ScvO2 changes after red-blood-cell transfusion for anaemia in cardiothoracic and vascular ICU patients: an observational study.

BACKGROUND AND OBJECTIVES: Haemoglobin threshold for transfusion has been significantly decreased, but haemoglobin plasma concentration may not be sufficient to assess the need of red-blood-cell (RBC) transfusion. Central venous oxygen saturation (ScvO2 ) is a clue of metabolic matching between O2 transport and consumption, which could help to assess when transfusion is appropriate once anaemia has been diagnosed in ICU patients. MATERIALS AND METHODS: Adult patients admitted consecutively to a cardiothoracic and vascular ICU were included in a prospective, observational and single-centre study over a 6-month period (September 2014 to February 2015), provided they were transfused with RBC. Patients with active bleeding or in unstable condition were excluded. Haemoglobin and ScvO2 were collected through a central venous catheter before and after transfusion. In order to identify a ScvO2 threshold, analysis of ScvO2 changes after transfusion was performed. RESULTS: Fifty-three patients received 100 RBC transfusions. Haemoglobin at the time of transfusion was 7·2 g/dl [6·8-7·7], while ScvO2 was 66·9% [60-73]. A 5% increase in ScvO2 after transfusion has the best specificity and positive predictive values, with a ScvO2 threshold of 65%. After transfusion (RBC units, 2 [1-2]), ScvO2 increased only in patients with ScvO2 ≤65%, from 58% [53-62] to 69% [64-73] (P < 0·001). CONCLUSION: In anaemic patients, RBC transfusion induced a significant increase in ScvO2 , provided it was low before transfusion. A 65% cut-off value of ScvO2 before transfusion showed good specificity and good positive predictive value for a 5% increase after transfusion.

Incidence of pertussis in subjects aged 50years and older in France in 2013-2014.

OBJECTIVE: To assess the incidence of pertussis (whooping cough) in subjects aged 50years and older in France. METHODS: Participating family physicians (FPs) using the patient record management software AxiSanté® included patients aged 50years and older, who had signed an informed consent form, presenting with persistent cough for 7 to 21days. Bordetella genetic material was detected by polymerase chain reaction (PCR) on nasopharyngeal samples collected at the FP's discretion. RESULTS: A total of 42 FPs included 129 patients from June 2013 to August 2014 (large cities: 38; medium-sized cities: 57; rural areas: 34); 106 samples were analyzed. Overall, 30 pertussis cases were diagnosed: 10 cases confirmed by PCR, 18 purely clinical cases, and two direct epidemiological cases. The crude incidence rate per 100,000 patients aged≥50years was 103.6 (95% CI: 69.9-47.9): 77.1 in large cities, 103.1 in medium-sized cities, and 143.9 in rural areas. The extrapolated incidence rate per 100,000 persons aged≥50years was 187.1 (95% CI: 126.2-67.1): 131.1 in large cities, 256.1 in medium-sized cities, and 242.2 in rural areas. CONCLUSION: The population aged 50years and older can serve as a reservoir. Its role in Bordetella pertussis circulation should be taken into account for pertussis booster vaccination programs.

[Relevant clinical and biological criteria for the diagnosis of androgen deficiency in the aging male (ADAM)]. / Critères cliniques et biologiques pertinents pour poser un diagnostic de déficit androgénique lié à l'âge (DALA).

INTRODUCTION: The androgen deficiency in the aging male (ADAM) affects 30 % of men after 70. It's responsible for many minor symptoms but also major complications. The objective of this study was to establish the clinical and biological criteria for the diagnosis of ADAM. MATERIAL AND METHOD: Data on clinical and biological criteria for the diagnosis of ADAM have been explored in Medline and Embase using the MeSH keywords: androgen deficiency; testosterone deficiency; late-onset hypogonadism; aging. The articles were selected based on their methodology, relevance, date and language of publication. RELEVANT CLINICAL CRITERIA FOR THE DIAGNOSIS OF ADAM: The prevalence of symptomatic ADAM in the old male ranges from 6 % to 12 %. The main clinical manifestations of ADAM include various sexual disorders associated with many nonspecific symptoms which can even be present without androgen deficiency. ADAM may induce type 2 diabetes or some cardiovascular complications which increase the risk of death. Because of low specificity, the use of diagnostic tools is not recommended to screen ADAM. VARIATION IN THE ANDROGEN SECRETION DURING AGING: The annual decrease rate of testosterone is 1.6 % after 30 leading to androgen deficiency in 50 % of patients after 80. ADAM is due to a concomitant reduction of testosterone and gonadotropin secretion. RELEVANT BIOLOGICAL CRITERIA FOR THE DIAGNOSIS OF ADAM: The biological diagnosis of androgen deficit is based on two determinations of total testosterone obtained between 7 AM and 11 AM. Levels below 8 nmol/L are an indication to hormonal substitution while patients with levels above 12 nmol/L don't seem to benefit from this type of treatment. Between 8 and 12 nmol/L, it is recommended to assess free testosterone levels. Because of a decrease in gonadotrophin secretion during aging, the LH levels are abnormally normal in ADAM. CONCLUSION: ADAM is a biological and clinical syndrome characterized by the association of nonspecific symptoms and decrease testosterone levels. Hormone replacement therapy appears to benefit patients at risk of metabolic, cardiovascular or bone complications.

[Burden of herpes zoster and postherpetic neuralgia: Incidence, proportion, and associated costs in the French population aged 50 or over]. / Évaluation de l'incidence du zona, de la proportion des douleurs post-zostériennes, et des coûts associés dans la population française de 50 ans ou plus.

BACKGROUND: Despite the perspective of vaccination against herpes zoster, there are few recent data available on the incidence of this disease, the proportion of postherpetic neuralgia cases, and associated disease management costs. This study was performed to evaluate these parameters in a representative sample of French physicians. METHODS: It was a retrospective, declarative study conducted from the medical files of patients who presented with herpes zoster and consulted in 2005, based on a random sample of GPs, dermatologists, neurologists, and physicians in pain clinics, weighted by demographic departmental distribution of patients aged 50 years and above. The analysis was performed on cases diagnosed by physicians themselves (incident cases). RESULTS: The annual incidence of herpes zoster was estimated at 8.99/1000 [8.34-9.64], all types of physicians pooled and at 8.67/1000 for GPs. This represents about 182,500 cases of herpes zoster in France in 2005 in patients aged 50 years and above. Incidence was slightly higher amongst women (1.3 times) and increased with age. Amongst the 777 cases of incident herpes zoster, 343 were complicated by postherpetic neuralgia one month after diagnosis. The proportion of patients presenting postherpetic neuralgia at 3 and 6 months was 32.1% and 17.6%, respectively. The annual cost of management of herpes zoster and postherpetic neuralgia was estimated at 170 [109-249] million euros, of which 61.0 million euros were covered by the national health insurance. CONCLUSION: In this study, the incidence of herpes zoster observed in France in subjects aged 50 years and above is close to that already estimated in France and Europe. The proportion of postherpetic neuralgia is high and this painful complication may persist for several months after diagnosis of herpes zoster. To our knowledge, EPIZOD is the first study conducted in France to assess the cost of herpes zoster and of postherpetic neuralgia, the most frequent complication of this viral disease.

[Herpes labialis and genitalis in general medicine]. / Herpès labial et génital en médecine génrale.

OBJECTIVE: The purpose of this study was to determine the respective importance of herpes labialis and genitalis in patients consulting general practitioners and ascertain their knowledge and opinions concerning herpes labialis and genitalis in order to analyze patient behavior in case of flare-ups. PATIENTS AND METHOD: A questionnaire was proposed to a representative sample of patients aged 15 years and older seen at consultation by 49 general practitioners participating in the General Medicine Observatory of the French Society of General Practitioners. RESULTS: Among the 4,403 patients who responded, a known history of herpes labialis was reported by 39. 9 p.100 and of herpes genitalis by 2.5 p.100. Their answers to the questions demonstrated insufficient knowledge of avoidable risks of herpes as a sexually transmitted disease, with very significant misunderstanding by men. Among the 1,711 patients who had experienced herpes labialis, 62.9 p.100 initiated self-medication, 29 p.100 preferred to wait and see and 7.5 p.100 sought medical assistance. Among the 108 patients who had experienced herpes genitalis, at the last flare-up 40 p.100 initiated self-medication, 7.5 p.100 preferred to wait and see and 52 p.100 sought medical assistance. The general practitioner was the first physician consulted for both types of herpes. DISCUSSION: This study illustrates the importance of herpes infections in the general medicine patients. It also confirms that new interventional strategies are needed both for health care and for health education.

[5-year assessment of daily multi-drug therapy of leprosy in Guadeloupe since 1980]. / Bilan à 5 ans de la polychimiothérapie quotidienne de la lèpre en Guadeloupe depuis 1980.

In Guadeloupe, from January 1980 to December 1984, 420 leprosy patients were put under daily multidrug therapy: 10 mg/kg RMP plus 100 mg DDS during six months for paucibacillary patients, 10 mg/kg RMP plus 100 mg DDS during 24 months supplemented during the 12 first months with 10 mg/kg of a thioamide, ethionamide or protionamide, for multibacillary patients. The approval to the treatment was satisfactory in all the patients with active leprosy, new cases and relapse cases, less in the inactive patients already treated with dapsone only. The patients's compliance to treatment was satisfactory too. The lepra reactions were observed with a 19% frequency which is not different of the 15% frequency of lepra reactions observed in patients treated with DDS only. Hepatitis were observed only in multibacillary patients treated with PTH and RMP with a 14% frequency. Discontinuing treatment with RMP and PTH but not DDS resulted in recovery. When RMP was resumed without PTH, the hepatitis did not recur. All patients responded favorably under multidrug therapy and no relapse was observed among the 45 paucibacillary patients after a four year-surveillance and among the 16 multibacillary patients after a three year-surveillance.

[Epidemiology of leprosy in Guadeloupe from 1970 to 1984]. / Epidémiologie de la lèpre en Guadeloupe de 1970 à 1984.

Analysis of computerized data compiled according to the OMSLEP system in the leprosy control service in Guadeloupe has shown that from 1970 to 1984, 80% of the patients were detected by passive case-finding (symptomatic patients), 10% by active case-finding among the school population and 10% by active case-finding among the house-hold contacts of known patients. During the same period of time, global incidence of new cases of leprosy declined from 24 to 11 per 100,000 inhabitants. The decline was greater for paucibacillary cases (y = -0,94) than for multibacillary cases (y = -0,45), and much greater among persons under 15 years of age (y = -3,22) than among those older ones (y = -0,67). Simultaneously 118 relapses, an annual incidence of 1,3%, were observed among the multibacillary patients previously treated by dapsone monotherapy for five years or more. All cases the biopsies of whom were inoculated for drug sensitivity testing in the mouse foot pad yielded dapsone-resistant M. leprae. The proportions of relapses among the annual sources of infection increased from 16% in 1970 to 47% in 1984. Chemoprophylaxis of relapses among multibacillary patients already treated for more than five years with dapsone monotherapy is one of the priorities for leprosy control in Guadeloupe.

[Acceptability, compliance and tolerance of daily polychemotherapy by leprosy patients in Guadeloupe]. / Acceptabilité, assiduité et tolérance d'une polychimiothérapie quotidienne de la lèpre en Guadeloupe.

From January 1980 to December 1984, 418 leprosy patients were treated in Guadeloupe with a daily multiple drug regimen using rifampin as an essential drug. The analysis of the data collected during this period of times gives the possibility of estimating the patient's approval, tolerance and attendance to this treatment. The approval is satisfactory in new cases of leprosy and in ancient cases relapsed under dapsone monotherapy but less in inactive ancient patients already treated with dapsone monotherapy. Attendance of the 418 patients to the multiple drug regimen is satisfactory too and similar to the attendance of patients treated with dapsone monotherapy in Guadeloupe and to the attendance of patients with monthly multiple drug regimen in another Caribbean country. Reactions did not occur with higher gravity or frequency than in patients under dapsone monotherapy. The high incidence of hepatitis (14%) due to the toxicity of protionamide in the combination rifampin-protionamide-dapsone make obligatory the monthly assessment of the liver functions in multibacillary patients treated with such a drug combination.