[Predictive factors for mandibular osteoradionecrosis after irradiation of head and neck cancers]. / Facteurs prédictifs de l'ostéoradionécrose mandibulaire après irradiation des cancers des voies aérodigestives supérieures.

The identification of the different risk factors for mandibular osteoradionecrosis (ORN) must be done before and after the management of patients with head and neck cancer. Various clinical criteria for this severe radiation-induced complication are related to the patient (intrinsic radiosensitivity, malnutrition associated with thin weight loss, active smoking intoxication, microcapillary involvement, precarious oral status, hyposalivation) and/or related to the disease (oral cavity, large tumor size, tumor mandibular invasion). Therapeutic risk factors are also associated with a higher risk of ORN (primary tumor surgery, concomitant radio-chemotherapy, post-irradiation dental avulsion, preventive non-observance with the absence of stomatological follow-up and daily installation of gutters fluoride and, non-observance curative healing treatments). Finally, various dosimetric studies have specified the parameters in order to target the dose values distributed in the mandible, which increases the risk of ORN. An mean mandibular dose greater than 48-54Gy and high percentages of mandibular volume receiving 40 to 60Gy appear to be discriminating in the risk of developing an ORN.

Characteristics and outcomes of reversed patients admitted to an emergency department for VKA-related intramuscular hematoma.

BACKGROUND: According to the International Society on Thrombosis and Haemostasis (ISTH), intramuscular hematoma without other severity criteria is not considered a major bleeding. OBJECTIVES: In a large cohort of reversed vitamin K antagonist (VKA) patients admitted to the emergency unit for muscular hematoma, we assess frequency, severity, and anticoagulation management based on whether ISTH criteria were met or not. MATERIALS AND METHODS: We performed a retrospective single-center study involving patients admitted to an emergency unit for VKA-induced intramuscular hematoma whose bleeding was reversed with prothrombin complex concentrates. RESULTS: During the study period, 631 VKA-induced bleeding events occurred in our emergency unit, of which 73 (11.6%) were intramuscular hematomas and half met ISTH criteria. The mean age was 75.5years (95% CI=72.6-78.3). Admission blood tests showed that patients with ISTH criteria had higher international normalized ratio (7.0±4.6 vs. 4.1±3.0, p=0.002) and lower hemoglobin (8.1±1.8 vs. 11.9±2.2, p<0.001) than those without. Patients with ISTH criteria were more likely to have intramuscular hematoma in the iliopsoas, gluteal, and pectoral muscles than those without. Interestingly, two-thirds of rectus sheath hematomas involved patients without ISTH criteria. However, patients with or without ISTH criteria exhibited a similar hospitalization duration and rate of re-bleeding. CONCLUSION: We showed that half of the patients admitted with intramuscular hematoma could not be qualified as having ISTH-criteria major bleeding. Interestingly, these patients displayed a similar hospitalization duration and rate of re-bleeding to those with ISTH-criteria major bleeding.

Evaluation of 'I-Preventive': a digital preventive tool for musculoskeletal disorders in computer workers-a pilot cluster randomised trial.

OBJECTIVES: I-Preventive is a digital preventive tool for musculoskeletal disorders (MSDs) in computer workers. We sought to determine its impact on pain in computer workers with upper limb MSDs and visual discomfort. METHODS: We conducted a pilot cluster randomised trial in 2 different sites of a tyre factory in France. We randomised 200 employees to either an intervention group (I-Preventive) or control group, each comprising symptomatic and asymptomatic employees. The workers were followed up for 5 months. The main outcome was overall recovery from symptoms following 1 month's intervention based on Nordic-style and eyestrain questionnaires. RESULTS: We included 185/200 workers: 96 in the intervention group (mean age 41.8±1.4 years; 88.5% males) and 79 in the control group (mean age 42.9±12.0 years; 94.5% males). The most painful areas (numerical scale ≥2) were the neck (40.0%), upper back (18.8%) and shoulders (15.7%). For the most painful anatomical area, the Nordic score significantly decreased after 1 month in the intervention group (p=0.038); no change was observed in the control group (p=0.59). After 1 month's use, the intervention group reported less pain in the painful area and less visual discomfort symptoms (p=0.02). Adherence to the I-Preventive program was 60%. CONCLUSIONS: I-Preventive is effective in the short term on musculoskeletal symptoms and visual discomfort by promoting active breaks and eyestrain treatment. This easy-to-use digital tool allows each worker to focus on areas of their choice via personalised, easy exercises that can be performed in the workplace. TRIAL REGISTRATION NUMBER: NCT02350244; Pre-results.

Evaluation of the efficacy and tolerance of a short 7 day third-generation cephalosporin treatment in the management of acute pyelonephritis in young women in the emergency department.

OBJECTIVES: Urinary tract infections, among the leading causes of antibiotic prescriptions in adult women, are complicated by increasing antibiotic resistance. Current recommendations propose a 7 day treatment with fluoroquinolones or a 10-14 day course of third-generation cephalosporins (3GC). Our aim was to study the efficiency and tolerance of a short 7 day treatment with 3GC in uncomplicated acute pyelonephritis in women aged between 18 and 65 years. PATIENTS AND METHODS: This study was an open, prospective, non-comparative, monocentric pilot study with consecutive patients. We included women between 18 and 65 years old who had been admitted to the emergency department with a diagnosis of acute pyelonephritis. The treatment consisted of 1 g of ceftriaxone injection followed by 6 days of 400 mg of cefixime per day. The primary endpoint was negative urine cultures on day 9. We opted for Fleming's multistage design for this trial. ClinicalTrials.gov number: NCT01390623. RESULTS: Thirty-seven patients were analysed. The bacteriological response consisted of negative urine cultures for all 37 patients on day 9. On day 9, 30 patients were completely asymptomatic, while 7 exhibited clinical improvement though persistence of bladder irritation or flank pain. On day 37, there were no remaining symptoms and no recurrences of urinary tract infection, as noted during the last follow-up visits. CONCLUSIONS: These results suggest that acute pyelonephritis in women could be successfully treated with a short-term course of 1 g of ceftriaxone on the first day followed by 400 mg of cefixime per day for 6 days. These positive results must be confirmed by a non-inferiority study.

[Retrospective study about 73 consecutive patients treated by direct oral anticoagulant and admitted to an emergency room]. / Étude rétrospective concernant 73 patients traités par un anticoagulant oral direct admis consécutivement dans un service d'urgence.

INTRODUCTION: Direct oral anticoagulants are a recent alternative to vitamin K antagonists but there is a lack of data regarding patients receiving these new types of treatment. The aim of the study was to identify and describe patients receiving direct oral anticoagulants admitted to an emergency unit. METHODS: All the patients taking direct oral anticoagulants, admitted to the emergency room of the Clermont-Ferrand Hospital from January to August 2013, were included in this retrospective and descriptive study. RESULTS: Among the 73 patients included, 47.9% were treated with dabigatran and 52.1% with rivaroxaban. The indication was stroke prevention in 62 patients with atrial fibrillation whose average CHADS2 score was 2.6 [2.3-3](IC95%). The average age was 76.4 years [73.7-79.1](IC95%). Twenty-nine patients (39.7%) had at least one drug association known for increasing the risk of bleeding. Average scores for bleeding risk were: HAS-BLED 3.1 [2.9-3.3](IC95%) and Beyth 1.5 [1.3-1.6](IC95%). Bleeding patients included a higher percentage of men (68.8 vs. 38.2%, P=0.032). Creatinine clearance was lower in patients with major bleeding (45.2% vs. 68.8 mL/min, P=0.002). The Beyth score was highest in both sub-groups. CONCLUSION: In our study, we have found that the bleeding risk factors were: male gender, a high Beyth score, and a lowered creatinine clearance. Overall, patients treated with direct oral anticoagulants admitted to the emergency room were old with many co-morbidities, especially cardiovascular conditions; polymedication was frequent.

[Pasteurella multocida meningitis in a 93-year-old woman following a cat bite]. / Méningite àPasteurella multocida chez une femme de 93ans après morsure par un chat.

Pasteurella multocida is commensal of the normal nasopharynx or gastrointestinal flora in many domestic and wild animals. Cat and dog bites usually cause soft tissue infections. P. multocida is an unusual causative agent of meningitis which tends to affect neonates or aged patients. The authors report a case (a 93-year-old woman) of P. multocida meningitis induced by a cat bite with dramatic sequels leading to complete patient disability.

[Cost/effectiveness comparison of the vaccine campaign and reduction of sick leave, after vaccination against influenza among the Clermont-Ferrand University Hospital staff]. / Comparaison coût/bénéfice de la campagne vaccinale et de la réduction de l'absentéisme, après vaccination contre la grippe du personnel du CHU de Clermont-Ferrand.

OBJECTIVE: The aim of this study was to compare the cost of vaccination for the Clermont-Ferrand University hospital (CHU) personnel and the cost of sick leave among vaccinated and non-vaccinated employees in 2003, 2004, and 2005. DESIGN: The study included 7256 CHU staff (medical and non-medical personnel). The cost of sick leave was calculated on the basis of short-term disease (four to nine days) over the three months of the epidemic season in 2004, 2005, and 2006. RESULTS: In 2005, the overall cost of vaccination was 4.02 euros per vaccinated employee. Over the three years, the total sick leave reached 804 days for employees vaccinated against 5670 for non-vaccinated employees. In 2003, 2004, and 2005, the vaccinal coverage was 13, 20.5, and 30.1%, the mean duration of sick leave was 0.16, 0.17, and 0.18 day among vaccinated staff, and 0.26, 0.39, and 0.34 day among non-vaccinated staff corresponding to a benefit per vaccinated employee of 5, 26, and 20 euros, respectively for each year. The total benefit for the institution was 86,458 euros (4630+38,168+43,660). If the vaccinated rate of 75% recommended by the Haute Autorité de santé (HAS) had been reached, the additional benefit would have been 250,193 euros (33,157+152,256+65,180). CONCLUSIONS: The number of sick leave days and the related cost were approximately twice less important for vaccinated employees, economically justifying this vaccination including a period of weak epidemic, as checked over three consecutive years.

[Relation between the level of knowledge and the rate of vaccination against the flu virus among the staff of the Clermont-Ferrand University hospital]. / Relation entre le niveau de connaissance et le taux de vaccination contre le virus de la grippe parmi le personnel du CHU de Clermont-Ferrand.

OBJECTIVE: The main aim of this study was to determine how much staff at the Clermont-Ferrand university hospital, France, knew about influenza and its relation with the vaccinal rate. The other aim was to develop better-targeted information campaigns and prevention policy in the work place. DESIGN: A self-administered questionnaire was sent to the 7601 salaried staff of the hospital in May 2005. The staff was asked to give details on socioprofessional characteristics, vaccinal status, and knowledge about the influenza virus (mode of transmission, contagiousness, measures of prevention, populations affected, mortality, vaccination schedule, and vaccination target populations). Multiple-choice questions on knowledge of influenza were scored according to the answer given. RESULTS: The response rate was 26.5%. The 2011 completed questionnaires were representative of the working staff. They showed a positive correlation between the rate of vaccination and knowledge of influenza, with a 0.98 coefficient. They also showed that the staff was very largely unaware of population groups most at risk for influenza (1% of correct answers). CONCLUSIONS: Primary prevention campaigns will only be effective if the target population has a better awareness of the issues involved. This study highlights the areas in which knowledge was heterogeneous or inadequate, and the information that could be decisive in increasing vaccinal coverage among staff. This information should focus on modes of transmission, contagiousness, mortality, and above all on populations at risk.

[Analysis of motivations for antiflu vaccination of the Clermont-Ferrand University Hospital staff]. / Analyse des motivations à la vaccination antigrippale du personnel du CHU de Clermont-Ferrand.

OBJECTIVE: The vaccination of hospital staff decreases patient mortality and disorganization of services due to sick leave. The main aim of our study was to determine the Clermont-Ferrand University hospital (CHU) personnel's motivations for or against antiflu vaccination to increase the effectiveness of prevention campaigns. DESIGN: An autoquestionnaire with multiple choices was given to the 7601 CHU staff in May 2005. It documented socioprofessional characteristics, vaccinal status, and reasons for vaccination, nonvaccination, or stopping antiflu vaccination. RESULTS: The answer rate was 26.5% (2011 autoquestionnaires returned) and representative of the CHU staff. The rate of vaccination in 2004 was 36.35% with a strong correlation between vaccination and former influenza infection (p<0.001). Five of the six principal reasons for vaccination were altruistic including the first two: avoiding transmission to patients (61.8%) and his family (59.8%). The main reason for stopping was the lack of time. The reasons for nonvaccination were linked to a feeling of invulnerability: conviction of not being at risk, of being too young, or in good health. CONCLUSIONS: The Haute Autorité de santé's objective of vaccinal coverage against influenza for 75% of the health professionals requires their active compliance. The effectiveness of future campaigns could aim at improving knowledge by insisting particularly on the young age of the risk populations. The lack of time can be compensated by offering on-site vaccination, including at night and by proposing larger schedules for vaccination.