien. Elle est en particulier conditionnée par un interrogatoire méticuleux du patient afin de ne pas méconnaître un antécédent d’accès palustre récent ou même plus ancien. Nous discutons ici des différents usages et de l’interprétation de ces outils diagnostiques, en prenant exemple d’un cas de paludisme particulièrement difficile à investiguer.

Serum proteins and urinary proteins electrophoresis are useful biological tests. They are often prescribed for the screening of monoclonal gammopathys and also during follow-up for treatment response. This test can be accredited according to standard NF ISO 15189 since laboratories use analysers and adapted reagents, but there are numerous protocols for the method validation. This paper present the results of a survey proposed in 2019 to biologists by CNBH and SFBC. The aim of this survey is to give biologists a choice among several protocols that have been positively evaluated by COFRAC.

Rapid and accurate identification of pathogens involved in urinary tract infections helps to guide antimicrobial therapy. Chromogenic agars provide presumptive identification directly from primary isolation media. They have been intended to make the bacterial isolation and identification process easier and faster. Our study aimed to compare the performance and the cost of the CPS ID3® and the Uriselect4® chromogenic agars with the conventional method for the isolation and identification of urinary tract infections bacteria. We included 301 urinary samples in a prospective study conducted in May 2018 in the clinical laboratory of the National institute of nutrition and food technology of Tunis. Isolates from routine media were identified using API® system while isolates from chromogenic media were directly identified by colony color with reference to the manufacturer's recommendations. Chromogenic media yielded more pure positive cultures and allowed better isolation of Escherichia coli, Klebsiella pneumoniae, Citrobacter koseri, Morganella morganii and Streptococcus agalactiae. Sensitivity and specificity of the presumptive identification of most commonly isolated uropathogens were higher with the Uriselect4® medium than with the CPS ID3® medium. Chromogenic media yielded the identification of pathogenic organisms 24 hours sooner than the conventional method in approximately 63 % of cases with the CPS ID3® medium and in 77.7% of cases with the Uriselect4® medium. Chromogenic media allowed a much better isolation of bacteria commonly involved in urinary tract infections with a quick, easy and accurate presumptive identification especially with the Uriselect4® medium.

International audience; Tuberculosis is caused by the M. tuberculosis complex. Its slow growth delays the bacteriological diagnosis based on phenotypic tests. Molecular biology has significantly reduced this delay, notably thanks to the deployment of the Xpert® MTB/RIF test (Cepheid), which detects the M. tuberculosis complex and rifampicin resistance in 2hours. Other tests detecting isoniazid and second-line antituberculous drugs resistance have been developed. However, the performances of molecular tests are significantly reduced if the acid-fast bacilli microscopy screening is negative. It is therefore crucial to limit their indication to strong clinical suspicions. Resistance detection tests only explore certain characterized positions; however, not all drug-resistance mutations are known. Moreover, the performances vary for different antituberculous drugs. The advent of genomic sequencing is promising. Its integration into routine workflow still needs to be evaluated and the data analysis remains to be standardized. The rise of molecular biology techniques has revolutionized the diagnosis of tuberculosis and drug resistance. However, they remain screening tests; results still have to be confirmed by phenotypic reference methods.; La tuberculose est due au complexe M. tuberculosis, dont la croissance lente entraîne un long délai de rendu des tests phénotypiques utilisés pour le diagnostic bactériologique. La biologie moléculaire a réduit considérablement ce délai, notamment grâce au déploiement de la méthode Xpert® MTB/RIF (Cepheid) qui permet de détecter le complexe M. tuberculosis et la résistance à la rifampicine en 2 heures. D’autres tests détectant en plus la résistance à l’isoniazide et aux antituberculeux de seconde ligne ont été développés. Cependant, les performances de ces tests sont nettement moins bonnes si l’examen microscopique est négatif. Il est donc crucial de restreindre leur indication aux fortes suspicions cliniques. Les tests de détection de la résistance n’explorent que certaines positions caractérisées ; or, toutes les mutations responsables de l’acquisition de résistance ne sont pas connues. De plus, les performances sont variables pour les différents antituberculeux. L’avènement du séquençage génomique est une perspective prometteuse. La faisabilité en routine doit encore être évaluée et l’analyse des données reste à standardiser. L’essor des techniques de biologie moléculaire a révolutionné le diagnostic de la tuberculose et de la résistance. Cependant, elles restent des tests de dépistage dont les résultats doivent être confrontés aux méthodes phénotypiques de référence.

In 2020, accreditation of molecular tests according to ISO 15189 is a requirement for all French medical laboratories. For many years, the GBMHM group (French Group of Molecular Biologists in Hematology) supports this approach through organization of external quality evaluation campaigns, and by publishing recommendations that have allowed the accreditation of the most frequent molecular tests for most laboratories. However, some molecular abnormalities concerns very few patients (and sometimes a single patient), and therefore cannot be evaluated in the same way, because of the lack of external quality controls or inter-laboratory comparisons. In order to allow the accreditation of these rare analyzes, the GBMHM proposes recommendations, based on the fact that analyzes using the same methodology than those already accredited by an extensive validation process, may be accredited without the need for full analytical validation. In particular, assays based on quantitative PCR or endpoint PCR may be accredited after verification of primer specificity, repeatability and/or reproducibility, and the determination of detection or linearity limits. These recommendations, by defining the validation approach for rare molecular abnormalities, make it possible to extend the requirement of accreditation for rare tests, to provide the best patient care.

Lung cancer remains the most common cause of cancer deaths in the world, but its mortality can be significantly reduced by diagnosis and early detection. Computerized resources were developed to assist radiologists in their management of the large volume of thoracic images to be analyzed. Their objective is the detection of pulmonary nodules with high sensitivity and a low rate of false-positives and the ability to differentiate benign and malignant nodules. The volume of a pulmonary nodule and its volume doubling time are essential to nodule management. Computer aided detection or diagnosis (CAD) software are not currently used in clinically settings on a routine basis . Significant advances are expected due to the implementation of the artificial intelligence systems who will probably be integrated into the multidisciplinary management of any pulmonary nodule.Le cancer du poumon reste la principale cause de décès par cancer dans le monde. Sa mortalité peut être significativement réduite par un diagnostic et un dépistage précoce. Des outils informatiques ont été développés afin d’aider les radiologues à gérer la quantité d’images thoraciques à analyser. Ils ont pour objectif la détection des nodules pulmonaires avec une haute sensibilité et un taux faible de faux positifs, mais aussi la différenciation des nodules bénins et malins. Le volume d’un nodule pulmonaire et le temps de doublement déterminent la suite de la prise en charge de ce nodule. Ces deux paramètres sont inclus dans la plupart des recommandations actuelles. Les logiciels de détection assistés par ordinateur (CAD) ne sont pas utilisés en routine clinique actuellement. Des avancées dans ce domaine sont attendues en utilisant l’intelligence artificielle, notamment dans le cadre de la prise de décision multidisciplinaire.

Screening for latent tuberculosis infection (LTI) is recommended in immunosuppressed patients due to an increased risk of progression from LTI to active tuberculosis. Screening involves indirect immunological tests such as the tuberculin skin test (TST) and the interferon-y release assays (IGRAs). IGRAs seem to show superior performance compared to TST in screening for LTI. However, their use and interpretation in immunosuppressed patients is questionable, particularly because of an increased number of false negative or indeterminate results and a low agreement between tests. Presently, there are no swiss national recommendations for their use in immunosuppressed -patients, except for candidates to anti-TNF treatment.Le dépistage d’une infection tuberculeuse latente (ITL) est ­recommandé chez les patients immunosupprimés en raison du risque accru de la progression de l’ITL vers la tuberculose active. Son dépistage se fait notamment à l’aide de tests immunologiques indirects que sont le test de sensibilité à la tuberculine (TST) et les tests de détection de production de l’interféron-gamma (IGRA). Les IGRA semblent montrer une performance ­supérieure par rapport au TST dans le dépistage d’une ITL. Mais leur utilisation et leur interprétation chez les immunosupprimés sont sujettes à caution notamment à cause d’un nombre accru de résultats faussement négatifs ou indéterminés et d’une mauvaise concordance entre tests. À l’heure actuelle, il n’existe pas de ­recommandations nationales suisses sur leur utilisation chez les immunosupprimés mis à part pour les candidats au traitement anti-TNF (

Nowadays, diagnostic biomarker research is oriented on a genomic characterisation of prostate cancer (PCa). This study evaluated diagnostic values of TMPRSS2-Erg fusion transcripts expression (TE) and androgen receptor variant 7 (AR-V7) on urine (tU) and biopsic rince material (tLRB) samples.TE and AR-V7 have been tested by RT-PCR and RT-qPCR on urine and biopsies' rince liquid on 372 patients referred for prostate biopsies.Two hundred thirty-three patients (62%) were diagnosed with PCa. tU.AR-V7 was positive for 15 healthy patients (28%) and 30 patients diagnosed with PCa (37%). tLRB.AR-V7 was positive for 66 patients (42%) diagnosed with PCa. Concerning TE for patients diagnosed with PCa, tU was positive for 59 patients (54%) and tLRB for 132 (55%). TE and TE/AR-V7 combination were significantly associated with PCa (P0.001), as tLRB.AR-V7 (P0.001). Sensitivity and specificity for TE/AR-V7 combination for PCa were respectively: tU.TE/AR-V7 67% and 70%, tLRB.TE/AR-V7 68.8% and 71%, and, tUtLRB.TE/AR-V7 83% and 60%. There was no benefit for AR-V7 and TE association versus TE alone when comparing AUC.AR-V7 is not specific of PCa because of detection on healthy patients. This study did not managed to show a sufficient diagnostic value for TE/AR-V7 combination on urine and biospic rince material tests.3.

Introduction Il y a plus de 2 millions de cas de fistule génitale en Afrique subsaharienne et en Asie. Elles surviennent dans les zones où l'accès aux soins à l'accouchement est limité ou de qualité médiocre et où peu d'hôpitaux offrent les interventions chirurgicales correctives nécessaires. L'objectif de cette étude est de développer un score prédictif permettant d'identifier les facteurs influant sur l'échec de la réparation chirurgicale de la fistule obstétricale vésico-vaginale (ERCF) dans la partie Sud-Est de la province du Haut-Katanga. Méthodes Il s'agit d'une étude transversale analytique menée sur 384 femmes porteuses d'une fistule obstétricale vésico-vaginale ayant bénéficié d'une prise en charge chirurgicale. Nous avons procédé par une analyse univariée puis multivariée. La discrimination du score était évaluée à l'aide de la courbe Receiving Operating Characteristics (ROC) et du C-index et la calibration du score selon le test d'Hosmer-Lemeshow. Résultats La réparation chirurgicale de la fistule obstétricale vésico-vaginale s'était soldée par un échec dans 17,19% des cas (66/384). Après modélisation logistique, quatre critères ressortent comme facteurs prédictifs d'ERCF: la présence d'une fibrose cicatricielle (ORa=15,22; IC95%: 7,34-31,58), la présence de 2 fistules ou plus (ORa=7,41; IC95%: 3,05-17,97), l'abord trans-vésical comme voie d'abord (ORa=4,26; IC95%: 1,92-9,44) et l'atteinte urétrale (ORa=3,93; IC95%: 1,99-7,77). L'aire sous la courbe ROC du score est de 0,8759 avec une sensibilité de 57,58%, une spécificité de 91,82% et une valeur prédictive positive de 91,25%.

The demographic evolution of our society has increased the need to assess the cognitive functions of people aged over 80. These assessments are made difficult due to the specificities of this population. It is possible to clarify the issues relating to the neuropsychological assessment in geriatrics and to put forward areas for discussion.

International audience; The demographic evolution of our society has increased the need to assess the cognitive functions of people aged over 80. These assessments are made difficult due to the specificities of this population. It is possible to clarify the issues relating to the neuropsychological assessment in geriatrics and to put forward areas for discussion.; L’évolution démographique de nos sociétés a augmenté la nécessité d’évaluer les fonctions cognitives des personnes âgées de plus de 80 ans. Ces évaluations sont rendues difficiles par les spécificités de cette population. Il est possible d’expliciter les problématiques relatives à l’évaluation neuropsychologique en gériatrie et de proposer des pistes de réflexion.

Non-invasive multimodal imaging, including optical coherence tomography angiography (OCTA), has demonstrated high sensitivity and specificity for the management of retinal diseases. Since the availability of OCTA in 2015, we have developed a policy of "as little fluorescein angiography as possible". In this study, we describe the rate of OCTA and fluorescein angiography (FA) performed and their indications.Retrospective descriptive single-centre study. Chart review of patients examined for retinal disorders by one medical retina specialist between January 2015 and June 2018.3487 patients were examined for a retinal disease. The charts of 651 of these patients (1170 eyes) were randomly selected for analysis (study group). The mean age in the study group was 72 years (60% female). Overall, OCTA and FA were performed in 49.4% and 6.5% of the studied eyes respectively. After the first year, the rate of FA decreased to 2%. The main indications for OCTA were age-related macular degeneration (AMD): 50%, central serous chorioretinopathy (CSC): 12% and retinal vascular occlusion: 10%. The most frequent indications for FA were AMD: 49%, diabetic retinopathy (DR): 18% and CSC: 14%. FA was performed in 16%, 11% and 10% of eyes diagnosed with DR, CSC and AMD respectively (P0.05).In routine practice, OCTA was performed in half of the eyes examined for a retinal disorder. The overall rate of FA was 6.5% and dropped to 2% after the first year of OCTA use. DR was the main disorder still requiring FA.

The objective of this study was to compare in general practice, patients aged 65 years and over: the MMSE, screening tools for cognitive disorder recommended by the HAS and the Codex.53 patients were included between June and October 2017 at La Charmille general practice in Limpiville in rural areas during an observational study. Patients over 65 years of age were included following a consultation with their general practitioner. The MMSE and the Codex were compared on their results, intrinsic variables, the time of handover. Geriatric comorbidity factors are compared between groups of patients "with" and "without" cognitive disorders detected.Of the 53 patients, 94% CI 95% [4.10; 20.25] had cognitive impairment, at an average age of 74.15 years. The predominance is female with 30 patients (57%). The passage time of the Codex is on average 1min 43s, significantly faster (p = 4,29*10Codex appears to be a rapid, reliable, reproducible cognitive impairment screening tool adapted to the general practice consultation format. An important axis to work, awareness, education of doctors at the university and continuing education on the screening and management of dementia syndromes and fragility.

Introduction: Non-invasive diagnosis of pulmonary hypertension (PH) relies on estimation of pulmonary arterial pressure (PAP) via Doppler echocardiographic measurement of tricuspid regurgitation pressure gradient (TRPG). The pulmonary vein-to-right pulmonary artery ratio (PV/PA) recently has been described for the detection of pulmonary venous congestion. Whether this variable could be used to detect the presence of precapillary PH is unknown. The objective of the present study was to investigate the diagnostic value of PV/PA for prediction of TRPG, as a surrogate of PAP, in dogs with PH of precapillary origin. Animals: Sixty-seven client-owned dogs were included in the study. Methods: This was a retrospective study. Dogs with a measurable TRPG were included and classified into group 1 (TRPG < 30 mmHg), group 2 (TRPG 30–49 mmHg), group 3 (TRPG 50–80 mmHg), or group 4 (TRPG > 80 mmHg). The PV/PA, acceleration time-to-ejection time ratio of pulmonary artery flow, main pulmonary artery diameter-to-aortic diameter ratio, and right pulmonary artery distensibility index were measured retrospectively from cineloops in each dog. Results: The PV/PA measured by both two-dimensional (2D) and time-motion mode(MM) echocardiography decreased proportionally with PH severity. Using regression analysis, PV/PA (2D) was identified as the strongest predictor for TRPG (R2 = 0.70, p < 0.0001) among other variables studied, with a good diagnostic accuracy (area under the curve = 0.94) for moderate PH (TRPG > 50 mmHg) using a cutoff value of < 0.70 (sensitivity = 96%, specificity = 82%). Conclusions: Results of the present study suggest that PV/PA can be useful as an additional, non-invasive, and indirect variable to identify precapillary PH in dogs., SCOPUS: ar.j, info:eu-repo/semantics/published

Infliximab (IFX) is a chimeric monoclonal antibody which has proven its efficacy in the treatment of inflammatory diseases. However, its efficacy can be limited by the development of anti-IFX antibodies (ATI) resulting in a therapeutic failure of IFX. ATI plasmatic monitoring is then indicated to optimize IFX treatment. The aim of this study was to validate an ELISA (enzyme linked immuno sorbent assay) method of ATI plasmatic monitoring. Methods Assessment of performance was based on the study of correlation and concordance (Bland Altman method) of the absorbances measured by the two readers. ELISA kit validation was made by calculating the accuracy and the exactitude. Results We collected 23 samples. Their mean age was 46 years and sex ratio M/W was 0.92. In nine cases, plasmatic AIT were positive and in 14 cases, they were not detected. Correlation between the two readers showed a correlation coefficient r2 of 99.95%. Concordance limits of the confidence interval 95% were [-112.768%-41.425%] with a bias of -35.671%. Repeatability and reproductibility were checked by a positive control and coefficients of variation were respectively of 5.574% and 14.184%. Limits of detection and quantification were respectively of 0.046 and 0.086. The positive predictive value was 0.5 and the negative predictive value was 1. The sensitivity was 100% and the specificity was 83%. Conclusion The assessment of the performance of the tested microplate reader and the validation of the tested ELISA kit showed good results allowing ATI routine measurement to optimize therapeutic management of patients treated by IFX.

The clinical and physiopathological clinical entity known as spastic angina or variant angina has been long documented. It remains, however, an under-estimated condition, which is insufficiently diagnosed and explored. This pathology is associated with severe complications such as heart rhythm disorders, which may potentially result in ventricular fibrillation and cause sudden death. In Japan, this condition occurs more frequently and is better documented. Stimulation tests are also carried out more often and have a higher positivity rate than in France where vasospastic angina is less frequently reported and where provocation tests are associated with negative results and are, consequently, performed less often. In order to improve the detection of this pathology, its potential presence should be explored in patients with rest angina who experience chest pain in the second half of the night and also in instances of acute coronary syndrome with sudden death and no angiographically visible coronary artery disease. The diagnosis should be confirmed by means of ergonovine provocation tests. In order to enhance the sensitivity of these tests without increasing the risk of complications, injection of ergonovine should be preferably carried out via the intracoronary route. By increasing the frequency and sensitivity of these tests, this pathology, which responds well to medical treatment in many cases, could be amenable to therapeutic management as any other form of coronary artery disease.

To determine the usefulness of the frozen section exams of lymph nodes dissection, ureteral and urethral section during radical cystectomy for urothelial carcinoma and define the impact on the surgical procedure.A retrospective, single-center study of data collected from 182 patients who underwent radical cystectomy for an cT=3bN0M0 urothelial bladder cancer between 2016 and 2018. Bladder cancer extension was determined by thoracoabdominal CT with contrast enhancement and urography and an 18-FDG PET scanner. No patient received neoadjuvant chemotherapy. The diagnostic performance of the frozen section exams was related to final examinations. The impact of the result on the initial intervention was determined.The frozen section were positive in 29 lymph nodes dissections (15.9 %), 59 (16.6 %) ureteral and 20 (10.9 %) ureteral recessions. With lymph nodes exams, sensitivity, specificity and positive and negative predictive values were 93.5 %, 100 %, 100 %, and 98.7 %, respectively. With ureteral sections exams the same values were 91.5 %, 100 %, 100 %, and 98.4 % respectively. With urethral section exams, all the values were of 100 %. Finally, all the procedure has been modified for all patients with positive frozen section exam except one positive urethral section that did not give rise to radical urethrectomy.Frozen section exams were useful to the urologist during radical cystectomy for urothelial carcinoma. The performances of the frozen section exams carried out were excellent. The information of the urologist of the positive frozen section leeds to modify its management during the intervention in all the studied cases with the exception of one case.

The impact of curative radiotherapy depends mainly on the total dose delivered homogenously in the target volume. Tumor sensitivity to radiotherapy may be particularly inconstant depending on location, histology, somatic genetic parameters and the capacity of the immune system to infiltrate the tumor. In addition, the dose delivered to the surrounding healthy tissues may reduce the therapeutic ratio of many radiation treatments. In a same population treated in one center with the same technique, it appears that individual radiosensitivity clearly exists, namely in terms of late side effects that are in principle non-reversible. This review details the different radiobiological approaches that have been developed to better predict the tumor response but also the radiation-induced late effects.

Estimating alcohol consumption using biomarkers raises interpretation problems. The biomarkers currently used in clinical settings have limited performances to identify unhealthy alcohol use (e.g. CDT, AST, ALT). New direct biomarkers, ethylglucuronide (EtG) and phosphatydilethanol (PEth) are available and offer better sensitivity and specificity compared to indirect biomarkers. In forensic medicine, EtG and PEth are replacing indirect biomarkers. However, in clinical routine practice these markers are usually not considered. Still, for specific purposes such in pre-liver transplant evaluations, direct markers may help specialists in the decision process.Estimer la consommation d’alcool en se basant sur des tests biologiques pose des problèmes d’interprétation. Les marqueurs actuellement utilisés en clinique (CDT et transaminases) présentent des performances limitées pour l’identification du mésusage d’alcool. Des nouveaux marqueurs directs, l’éthylglucuronide (EtG) et le phosphatidyléthanol (PEth), sont à disposition et offrent de meilleures performances en termes de sensibilité et spécificité que les marqueurs indirects. Ils sont principalement utilisés dans le cadre de suivis médico-légaux et remplacent les marqueurs indirects. En pratique clinique, l’EtG et le PEth ne sont que peu utilisés. On voit apparaître l’utilisation de ces tests dans le cadre d’évaluations spécifiques, par exemple avant transplantation hépatique.