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Loo V.G.,McGill University | Bourgault A.-M.,University of Montréal | Bourgault A.-M.,Institute National Of Santepublique Du Quebec | Poirier L.,University of Montréal | And 14 more authors.
New England Journal of Medicine | Year: 2011

BACKGROUND: Clostridium difficile infection is the leading cause of health care-associated diarrhea, and the bacterium can also be carried asymptomatically. The objective of this study was to identify host and bacterial factors associated with health care-associated acquisition of C. difficile infection and colonization. METHODS: We conducted a 15-month prospective study in six Canadian hospitals in Quebec and Ontario. Demographic information, known risk factors, potential confounding factors, and weekly stool samples or rectal swabs were collected. Pulsed-field gel electrophoresis (PFGE) was performed on C. difficile isolates to determine the genotype. Levels of serum antibodies against C. difficile toxins A and B were measured. RESULTS: A total of 4143 patients were included in the study; 117 (2.8%) and 123 (3.0%) had health care-associated C. difficile infection and colonization, respectively. Older age and use of antibiotics and proton-pump inhibitors were significantly associated with health care-associated C. difficile infection. Hospitalization in the previous 2 months; use of chemotherapy, proton-pump inhibitors, and H 2 blockers; and antibodies against toxin B were associated with health care-associated C. difficile colonization. Among patients with health care-associated C. difficile infection and those with colonization, 62.7% and 36.1%, respectively, had the North American PFGE type 1 (NAP1) strain. CONCLUSIONS:In this study, health care-associated C. difficile infection and colonization were differentially associated with defined host and pathogen variables. The NAP1 strain was predominant among patients with C. difficile infection, whereas asymptomatic patients were more likely to be colonized with other strains. (Funded by the Consortium de Recherche sur le Clostridium difficile.) Copyright © 2011 Massachusetts Medical Society.

Rousseau-Gagnon M.,CHU de Quebec Hotel Dieu de Quebec | Rousseau-Gagnon M.,Laval University | Agharazii M.,CHU de Quebec Hotel Dieu de Quebec | Agharazii M.,Laval University | And 4 more authors.
PLoS ONE | Year: 2015

Introduction: In cases of myeloma cast nephropathy in need of haemodialysis (HD), reduction of free light chains using HD with High-Cut-Off filters (HCO-HD), in combination with chemotherapy, may be associated with better renal recovery. The aim of the present study is to evaluate the effectiveness of haemodiafiltration (HDF) in reducing free light chain levels using aless expensive heat sterilized high-flux polyphenylene HF dialyzer (HF-HDF). Methods: In a single-centre prospective cohort study, 327 dialysis sessions were performed using a 2.2 m2 heat sterilized high-flux polyphenylene HF dialyzer (Phylther HF22SD), a small (1.1m2) or large (2.1 m2) high-cut-off (HCO) dialyzer (HCOS and HCOL) in a cohort of 16 patients presenting with dialysis-dependent acute cast nephropathy and elevated free lightchains (10 kappa, 6 lambda). The outcomes of the study were the mean reduction ratio (RR) of kappa and lambda, the proportion of treatments with an RR of at least 0.65, albuminloss and the description of patient outcomes. Statistical analysis was performed using linear and logistic regression through generalized estimating equation analysis so as to take intoaccount repeated observation within subjects and adjust for session duration. Results: There were no significant differences in the estimated marginal mean of kappa RR, which were respectively 0.67, 0.69 and 0.70 with HCOL-HD, HCOS-HDF and HF-HDF (P = 0.950). The estimated marginal mean of the proportions of treatments with a kappa RR ≥0.65 were 68%, 63% and 71% with HCOL-HD, HCOS-HDF and HF-HDF, respectively (P = 0.913). Theestimated marginal mean of lambda RR were higher with HCOL-HDF (0.78), compared to HCOL-HD and HF-HDF (0.62, and 0.61 respectively). The estimated marginal mean proportion of treatments with a lambda RR ≥0.65 were higher with HCOL-HDF (81%), comparedto 57% in HF-HDF (P = 0.042). The median albumin loss were 7, 21 and 63 g/session with HF-HDF, HCOL-HD and HCOL-HDF respectively (P = 0.044). Among survivors, 9 out of 10episodes of acute kidney injuries became dialysis-independent following a median time of renal replacement therapy of 40 days (range 7-181). Conclusion: Therefore, in patients with acute dialysis-dependent myeloma cast nephropathy, in additionto chemotherapy, HDF with a heat sterilized high-flux polyphenylene HF dialyzer could offer an alternative to HCO dialysis for extracorporeal kappa reduction with lower albumin loss. © 2015 Rousseau-Gagnon et al.This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PubMed | CHU de Quebec Hotel Dieu de Quebec
Type: Journal Article | Journal: Medical physics | Year: 2016

Artifacts can reduce the quality of dose re-calculations on CBCT scans during a treatment. The aim of this project is to correct the CBCT images in order to allow for more accurate and exact dose calculations in the case of a translation of the tumor in prostate cancer.Our approach is to develop strategies based on deformable image registration algorithms using the elastix software (Klein et al., 2010) to register the treatment planning CT on a daily CBCT scan taken during treatment. Sets of images are provided by a 3D deformable phantom and comprise two CT and two CBCT scans: one of both with the reference anatomy and the others with known deformations (i.e. translations of the prostate). The reference CT is registered onto the deformed CBCT and the deformed CT serves as the control for dose calculation accuracy. The planned treatment used for the evaluation of dose calculation is a 2-Gy fraction prescribed at the location of the reference prostate and assigned to 7 rectangular fields.For a realistic 0.5-cm translation of the prostate, the relative dose discrepancy between the CBCT and the CT control scan at the prostates centroid is 8.9 0.8 % while dose discrepancy between the registered CT and the control scan lessens to -2.4 0.8 %. For a 2-cm translation, clinical indices like the V90 and the D100 are more accurate by 0.7 0.3 % and 8.0 0.5 cGy respectively when using registered CT than when using CBCT for dose calculation.The results show that this strategy gives doses in agreement within a few percents with those from calculations on actual CT scans. In the future, various deformations of the phantom anatomy will allow a thorough characterization of the registration strategies needed for more complex anatomies.

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