Association of tramadol with risk of myocardial infarction among patients with osteoarthritis.

OBJECTIVE: Tramadol has been widely used among patients with osteoarthritis (OA); however, there is paucity of information on its cardiovascular risk. We aimed to examine the association of tramadol with risk of myocardial infarction (MI) among patients with OA. DESIGN: Among OA patients aged 50-90 years without history of MI, cancer, or opioid use disorder in The Health Improvement Network database in the United Kingdom (2000-2016), three sequential propensity-score matched cohort studies were assembled, i.e., (1) patients who initiated tramadol or naproxen (negative comparator); (2) patients who initiated tramadol or diclofenac (positive comparator); and (3) patients who initiated tramadol or codeine (a commonly used weak opioid). The outcome was incident MI over six-months. RESULTS: Among tramadol and naproxen initiators (n = 33,024 in each cohort), 77 (4.8/1000 person-years) and 46 (2.8/1000 person-years) incident MI occurred, respectively. The rate difference (RD) and hazard ratios (HR) for incident MI with tramadol initiation were 1.9 (95% confidence interval [CI] 0.6 to 2.3)/1000 person-years and 1.68 (95% CI 1.16 to 2.41) relative to naproxen initiation, respectively. Among tramadol and diclofenac initiators (n = 18,662 in each cohort), 58 (6.4/1000 person-years) and 47 (5.1/1000 person-years) incident MIs occurred, respectively. The corresponding RD and HR for incident MI were 1.2 (95%CI -2.1 to 14.1)/1000 person-years and 1.24 (95%CI 0.84 to 1.82), respectively. Among tramadol and codeine initiators (n = 42,722 in each cohort), 127 (6.1/1000 person-years) and 103 (5.0/1000 person-years) incident MI occurred, respectively, and the corresponding RD and HR were 1.1 (95%CI:-0.3 to 2.5)/1000 person-years and 1.23 (95%CI:0.95 to 1.60), respectively. CONCLUSIONS: In this population-based cohort of patients with OA, the six-month risk of MI among initiators of tramadol was higher than that of naproxen, but comparable to, if not lower than, those of diclofenac or codeine.

Exploring underwater target detection by imaging polarimetry and correlation techniques.

Underwater target detection is investigated by combining active polarization imaging and optical correlation-based approaches. Experiments were conducted in a glass tank filled with tap water with diluted milk or seawater and containing targets of arbitrary polarimetric responses. We found that target estimation obtained by imaging with two orthogonal polarization states always improves detection performances when correlation is used as detection criterion. This experimental study illustrates the potential of polarization imaging for underwater target detection and opens interesting perspectives for the development of underwater imaging systems.

Spatial genetic structure of Taxus baccata L. in the western Mediterranean Basin: past and present limits to gene movement over a broad geographic scale.

English yew (Taxus baccata L., Taxaceae), a Tertiary relict, provides a seminal example of a widespread albeit locally endangered (often close to extinction) tree species. In order to gain detailed insights into the evolutionary dynamics of the species on a broad geographical scale, over 1000 trees from 91 populations of English yew in the western Mediterranean were analyzed using seven nuclear microsatellite markers. Our results revealed contrasting patterns of genetic structure at different spatial scales: genetic variation was highly structured at the local scale, while only a low proportion of the observed variation was attributed to regional differences. We also found a geographic gradient of decreasing diversity and increasing population divergence from northwest (central Europe and northern Iberian Peninsula) to southeast (Mediterranean Iberia and North Africa). The patterns revealed in this study probably reflect the combined effects of Quaternary climatic changes and recent impact of human activities, and potentially also more ancient events dating back to the Tertiary. Both climatic and anthropogenic factors seem to have conducted to a long history of population isolation, which may have contributed significantly to enhance population divergence through restricted gene flow and genetic drift.

[HIV, only the tip of the iceberg in Burundi]. / Le Burundi au-delà du VIH.

In Burundi, like in many other resource-limited settings, HIV sector is mainly financed by international funding (IF). Through this way, HIV-infected people may have access to care, antiretroviral therapy and opportunistic infections medications free of charge. In addition, IF can also contribute to major the HIV-health care professionals (HCP) salary. Indeed, because of dramatically low incomes, public sector HCP move frequently through the country or migrate towards foreign countries, attracted by higher salaries and better working environment. To date, relatively large funding became available in some settings for HIV-care. Through illustrative examples from the field in Burundi, we are discussing why consequences are, in many cases, a worsening of inequities and disorganization of the public health sector, instead of leading this latter one towards a global improvement. Furthermore, we are suggesting that HIV-programs per se are not sufficient to provide a proper management of the epidemic at a global scale.

Depression among cocaine abusers in treatment: relation to cocaine and alcohol use and treatment outcome.

OBJECTIVE: The authors investigated the theoretical and clinical role of depression among cocaine abusers in treatment. METHOD: Eighty-nine cocaine-abusing patients underwent 2 weeks of substance abuse treatment. Posttreatment major depressive disorder, depressive symptoms before and after substance abuse treatment, and alcohol diagnoses were assessed and their relation to pretreatment substance use, cravings in high-risk situations, and 3-month follow-up status was examined. RESULTS: High rates of major depressive disorder were found but were unrelated to pretreatment substance use. The decrease in depressive symptoms during treatment was independent of major depressive disorder or alcohol diagnoses and predicted treatment attrition. Higher levels of depressive symptoms during treatment were associated with greater urge to use cocaine, alcohol, and other drugs in high-risk situations. Concurrent major depressive disorder and depressive symptoms did not predict cocaine use at follow-up. However, patients who had an alcohol relapse episode experienced more depressive symptoms during treatment than did those who abstained. CONCLUSIONS: The results highlight the relationship of depression to alcohol use among cocaine abusers and suggest a need for further studies of the association between depression and substance use disorders.

Intensive chemotherapy (LNHIV-91 regimen) and G-CSF for HIV associated non-Hodgkin's lymphoma.

The purpose of the study was to evaluate the safety and long-term efficacy of an intensive chemotherapy regimen associated with G-CSF in HIV-associated non-Hodgkin's lymphoma (NHL). Fifty two consecutive patients with HIV infection, aggressive NHL and CD4+ cells > or = 100 x 10(6)/l were included. The median CD4 cell count was 276 x 10(6)/l. Nineteen tumors were of the Burkitt's type, 23 were large cells, 7 immunoblastic, and 3 anaplastic. Twenty-five patients had stage IV disease (bone marrow involvement in 7, and central nervous system in 9). Three cycles of ACVBP (doxorubicine, cyclophosphamide, vindesine, bleomycin, prednisolone) were given. A fourth cycle was delivered to patients in partial remission or with initial bulky disease. The induction was followed by three cycles of CVM (cyclophosphamide, etoposide, methotrexate). G-CSF 5 microg/kg was used at each cycle. Results showed that 37 patients (71%) achieved a complete remission. With a median follow-up of 74 months, 8 of them have relapsed. The median survival was 15 months and 34 patients have died (21 with NHL). The 4-year estimate survival was 33.9% (95% CI, 19.8%-47.4%). The Relative Dose-Intensity of the chemotherapy was 85% for doxorubicine and 87% for cyclophosphamide. In a multivariate analysis, homosexual men and patients with ECOG < 2 had a lower risk for death: RR = 0.32 (95% CI, 0.15-0.65) and RR = 0.36 (95% CI, 0.18-0.74), respectively. Achievement of complete remission was strongly associated with survival. In conclusion, it seems that in HIV-infected patients with NHL and a CD4 cell count above 100 x 10(6)/l, high complete remission rate and prolonged survival can be achieved with the intensive LNHIV-91 regimen.

Plasma amino acid pattern in burn subjects: influence of septicemia.

A comparison of plasma amino acid levels was made between two groups of burn subjects, septic and non-septic. On day 4 after injury, results do not show any differences between patients who later went on to develop sepsis on day 7 and those who remained non-septic. Similarly, no differences between these two groups were discernable on day 7. Thus metabolic variations induced by septicemia do not seem to modify the usual burn-induced amino acid variations; consequently, plasma amino acid determination in burn patients do not appear to predict septicemia.

Carbonic anhydrase and horseradish peroxidase: double labelling of rat dorsal root ganglion neurons innervating motor and sensory peripheral nerves.

Dorsal root ganglion neurons supplying peroneus longus, soleus and gastrocnemius medius muscles and the sural nerve of the rat were labelled with horseradish peroxidase and analysed for their carbonic anhydrase content. Staining of the sections was done either on the same or on alternate slides. Both methods led to the same results, despite a slight fading of the carbonic anhydrase reaction in double-stained sections. The data indicated that the muscles under study were supplied by approximately the same number of horseradish peroxidase-labelled cells, irrespective of their differences in size. 74.9% of these labelled neurons had diameters exceeding 30 microns and 52.4% of them also stained for carbonic anhydrase. The double-labelled cells represented 66.9% of the population of large neurons (greater than 30 microns) and comprised most of those measuring over 47.5 microns. Richness in carbonic anhydrase of the large muscle afferent neurons may be linked to their innervation of the stretch receptors, as components of an active apparatus which includes the gamma motor axons which also stain positively for carbonic anhydrase. In contrast, the ganglion cells supplying the sural nerve were almost totally devoid of carbonic anhydrase, as only 6.4% showed double labelling. This contingent possibly represents the muscle afferents of the small motoneural population which supplies, through this nerve, part of the foot musculature of the rat.

Exercise attitudes and behaviors among persons in treatment for alcohol use disorders.

The present study investigated self-reported exercise behaviors and exercise-related attitudes in a sample (N = 105) of adults in treatment for alcohol use disorders (AUD) (abuse or dependence). Slightly less than half (47%) of participants reported engaging in regular physical exercise (3 times per week or more). Level of alcohol dependence was not significantly associated with level of physical exercise activity. Level of nicotine dependence was significantly and negatively associated with physical activity level. Nicotine dependence and level of depressive symptoms were both significantly negatively associated with self-efficacy for physical exercise (SPE). Exercise self-efficacy mediated the relationship between nicotine dependence and physical activity level. Tension and stress reduction were among the most strongly endorsed of the perceived benefits of physical activity. Other perceived benefits included more positive outlook and increased self-esteem. Financial costs associated with exercise, lack of motivation, and time constraints were among the most common perceived barriers to exercise in this sample. Together, these preliminary data indicate that exercise-based interventions are may be well-received by those early in recovery from AUDs.

Minced beef and human salmonellosis: review of the investigation of three outbreaks in France.

The synthesis of investigations of three salmonellosis outbreaks which occured in France between 1998 and 2000 confirms the role of the consumption of minced beef and highlights the importance of prevention measures.

Primitive pharyngeal dyskinesia associated with upper airway collapse in an infant.

We report a case of total collapse of the upper pharyngeal airway in a slightly premature baby, resulting in a noisy breathing disorder. Primary immaturity of the central nervous system contributing to pharyngeal muscle hypotonia has been implicated in association with the increase in nasal pressure. The infant experienced complete resolution of symptoms a few weeks after the placement of a nasopharyngeal tube. This case report demonstrates the difficulty in diagnosis and management. The developmental spectrum and exploration are reviewed.

[Comparison of two measurement methods: the Bland and Altman assessment]. / Comparaison de deux méthodes de mesure d'une même grandeur: méthode de Bland et Altman.

Bland-Altman analysis for comparison of two methods of clinical measurement is frequently used in scientific publications. This article is more appropriate than the conventional linear regression analysis. This paper gives an overview of the principles for the use of Bland-Altman analysis as well as the specific terminology attached to it. The Bland-Altman comparison analysis is mainly a tool for clinical interpretation. The bias and the agreement limits provide the variation of the values of the technique compared to the other. The difference between the two methods of measurement is plotted against the average obtained with each of the two techniques. Bland-Altman analysis can also be used to check the repeatability of a measurement technique within the same subject and to determine a repeatability coefficient. With an adaptation of the calculation of the agreement limits, the average of multiple measurements for each subject with two measurement techniques can be used for the Bland-Altman analysis.

-A difficult intubation of an infant with McKusick-Kaufman syndrome. Failure of the laryngeal mask-fibroscope sequence-. / Intubation difficile chez un nourrisson atteint d'un syndrome de McKusick-Kaufman. Echec de la séquence masque laryngé-fibroscope.

Fibreoptic intubation through the laryngeal mask airway is a recommended technique for the management of a restricted airway. We report the failure of this technique in a 20-month-old infant presenting with McKusick-Kaufman syndrome.

[Acral erythema and HIV infection]. / Erythème acral et infection par le VIH.

BACKGROUND: Acral erythema is a non specific skin condition observed in connective tissue diseases, viral infections and toxic skin reactions. More recently, this symptom has been reported in HIV-infected patients. CASE REPORT: We observed two cases of acral erythema in HIV seropositive patients. Both patients were drug abusers. Erythema was limited to the limbs with no clinical manifestation of connective tissue disease. Both consumed approximately 40 tablets of codeine daily and had hepatitis C without cirrhosis. DISCUSSION: Our 2 cases of acral erythema in HIV-infected patients can be added to 32 cases of digital erythema in HIV patients reported in the literature. The common features in most of these patients was intravenous opiate abuse and hepatitis C without cirrhosis. The degree of immunodeficiency, the nature of opportunistic infections and antiretroviral treatments do not appear to affect the development of skin signs. HIV infection, simultaneous HIV-HCV infection and codeine suggest they might have a pathogenic role in the development of distal vascularization disorders.

[Capnography in pediatric anesthesia: pitfalls and applications]. / Capnographie en anesthésie pédiatrique: pièges et applications.

Expired CO2 analysis is an important area of anaesthetic monitoring. It ranges from ventilator connection to the estimation of alveolar dead space. In paediatric anaesthesia, end tidal CO2 measurement and analysis as well as PaCO2 estimation are subject to a rather large number of mistakes. Confrontation between the technical specificities of CO2 monitors and the anatomical and physiological distinctive characteristics of the paediatric patient is mainly responsible for the interpretation difficulties encountered. Nevertheless capnography remains fundamental for paediatric ventilation monitoring.

Liposome-encapsulated antibiotics: preparation, drug release and antimicrobial activity against Pseudomonas aeruginosa.

Ticarcillin- and tobramycin-resistant strains of Pseudomonas aeruginosa were shown to have a markedly increased sensitivity to antibiotics enclosed in liposomes. This was demonstrated by growth inhibition of two resistant P. aeruginosa strains in the presence of the liposome-enclosed ticarcillin and tobramycin at 2 per cent and 20 per cent of their respective minimum inhibitory concentration. The liposome-enclosed antibiotic was as effective against the beta-lactamase-producing strain as against the non-beta-lactamase producing strain. Entrapment efficiency of the two antibiotics with the dehydration-rehydration vesicle (DRV) method was largely superior to other methodologies used. Kinetic studies with DRV demonstrated that tobramycin and ticarcillin-loaded liposomes still contained 83 per cent and 67 per cent of drug respectively after 24 h at 37 degrees C.