Impact of drug consumption rooms on non-fatal overdoses, abscesses and emergency department visits in people who inject drugs in France: results from the COSINUS cohort.

BACKGROUND: The effectiveness of drug consumption rooms (DCRs) for people who inject drugs (PWID) has been demonstrated for HIV and hepatitis C virus risk practices, and access to care for substance use disorders. However, data on other health-related complications are scarce. Using data from the French COSINUS cohort, we investigated the impact of DCR exposure on non-fatal overdoses, abscesses and emergency department (ED) visits, all in the previous 6 months. METHODS: COSINUS is a 12-month prospective cohort study of 665 PWID in France studying DCR effectiveness on health. We collected data from face-to-face interviews at enrolment, and at 6 and 12 months of follow-up. After adjusting for other correlates (P-value < 0.05), the impact of DCR exposure on each outcome was assessed using a two-step Heckman mixed-effects probit model, allowing us to adjust for potential non-randomization bias due to differences between DCR-exposed and DCR-unexposed participants, while taking into account the correlation between repeated measures. RESULTS: At enrolment, 21%, 6% and 38% of the 665 participants reported overdoses, abscesses and ED visits, respectively. Multivariable models found that DCR-exposed participants were less likely to report overdoses [adjusted coefficient (95% CI): -0.47 (-0.88; -0.07), P = 0.023], abscesses [-0.74 (-1.11; -0.37), P < 0.001] and ED visits [-0.74 (-1.27; -0.20), P = 0.007]. CONCLUSION: This is the first study to show the positive impact of DCR exposure on abscesses and ED visits, and confirms DCR effectiveness in reducing overdoses, when adjusting for potential non-randomization bias. Our findings strengthen the argument to expand DCR implementation to improve PWID injection environment and health.

Translocation of the macula for management of subfoveal choroidal neovascularization: comparison of results in age-related macular degeneration and degenerative myopia.

PURPOSE: To report the results of limited macular translocation in subfoveal choroidal neovascularization resulting from age-related macular degeneration or degenerative myopia. METHODS: The first consecutive 32 patients (23 age-related macular degeneration eyes and nine myopic eyes) were operated on with the limited macular translocation technique described by de Juan. Before and after surgery, a complete examination included fluorescein and indocyanine-green angiographies and optical coherence tomography. Mean follow-up was 9 months in the age-related macular degeneration group (range, 6 to 14 months) and 10 months in the myopic group (range, 6 to 15 months). RESULTS: The improvement in visual acuity was better in the myopic group than in the age-related macular degeneration group and was correlated with younger age in the myopic group (P <.05). At the end of follow-up, visual acuity improved by 2 lines or more in seven age-related macular degeneration eyes (30%), including four eyes (13%) with an improvement of 6 lines or more, and in six myopic eyes (67%), including two eyes (22%) with an improvement of 6 lines or more. Final visual acuity was unchanged in four age-related macular degeneration eyes (17%) and three myopic eyes (33%), and decreased in 12 age-related macular degeneration eyes (52%). Conversely, the mean foveal displacement was greater in age-related macular degeneration than in myopia (1,105 microm and 685 microm, respectively; P <.05). Main complications were retinal detachment (six eyes), neovascularization at the injection site (two eyes), and recurrence of neovascularization (43% of the age-related macular degeneration group and 11% of the myopic group). CONCLUSIONS: Limited macular translocation allowed a significant improvement in visual acuity in some eyes with subfoveal neovascularization and resulted in a moderate rate of complications. Longer follow-up and additional studies are required to confirm these findings.

[Glaucoma and ultrasound biomicroscopy]. / Glaucomes et biomicroscopie ultrasonore.

Ultrasound biomicroscopy (UBM) can provide high-resolution images in the living human eye; this resolution has been compared to microscopic resolution. This system is particularly useful in studying the anterior segment and analyzing the different types of glaucoma. Anatomical aspects, physiopathological processes and surgical results in glaucoma could be evaluated with UBM. This exploration is also important in determining differential diagnosis, risk factors, and prognostic elements. In addition, using UBM after filtering surgery helps detect early complications and understand poor surgical outcome.

[Is cheating with automatic perimetry possible?]. / Peut-on tricher en périmétrie automatique?

INTRODUCTION: Automatic perimetry examination requires the patient's cooperation, but the programs used check response validity. This study evaluated the possibility of patient cheating on this examination. MATERIALS AND METHOD: This study investigated 27 visual fields of automatic perimetry with patients who had no ophthalmological history. Each subject had to reproduce a visual field loss that was observed for 5 minutes (two diffuse losses, five fields reflecting hemianopsia, four reflecting quadranopsia, two tubular losses, five nasal steps, nine absolute and arciform losses). The 24-2 Fastpac of the Humphrey field analyzer and the G2 of the Octopus perimeter were used for this study. RESULTS: Simple deficits were easy to reproduce, but visual field defects are often deeper and simulated test results tend to be too perfect. On the other hand, complex defects such as arciform scotoma or nasal steps were more difficult to reproduce. Visual field defect simulations were exaggerated beyond what was reasonable. CONCLUSION: This study reports on whether it is possible to cheat with automatic perimetry. The different parameters analyzed by computer programs are not able to detect cheating patients.

[How patients react when glaucoma is diagnosed?]. / Comment les patients réagissent-ils à la découverte d'un glaucome?

PURPOSE: Evaluate the psychological consequences of announcing the diagnosis of glaucoma. MATERIALS AND METHODS: Two hundred patients completed a 20-item questionnaire designed to analyze the context in which glaucoma was discovered and the patients' reaction to this diagnosis. Behavioral modification in patients and their families are specified as well as their perception of the information received. COMMENTS: Most patients had open-angle glaucoma and showed either an anxious or a passive reaction to the announcement of the diagnosis. Severe anxiety led to prescription of minor tranquilizers or antidepressants in 11% of cases. Nearly half of the patients declared that they had modified their behavior after receiving the diagnosis, indicating a need to play an active role in disease management. A large majority of the patients were conscious of the risk of blindness related to glaucoma; however, they did not feel ill but rather handicapped . Most were dissatisfied with the information provided by their doctor and sought other sources of information. CONCLUSION: Announcing a diagnosis of glaucoma is a decisive step in the physician-patient relationship, known to be important in future treatment compliance. Better adapted information with regular reevaluation of the need for additional information is necessary. The psychological impact should be evaluated regularly in order to promote an active role on the part of the patient and avoid a decline in quality of life.

[Clinical features of gliomas of the chiasma. A retrospective study of a series of 18 patients]. / Particularités cliniques des gliomes du chiasma. Etude rétrospective sur une série de 18 patients.

Eighteen patients with a glioma of the chiasma were managed between 1980 and 1994. A retrospective analysis of this series showed that the most frequent functional ophthalmological signs were visual loss, nystagmus, or strabismus. Funduscopic examination was abnormal in 65%, mostly with optic atrophy. Other exams (visual field and electrophysiology) were inadequate for diagnosis. Our series demonstrated that early diagnosis of involvement of the chiasma could improve functional prognosis as rapid management can improve prognosis.

[Fronto-naso-ethmoido-sphenoido-maxillo-orbital mucocele with ophthalmologic presentation]. / Mucocèle fronto-naso-ethmoïdo-sphénoïdo-maxillo-orbitaire à révélation ophtalmologique.

PURPOSE: We present a case of a large mucocele pressing the orbit forward and compared our findings with those reported by others. CASE REPORT: A 23-year-old woman was examined for an inflammatory tumor of the internal canthus. She had a 6/10 vision loss of the left eye, diplopia, and non-axial exophthalmos. CT scan and magnetic resonance imaging evidenced a huge sinus mucocele behind the orbit. Surgery using the paralateronasal approach was performed. Pathology confirmed the diagnosis of mucocele. DISCUSSION: Ophthalmic complications of mucoceles result from tumor growth leading to compressive optic neuropathy or even compression of the chiasma. A sinus mucocele should be suspected upon indirect clinical signs and lead to neuroradiological explorations. Magnetic resonance imaging reveals iso- or high signals on T1-weighted sequences and high signal on T2-weighted sequences. MRI evidences intracranial or orbital extension. CT scan reveal the degree of bone erosion. Prognosis is favorable after surgical treatment. It is important to correctly diagnose mucocele on the basis of clinical and neuroradiological findings in order to propose early surgery and prevent permanent visual loss by compressive optic neuropathy.

Evaluation of factors influencing confidence and trust in the patient-physician relationship: a survey of patient in a hand clinic.

OBJECTIVES: The purpose of this study was to identify the skills found most important to gain patient's trust from a patient's perspective. METHODS: One hundred and twenty-two patients were surveyed prospectively using a questionnaire assessing professionalism, physical environment, verbal and non-verbal communication skills. Factors required to establish a trusting patient-surgeon relationship were ranked in order of importance before and after initial consultation with a surgeon in a hand surgery clinic model. RESULTS: No significant relationship was identified between gender, age, education or income, and answers provided by respondents. Technical ability, verbal communication skills and respect of patient's autonomy by the physician were found most important. CONCLUSION: The visit with the surgeon significantly affected the ranking of some of the skills deemed important. Patients view respect of autonomy and verbal communication skills as the most important attributes when developing trust and confidence in a surgeon, followed by technical proficiency.

[The physician-patient relationship in glaucoma]. / La relation médecin-malade dans le glaucome.

Healthcare of chronic pathologies, especially in glaucoma, which is asymptomatic for a long period of time, is based on a good, confident relationship between physicians and patients. This relationship has to be created, maintained, and reinforced throughout follow-up. The patient's information source is to a large extent the physician, who must provide all the necessary information concerning the disease, including the definition, prognosis, follow-up, and treatment. How the information is transmitted should be personally adapted to patients, taking into account their own and their family's psychological reactions. It is also important to keep in mind the factors influencing poor compliance when talking to our patients.

Chronic effects of the novel glucocorticosteroid RPR 106541 administered to beagle dogs by inhalation.

The preclinical safety of RPR 106541, a novel 17-thiosteroid, was evaluated in young adult and mature dogs by inhalation exposure for 26 weeks and 52 weeks, respectively. A dry powder formulation of RPR 106541 in lactose was administered to young adult dogs (approximately 6 months of age at initiation) at doses of 0 (air and placebo controls), 10, 100, or 1,000 microg/kg/d for 26 weeks. A solution-based aerosol formulation was administered to mature dogs (approximately 10 months at initiation) from a pressurized metered dose inhaler at 0 (air and placebo controls), 10, 50, and 150 microg/kg/d for 52 weeks. Clinical evidence of glucocorticosteroid-induced immunosuppression was observed by weeks 20-26 following relatively high dose exposures (100 microg/kg/d and 1,000 microg/kg/d) in young dogs receiving the dry powder formulation for 26 weeks. Classic glucocorticosteroid effects were observed, including adrenocortical atrophy, reduced bone mass with retention of epiphyseal growth plates in long bones, prominence of stromal adipose tissue in bone marrow, and atrophy of lymphoid tissues. Inhalation administration of RPR 106541 to sexually mature dogs facilitated more definitive characterization of endocrine affects of RPR 106541 as compared with administration in younger, sexually immature animals. Significant effects in female reproductive organs included absence of corpora lutea in association with atresia of vesicular follicles within the ovaries, endometrial hyperplasia, and lobular development of mammary tissue. Discordant development of mammary tissue, accumulation of secretory material within hyperplastic endometrial glands, and hypertrophy of uterine lining epithelium in absence of ovulation were consistent with a secondary progestin effect by a potent glucocorticosteroid.

The effects of hemodilution with Hemolink upon hemodynamics and blood flow distribution in anesthetized dogs.

Hemoglobin based oxygen-carrying solutions (HBOCs) as hemoglobin replacement therapeutics are being tested for clinical use. Some of these products are associated with elevations in both systemic and pulmonary vascular resistances but their effect on the distribution of blood flow to major organs in larger animals have not been extensively described. We tested two formulations of o-raffinose cross-linked human hemoglobin, Hemolink (frozen-Hemolink-1 and refrigerated Hemolink-2) and compared them to Pentaspan, a colloid volume expander in extensive clinical use. Cardiovascular measurements and the distribution of blood flow (radionuclide-labeled microspheres) to the major organs were determined in Beagle dogs (n = 5 per group). After baseline measurements, either Hemolink-1, Hemolink-2, or Pentaspan was exchange transfused in an isovolemic manner (resulting in hematocrit reduction to approximately 20-25%); measurements were made 30, 60, 120 and 180 min post-exchange. There was no significant difference in cardiac output, mean arterial pressures and systemic or pulmonary vascular resistances after exchange in any of the three groups. Myocardial blood flow increased in all three groups post-exchange but the increase was more sustained in the Hemolink groups. Endocardial/epicardial flow ratios were also maintained after exchange in all groups. Thus, Hemolink is ideally suited for volume replacement when used in conjunction with acute normovolemic hemodilution because under these circumstances, the adverse hemodynamic effects are alleviated while extra hemoglobin is added to the blood.

The effects of hemodilution with Hemolink upon hemodynamics and blood flow distribution in anesthetized dogs.

Hemoglobin based oxygen-carrying solutions (HBOCs) as hemoglobin replacement therapeutics are being tested for clinical use. Some of these products are associated with elevations in both systemic and pulmonary vascular resistances but their effect on the distribution of blood flow to major organs in larger animals have not been extensively described. We tested two formulations of o-raffinose cross-linked human hemoglobin, Hemolink (frozen Hemolink-1 and refrigerated Hemolink-2) and compared them to Pentaspan, a colloid volume expander in extensive clinical use. Cardiovascular measurements and the distribution of blood flow (radionuclide-labeled microspheres) to the major organs were determined in Beagle dogs (n=5 per group). After baseline measurements, either Hemolink-1, or Hemolink-2, or Pentaspan was exchange transfused in an isovolemic manner (resulting in hematocrit reduction to approximately 20-25%); measurements were made 30, 60, 120 and 180 min post-exchange. There was no significant difference in cardiac output, mean arterial pressures and systemic or pulmonary vascular resistance after exchange in any of the three groups. Myocardial blood flow increased in all three groups post-exchange but the increase was more sustained in the Hemolink groups. Endocardial/epicardial flow ratios were also maintained after exchange in all groups. Thus, Hemolink is ideally suited for volume replacement when used in conjunction with acute normovolemic hemodilution because under these circumstances, the adverse hemodynamic effects are alleviated while extra hemoglobin is added to the blood.