Predictive factors of dropout from inpatient treatment for anorexia nervosa.

BACKGROUND: Patients with severe Anorexia Nervosa (AN) whose condition is life-threatening or who are not receiving adequate ambulatory care are hospitalized. However, 40 % of these patients leave the hospital prematurely, without reaching the target weight set in the treatment plan, and this can compromise outcome. This study set out to explore factors predictive of dropout from hospital treatment among patients with AN, in the hope of identifying relevant therapeutic targets. METHODS: From 2009 to 2011, 180 women hospitalized for AN (DSM-IV diagnosis) in 10 centres across France were divided into two groups: those under 18 years (when the decision to discharge belongs to the parents) and those aged 18 years and over (when the patient can legally decide to leave the hospital). Both groups underwent clinical assessment using the Morgan & Russell Global Outcome State questionnaire and the Eating Disorders Examination Questionnaire (EDE-Q) for assessment of eating disorder symptoms and outcome. Psychological aspects were assessed via the evaluation of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Socio-demographic data were also collected. A number of factors identified in previous research as predictive of dropout from hospital treatment were tested using stepwise descending Cox regressions. RESULTS: We found that factors predictive of dropout varied according to age groups (being under 18 as opposed to 18 and over). For participants under 18, predictive factors were living in a single-parent family, severe intake restriction as measured on the "dietary restriction" subscale of the Morgan & Russell scale, and a low patient-reported score on the EDE-Q "restraint concerns" subscale. For those over 18, dropout was predicted from a low depression score on the HADS, low level of concern about weight on the EDE-Q subscale, and lower educational status. CONCLUSION: To prevent dropout from hospitalization for AN, the appropriate therapeutic measures vary according to whether patients are under or over 18 years of age. Besides the therapeutic adjustments required in view of the factors identified, the high dropout rate raises the issue of resorting more frequently to compulsory care measures among adults.

Prostate Cancer at a regional hospital in South Africa: we are only seeing the tip of the iceberg.

OBJECTIVES: The objectives were to document the presentation of prostate cancer in the Zulu population of KwaZulu-Natal in South Africa, to identify this as a high-risk population, and to determine the potential for under-diagnosis in this population. METHOD: All histopathology results confirming prostatic adenocarcinoma from biopsies preformed at Edendale hospital from 01/11/2012 to 30/04/2014 were collected. A total of 81 participants were enrolled, and a review of their outpatient records was performed. Patient presentation was analysed, younger patients were compared to older patients, and observed incidence was compared to expected incidence. RESULTS: The majority of patients (66%, 95% confidence interval [CI]:54-76%) presented with radiographic evidence of metastatic disease or PSA greater than 100 ng/ml. The median PSA level at presentation was 154 ng/ml (Interquartile range [IQR] = 39-448). Clinically staged T4 disease was present in 44% of patients and only 10% of patients presented with PSA detected disease. Poorly differentiated tumours (Gleason grades 8, 9 and 10) were found in 43% of patients. Only 81 out of a maximum potential of 625 incident prostate cancer cases were diagnosed. CONCLUSION: Black South African men from a predominantly rural Zulu population present late and with advanced and aggressive disease. We are missing the opportunity for remission in most patients in this high risk population group. The establishment of a National Prostate Cancer Registry and further research into a prostate cancer screening programme may be beneficial to this community.

[Epidemiology of anorexia nervosa: a review]. / Épidémiologie de l'anorexie mentale : revue de la littérature.

UNLABELLED: A critical review of the literature was conducted to provide answers to three questions: firstly, are we facing a national and/or international epidemic of anorexia nervosa (AN) as claimed in the media by certain professionals? Secondly, is AN simply an ordinary crisis of adolescence? Thirdly, is it a pathology that solely affects the higher socio-professional categories? METHOD: A Medline search was conducted and backed up by a manual search to find all the studies or literature reviews published on prevalence, incidence rates, outcomes, morbidity and mortality in AN and its links with social class, covering the period 2000-2011. RESULTS: The differing methodologies of the studies on these themes have a considerable impact on the interpretation of results. For each indicator retained, the results observed in the different studies are detailed and commented in the light of these differences. The prevalence of AN in women aged 11 to 65 in non-clinical population ranges from 0 to 2.2 %. It varies in particular with the age of the studied subjects, the measurements used, and the definition criteria for AN. Among men, the lifetime prevalence is around 0.3%. The marked disparities in incidence rates observed are related to the nature of the samples considered: subjects consulting in hospital, whether in a specialised department or in any department, those consulting general practitioners (GPs), or subjects from general population samples recruited in different surveys (girls in schools for example). The incidence of female cases is low in general medicine or specialised consultation in town (whatever the speciality): from 4.2 and 8.3/100,000 individuals per year. It is much higher in the general population, ranging from 109 to 270/100,000 individuals per year. In fact, the studies reporting variations in the incidence of AN were conducted on samples from clinical populations in certain countries (United States and United Kingdom). They are probably more a reflection of variations in detection rates and use of healthcare, than of variations in the incidence in the general population. The mean duration of AN appears shorter in the general population than in clinical populations. On average, 47% of the individuals treated for AN recovered, 34% improved, 21% had a chronic eating disorder, and 5% died. The outcome is better for subjects treated during adolescence. Mortality is frequently expressed in crude mortality rate (CMR), which is not very informative on account of the heterogeneous natures of the cohorts followed; only the studies reporting standardised mortality rate (SMR) are informative. AN appears as having one of the highest mortality rates among psychiatric pathologies. Mortality varies according to the population considered. Rates observed are 6.2 to 10.6 times greater than that observed in the general population for a follow-up duration ranging respectively from 13 to 10 years. It is lower for longer follow-up periods, only 3.7 times more frequent than in the general population for follow-up periods of 20 to 40 years. It appears lower for subjects treated before the age of 20. The main causes of death are eating disorder complications, suicide and cancer. One review of the literature concluded in the absence of any significant link between this pathology and social class. DISCUSSION: There is nothing in the incidence and prevalence data to back up the notion of a recent "epidemic" of AN. AN is not simply a crisis of adolescence: morbidity and mortality are considerable in this pathology. The relationship between AN and social class is not established.

A Survey for 'Candidatus Liberibacter' Species in South Africa Confirms the Presence of Only 'Ca. L. africanus' in Commercial Citrus.

Greening disease of citrus is a serious disease known in South Africa since the late 1920s. In South Africa, it is associated with infection by 'Candidatus Liberibacter africanus', a heat sensitive, phloem-limited, noncultured alpha-proteobacterium. Huanglongbing (HLB), a similar, but more devastating disease that was described initially from China but which now occurs in several citrus producing countries, is associated with a different Liberibacter species, 'Ca. L. asiaticus'. A 'Ca. L. africanus' subspecies, 'Ca. L. africanus subsp. capensis', has been found only in South Africa infecting an indigenous Rutaceous species, Calodendrum capense (Cape Chestnut), in the Western Cape in 1995. The discovery of a new Liberibacter species in Brazil, 'Ca. L. americanus', and the spread of 'Ca. L. asiaticus' to a number of additional countries over the last few years prompted us to assess whether only 'Ca. L. africanus' is present in commercial citrus orchards in South Africa. Samples displaying greening or similar symptoms were collected from 249 citrus trees from 57 orchards distributed throughout the greening affected citrus production areas of South Africa. Multiplex polymerase chain reaction (PCR) was performed on DNA extracts to detect the known citrus Liberibacters. Amplicons were obtained from 197 samples. None of the samples yielded a 1,027-bp amplicon indicative of 'Ca. L. americanus' infection. The amplicons of 84 samples were sequenced, and all were identical to the cognate 'Ca. L. africanus' Nelspruit sequence in GenBank. No instance of 'Ca. L. asiaticus' or 'Ca. L. africanus subsp. capensis' sequence was found. Geographically representative samples that tested negative for Liberibacter also tested negative for phytoplasmas based on real-time PCR results. Based on the results of this survey, it is concluded that to date only 'Ca. L. africanus' is associated with citrus greening in commercial citrus in South Africa.

[Cephalometric study of cranio-facial growth of 902 Black African children and adolescents aged 8 to 20]. / Etude céphalométrique de la croissance crânio-faciale de 902 enfants et adolescents mélano-africains agés de 8 a 20 ans.

Cephalometric studies of the growth are numerous and represent a contribution to the field of the anthropological knowledge of the stages of the cranio-facial growth and for a better adaptation of the orthodontic treatments. However, in Black Africa people there are very few studies of this kind. The purpose of this investigation is to analyze the growth of the cranial base, the maxillary skeletal region and mandibular skeletal region at the young African subjects. The sample of study consists of 386 girls and 516 boys in period of growth, old from 8 to 20 years, presumedly orthomorphic and having lateral cephalometric radiograph in occlusion. The statistical analysis of the data recorded on the layouts cephalometric (test U of Mann Whitney) announces the existence of a sexual dimorphism which is strongly significant around 9 years, 11 years and 17 years. Maxilla and mandible present different rates of growth while remaining active up to 20 years but the growth of the base of cranium seems to be stabilized earlier, after 11 years. The taking into account of these morphological variations are determining for the conduit of treatments more stable and adapted to our populations.

HLA DRB1, DMA, and DMB gene polymorphisms in rheumatoid arthritis.

OBJECTIVE: To study the influence of DMA and DMB genes on susceptibility to Rheumatoid Arthritis (RA). METHODS: HLA-DRB1, DMA and DMB polymorphisms were defined by PCR SSOP in 203 European Mediterranean RA patients and 181 unrelated healthy controls. RESULTS: No significant difference in the phenotype frequencies of DMA and DMB alleles was observed between patients and controls. We found decreased frequencies of DMA*0102 and DMB*0104 in patients but this did not reach significance. These decreased frequencies could be due to a positive linkage disequilibrium with DRB1*0701, an allele which is underrepresented in RA patients. In stratified analysis with RA susceptibility Epitope positive (SE) DRB1 alleles, there was no significant difference in DMA and DMB phenotype frequencies between SE/SE, SE/X, and X/X patients versus controls. Among SE/X subjects, no significant difference in DM distribution frequencies was observed in DRB1*0101/X, 0102/X, 0401/X, 0404/X and 0405/X groups. CONCLUSION: DMA and DMB polymorphism does not seem to influence susceptibility to develop RA. Differences in DMA phenotype frequencies between patients and controls are secondary to linkage disequilibrium with DRB1 alleles.

Multiple sclerosis: cell-mediated immunity to human brain gangliosides.

Cell-mediated immunity (CMI) to myelin components has been implicated in Multiple Sclerosis (MS) pathogenesis: two targets were suggested, Myelin Basic Protein with controversial results and, more recently, gangliosides. In order to investigate their possible involvement, we have performed Leukocyte Migration inhibition (LMI) tests in the presence of human brain gangliosides. Thirty nine MS patients (twenty four being "definite", according to McDonald and Halliday's classification), twenty nine patients with Other Neurological Diseases (OND), thirty six patients with Inflammatory diseases (ID) and forty healthy controls were tested. MS patients were divided into two groups, depending on the clinical stage of the disease. The mean migration inhibition percentage of the MS-attack group was found to be significantly different from the four others (p less than 0.01) (24.4 +/- 16.2 versus 10.9 +/- 8.5 in MS without attack, 4.4 +/- 12.9 in OND, 3.9 +/- 13.9 in ID and 11.1 +/- 12.1 in healthy subjects). LMI to gangliosides is therefore significantly increased during the attack stage in MS. These results support the notion of a Delayed Type Hypersensitivity to these glycolipids during the active stage of the disease.

Chronic neurogenic quadriceps amyotrophies.

Two cases of quadriceps amyotrophy, probably of chronic neurogenic origin are reported. Only the knee jerks were diminished, the calves hypertrophic, and the serum creatine kinase level very high in one case, and there were neurogenic electromyographic abnormalities in the quadriceps. In the first case, biopsy of the quadriceps muscle revealed a neurogenic origin with hyalinized hypertrophic fibres. CT scan showed abnormalities not only in the quadriceps but also in the sartorius, gracilis and gastrocnemius muscles. A second biopsy specimen from the gastrocnemius muscle showed histological findings similar to those of the quadriceps. In the second case, the EMG and biopsy findings suggested a myogenic origin, but 6 years later they were compatible with neurogenic atrophy. Differentiation from Becker dystrophy is very difficult in the first case and the second case is more a focal spinal amyotrophy. Further, in spite of their localization, the extension of the affected muscles changes the diagnosis. The same applies to chronic quadriceps amyotrophy in general, which cannot be regarded as an entity, but which suggests muscular dystrophy, spinal atrophy, polymyositis or a metabolic disorder. These cases can be compared with the four cases reported in the literature, which were regarded as a "forme fruste" of chronic spinal amyotrophy.

Three cases of arthritis after BCG therapy for bladder cancer.

The authors report three cases of arthritis occurring after treatment with BCG immunotherapy for bladder disease. This complication is observed in 0.5 to 1% of treated patients and affects the small joints within 1 to 5 months of the first BCG injection. The clinical outcome is favourable with non-steroidal antiinflammatory drugs. This form of arthritis may be attributable to a cross-reaction between antigenic components of cartilaginous proteoglycan and BCG, influenced by a particular HLA-DR pattern, and with the intervention of a heat shock protein.

Early effects of nimodipine on intracranial and cerebral perfusion pressures in cerebral anoxia after out-of-hospital cardiac arrest.

Some calcium entry blockers seem to improve the neurological survival of anoxic comas. The early monitoring of intracranial pressure shows the frequency of intracranial hypertension. A calcium channel blocker has been shown to increase the cerebral blood flow which can potentially lead to deleterious increases of the intracranial pressure. This study presents 39 out-of-hospital cardiac arrests resuscitated with success. The intracranial pressures were registered by means of an extra dural screw set up as soon as possible. Nineteen patients received an early continuous 5 days nimodipine treatment (0.58 gamma/kg weight/min. after a 12.3 gamma/kg weight bolus). The other 20 patients did not receive any calcium entry blocker. The two groups were similar in terms of age, origin and electrical type of cardiac arrest, duration of cardiac arrest before BLS and before ACLS, principles of the treatment, initial neurological status and biological values. The maximum and mean intracranial pressures of the nimodipine group were always lower than the intracranial pressure of the control group. The cerebral perfusion pressure was never significantly different in both groups. If the nimodipine treatment proves to be efficient on neurological survival, it would be all the more interesting because it seems to limit the intracranial hypertension phenomenon which aggravates the neurological prognosis.

IgM antiplatelet antibodies in 7 out of 20 rheumatoid arthritis sera. A new antiplatelet antibody ELISA. Reverse correlation with anti-B-lymphocyte antibodies in the same sera.

In a previous work, we had found that anti-B lymphocyte antibodies exist in rheumatoid arthritis. To investigate whether these antibodies were directed against surface immunoglobulins or not we have investigated if RA sera could recognize similar structures on other targets such as platelets (on which immunoglobulins and immune complexes are present) by a new ELISA method. No IgG antiplatelet antibody was found in 20 RA sera. But 7 out of these 20 RA sera had IgM antiplatelet antibodies when tested on platelets from 5 donors. The comparison of the positivities of these sera on B lymphocytes and platelets from the same donors showed a statistically significant reverse (X2 = 20,008, p much less than 0.0001) correlation. The target antigen and the meaning of these IgM antiplatelet antibodies, which seem to be associated with severe RA, is still under investigation.

Monocytes and granulocytes in rheumatoid arthritis (RA): phagocytic activity and superoxide anion production.

It is suggested by many tests that phagocytic cells were implied in inflammation which occurred during rheumatoid arthritis (RA). Further, three subject populations were selected for this study: Rheumatoid arthritis patients diagnosed according to American Rheumatism Association criteria (ARA mean = 6) and treated with gold compounds. Control subjects treated with the same non-steroidal anti-inflammatory drug (NSAID), diclofenac (75 mg per day). Normal subjects without disease or treatment. Blood granulocytes and monocytes were separately tested for ingestion of three different particle species (opsonized zymosan, immunoglobulin G sheep red cells, glutaraldehyde-treated sheep red cells) and stimulation of superoxide anion production by these particles. All phagocytic cells in RA patients have normal phagocytic response and superoxide anion production. Autologous serum does not inhibit the activity of these cells. In addition the NSAID (diclofenac) does not act upon phagocytosis and oxidative burst of control cells.

Aetiologies of male osteoporosis: identification procedures.

Secondary causes and risk factors assume far greater importance in male osteoporosis than in female osteoporosis. The principal problem in dealing with male osteoporosis, above all in young men, is the difficulty to find a curable aetiology. Six groups of aetiologies can be drawn up: toxic causes or causes due to a change in the general state of health, drug-induced causes, renal causes, hormonal causes, exceptional causes and lastly the idiopathic form. The minimum number of investigations necessary so as to be quite sure not to overlook these various aetiologies is proposed.

HLA-DR typing in 58 cases of rheumatoid arthritis.

The results of a previous study led us to believe that the association of HLA-DR4 and rheumatoid arthritis could be of particular interest in our region. In this work we typed 58 caucasoid patients in the Marseilles area by microlymphocytotoxicity assay in B-cells. HLA-DR4 was found to be at the same level as that observed by the authors in the 8th Workshop of histocompatibility (1980) (X2:32.36, P less than 0.001) and very high in the seropositive patients (61.5 per cent). No correlation with sex was observed. We again found a low frequency of HLA-DR4 (15.8 per cent) in our controls.

Broadband ultrasound attenuation of the os calcis: preliminary study.

Broadband ultrasound attenuation (BUA) measurements of the calcaneus were performed in 87 healthy subjects and in 17 patients with osteoporotic vertebral fractures. In 52 normal subjects, bone mineral densities (BMD) of the lumbar spine were measured by quantitative CT (QCT), and in another group of 15 normal subjects, BMD of the lumbar spine was measured using dual energy X-ray absorptiometry (DXA). BUA showed a negative significant correlation with age (r = 0.44; p < 0.001), and was more pronounced in women. A significant positive correlation of BUA in the os calcis with lumbar BMD using QCT (r = 0.53, p < 0.001) or DXA (r = 0.81; p < 0.001), was observed. We found no significant difference between osteoporotic patients (n = 17; mean BUA value: 58.4 +/- 18) and controls (n = 17; mean BUA value; 61 +/- 15). The mean coefficient of variation was high: 6%. These results suggest that BUA is not yet a valuable tool in general clinical practice and that further additional improvements are necessary in order to use it in the management of osteoporosis.

Lumbar bone mineral density in anorexia nervosa.

We studied lumbar bone mineral densities (BMD) using a dual photon absorptiometer in 18 women with anorexia nervosa (AN). Results were compared with data from a control group of 36 healthy women. We found significantly reduced mean bone densities as compared with control group (0.814 +/- 0.072 g/cm2 hydroxy-apatite equivalent vs 1.011 +/- 0.023; p < 0.01). Only one patient developed vertebral compression fracture. BMD was negatively correlated with duration of amenorrhoea (r = -0.68; p < 0.01) but not significantly with duration of AN. We found no correlation between BMD and estradiol blood levels, age of onset, body mass index and daily calorie intake. The correlation between BMD and duration of amenorrhoea may indicate that long standing estrogen deficiency is a major factor in the osteoporosis (OP) observed in AN.

Surgical management of calcific tendinitis of the shoulder: an analysis of 26 cases.

Chronic calcific tendinitis of the shoulder has good results after medical treatment in most cases. Around 10% of the patients resistant to medical treatment require surgery. We report 22 patients operated on using an open procedure. The operation included removal of the calcific deposit and an acromioplasty. The patients were rated preoperatively and postoperatively for pain, limitations in activities of daily living, range of movement and power according to a questionnaire and the Constant assessment. Globally the average score increased from 52.2 points out of 100 at the preoperative examination to 89.3 postoperatively with a mean follow up of 23 months. The most favourable results are obtained in patients with the longest interval between onset of disease and intervention (over 1 year) and with a progressive course of disease. Different techniques are discussed. Arthroscopically assisted procedures and open techniques are compared.

Magnetic resonance imaging of the wrist in rheumatoid arthritis: comparison with other inflammatory joint diseases and control subjects.

The aim of this study was to evaluate magnetic resonance images (MRI) of the wrist of rheumatoid arthritis (RA) patients. MRI and plain X-ray of the wrists were performed in 15 patients with RA, 7 patients with another chronic inflammatory joint disease (CIJD), and 10 control subjects. Patients had only minor changes on plain X-ray. Coronal T1 weighted spin echo sequences were performed before and after an intravenous pulse of gadolinium (GD). Contiguous 3 mm thick slices were obtained. Synovitis was frequently objectivized in the two groups of patients. MRI detected far more erosions and central bone geodes than plain X-ray. Geodes were frequent among controls while cortical bone erosions were frequent in patients. Most of the erosions were enhanced after GD injection in the RA patients but not in the 2 other groups. Thus MRI is not only useful in diagnosing inflammatory changes of the wrist but also in distinguishing early stage RA from other CIJD.

Antiphospholipid syndrome and factor V Leiden. Three cases with recurrent venous thrombosis.

Recurrent thrombosis is a common complication of various rheumatic disorders and is part of the definition of antiphospholipid syndrome. We report three cases of recurrent venous thrombosis due not only to antiphospholipid syndrome with a normal activated partial thromboplastin time but also to resistance to activated protein C caused by the factor V Leiden mutation. These three cases confirm that thrombotic disease is frequently multifactorial and suggest that resistance to activated protein C should be looked for routinely in patients with suggestive clinical manifestations, particularly when standard clotting tests are normal.

Serum and synovial fluid osteocalcin in rheumatic diseases.

The mechanisms involved in juxta-articular bone destruction are poorly understood. Osteocalcin or gamma-carboxyglutamic acid (GLA) protein is a small non-collagenous bone protein. It is a sensitive marker of osteoblastic bone formation. Its seric variations in the serum in such rheumatisms as rheumatoid arthritis remain unclear. Further information on local osteoblastic activity may be obtained by assaying the level of osteocalcin in the synovium. Its serum level can be evaluated by radioimmunoassay. The same method can be used in the synovial fluid. Paired serum and synovial fluid samples have been assayed from 63 patients, 33 patients with inflammatory arthritis (rheumatoid arthritis, psoriasis, chondrocalcinosis, pyogenic arthritis) and 30 patients with mechanical joint effusion (osteoarthritis, meniscal lesions). Serum levels of osteocalcin were the same in the inflammatory group (m: 8.69 +/- 0.68 ng/ml) and in the mechanical group (m: 10.2 +/- 0.67 ng/ml). In the synovial fluid, the levels of osteocalcin were significantly lower in the inflammatory group (m: 3.27 +/- 0.40 ng/ml) than in the mechanical group (m: 6.91 +/- 0.47 ng/ml). The same results were obtained with the ratio of synovial fluid osteocalcin on serum osteocalcin. There was a significant correlation between serum and synovial fluid osteocalcin and an inverse correlation between synovial fluid osteocalcin and the number of synovial fluid cells. The present study suggests that periarticular osteoblastic depression, among patients with inflammatory arthritis, is likely.