No abstract

In March 2020, COVID-19 caused an overwhelming pandemic. To relieve overloaded Intensive Care Units in the most affected regions, French Ministry of Defence triggered collective Air Medical Evacuations (MEDEVAC) on-board of an Airbus A330 Multi Role Tanker Transport of the French Air Force. Such collective air MEDEVAC is a big challenge regarding biosafety, as until now, only evacuations of a single symptomatic patient with an emergent communicable disease, like Ebola virus disease, have been conducted. However, the COVID-19 pandemic required collective MEDEVAC for critically ill patients and involved a virus still little known. Thus, we performed a complete risk analysis using a process map and an FMECA (Failure Modes, Effects and Criticality Analysis) to assess the risk and implement mitigation measures for health workers, flight crew as well as for the environment. We reported the biosafety management experienced during six flights with a total of 36 critically ill COVID-19 positive patients transferred with no casualties whilst preserving both staffs and aircraft.

Because of logistics and cost constraints, monitoring of the compliance to antimalarial chemoprophylaxis by the quantitation of drugs in biological samples is not a simple operation on the field. Indeed, analytical devices are fragile to transport and must be used in a perfectly controlled environment. This is also the case for reagents and supplies, and the waste management is constraining. Thus, samples should be repatriated. They should be frozen after collection and transported with no rupture in the cold chain. This is crucial to generate available and interpretable data but often without any difficulties. Hence, to propose an alternative solution easier to implement, a quantitation method of determining doxycycline in urine has been validated using a volumetric absorptive microsampling (VAMS®) device. As blotting paper, the device is dried after collection and transferred at room temperature, but contrarily to dried spot, the collection volume is perfectly repeatable. Analysis of VAMS® was performed with a high-performance liquid chromatography coupled to a mass spectrometer. The chromatographic separation was achieved on a core-shell C18 column. The mean extraction recovery was 109% (mean RSD, 5.4%, n = 6) for doxycycline and 102% (mean RSD, 7.0%) for the internal standard. No matrix effect has been shown. Within-run as within-day precision and accuracy were, respectively, below 14% and ranged from 96 to 106%. The signal/concentration ratio was studied in the 0.25–50 µg/mL range, and recoveries from back-calculated concentrations were in the 96–105% range (RSD < 11.0%). The RSD on slope was 10%. To achieve the validation, this new quantitation method was applied to real samples. In parallel, samples were analyzed directly after a simple dilution. No statistical difference was observed, confirming that the use of VAMS® is an excellent alternative device to monitor the doxycycline compliance.

IntroductionDepending on the individual, exposure to an intense stressor may, or may not, lead to a stress-induced pathology. Predicting the physiopathological evolution in an individual is therefore an important challenge, at least for prevention. In this context, we developed an ethological model of simulated predator exposure in rats: we call this the multisensorial stress model (MSS). We hypothesized that: (i) MSS exposure can induce stress-induced phenotypes, and (ii) an electrocorticogram (ECoG) recorded before stress exposure can predict phenotypes observed after stress.MethodsForty-five Sprague Dawley rats were equipped with ECoG telemetry and divided into two groups. The Stress group (n = 23) was exposed to an MSS that combined synthetic fox feces odor deposited on filter paper, synthetic blood odor, and 22 kHz rodent distress calls; the Sham group (n = 22) was not exposed to any sensorial stimulus. Fifteen days after initial exposure, the two groups were re-exposed to a context that included a filter paper soaked with water as a traumatic object (TO) reminder. During this re-exposure, freezing behavior and avoidance of the filter paper were measured.ResultsThree behaviors were observed in the Stress group: 39% developed a fear memory phenotype (freezing, avoidance, and hyperreactivity); 26% developed avoidance and anhedonia; and 35% made a full recovery. We also identified pre-stress ECoG biomarkers that accurately predicted cluster membership. Decreased chronic 24 h frontal Low θ relative power was associated with resilience; increased frontal Low θ relative power was associated with fear memory; and decreased parietal β2 frequency was associated with the avoidant-anhedonic phenotype.DiscussionThese predictive biomarkers open the way to preventive medicine for stress-induced diseases.