Factors influencing emergency delays in acute stroke management.

Early admission to hospital with minimum delay is a prerequisite for successful management of acute stroke. We sought to determine our local pre- and in-hospital factors influencing this delay. Time from onset of symptoms to admission (admission time) was prospectively documented during a 6-month period (December 2004 to May 2005) in patients consecutively admitted for an acute focal neurological deficit presented at arrival and of presumed vascular origin. Mode of transportation, patient's knowledge and correct recognition of stroke symptoms were assessed. Physicians contacted by the patients or their relatives were interviewed. The influence of referral patterns on in-hospital delays was further evaluated. Overall, 331 patients were included, 249 had an ischaemic and 37 a haemorrhagic stroke. Forty-five patients had a TIA with neurological symptoms subsiding within the first hours after admission. Median admission time was 3 hours 20 minutes. Transportation by ambulance significantly shortened admission delays in comparison with the patient's own means (HR 2.4, 95% CI 1.6-3.7). The only other factor associated with reduced delays was awareness of stroke (HR 1.9, 95% CI 1.3-2.9). Early in-hospital delays, specifically time to request CT-scan and time to call the neurologist, were shorter when the patient was referred by his family or to a lesser extent by an emergency physician than by the family physician (p < 0.04 and p < 0.01, respectively) and were shorter when he was transported by ambulance than by his own means (p < 0.01). Transportation by ambulance and referral by the patient or family significantly improved admission delays and early in-hospital management. Correct recognition of stroke symptoms further contributed to significant shortening of admission time. Educational programmes should take these findings into account.

Microbial diagnosis of bloodstream infection: towards molecular diagnosis directly from blood.

When a bloodstream infection (BSI) is suspected, most of the laboratory results-biochemical and haematologic-are available within the first hours after hospital admission of the patient. This is not the case for diagnostic microbiology, which generally takes a longer time because blood culture, which is to date the reference standard for the documentation of the BSI microbial agents, relies on bacterial or fungal growth. The microbial diagnosis of BSI directly from blood has been proposed to speed the determination of the etiological agent but was limited by the very low number of circulating microbes during these paucibacterial infections. Thanks to recent advances in molecular biology, including the improvement of nucleic acid extraction and amplification, several PCR-based methods for the diagnosis of BSI directly from whole blood have emerged. In the present review, we discuss the advantages and limitations of these new molecular approaches, which at best complement the culture-based diagnosis of BSI.

L'Écho de Paris

1885/02/05 (Numéro 331).

Guiron le Courtois, translaté de latin en françois par Luce du Châtel du Gat.

Commencement : « O Dieu qui m'a donné povoir et engin... » — Fin : « ...et retourne au roy Melyadus pour compter partie de ses aventures. — Cy fine le premier livre Guyron le Courtoys. »

Biblia Ludovici XI regis Franciae.

Avec quelques prologues, arguments et « capitula ». Genesis, sans prologue (2), etc. — Reg. I-IV (82) ; Isaias (125v) ; Jeremias (140v) ; Jeremiae Lament. et Oratio (157v, 159v) ; Ezechiel (160) ; Daniel, I, 1-XIV, 41 (175v) ; XII Proph. min. (181) ; Job (193v), etc. — Ecclesiasticus (239v) ; Oratio Salomonis (252v) ; Paralip. I-II (253v) ; Oratio Manasse (273) ; Esdras I-II (273v) ; Esther (282) ; Tobias (286) ; Judith (289) ; Macchab. I-II (293v). — Evang. Matthaei (311v), Marci (321v), Lucae (328v-329, 338-343v, 336-337, 330), Johannis (331-335v, 344-346) ; Actus Apost. (347) ; VII Epist. canon. (358) ; Apocalypsis (364v) ; XIV Epist. Pauli (370v).

Breviarium Sancti Martialis Lemovicensis.

F. 3-98 Sanctoral (incompl.) : — s. Martial (15) ; — s. Yrieix (83). F. 1-3 et 99-151 Commun des saints. F. 151v Vig. des morts ; — s. Nicolas (office noté, incompl. de la fin). Vies de s. Afre (63), s. Yrieix (83), s. Julien (86) (M. G., SS. rer. merov., III, 45, 55-56. 583-584 ; I, 879-881).

Breviarium Senonense.

F. 1 Calendrier de Sens. F. 5v Ordo officii. F. 7 Psautier, litanies de Sens et « preces ». F. 35 Temporal. F. 171 Vig., jour et oct. de la dédicace. F. 173-268v Sanctoral ; — ste Colombe (219) ; — ss. Savinien et Potentien (239 et 256) ; — ss. Augustin et Félicité (265v). F. 268v Commun des saints. F. 282v « Pro fidelibus defunctis. » F. 286-341v Offices divers, avec additions du XIVe s. (298-341v) ; — Fête-Dieu (313) ; — s. Louis (328). F. 342v Hymne à la Vierge (XVIe s.). Cf. Chevalier, n° 1183.