Empathy in medicine: A ritualistic healing function?

Marcel Réja (1873-1957) French alienist evokes in his book « Au pays des miracles ¼ this innumerable people of healers, mystics, empirics, magnetizers, mediums and fantasists. All operating "cures more wonderful than each other". This book questions in a very relevant way the role of the power of the spirit, of healing by the spirit and therefore of suggestion. This "art" of healers includes an affective and emotional coefficient which constitutes its essential spring. There is a mysterious force between the sick and the physician that goes "soul to soul". Current medicine is still very much borrowed from its past with a remnant of "magical" thought. Also, the empathetic dimension of the care relationship remains one of the most necessary dimensions for the exercise of the medical profession.

At the feet of storytellers: Implications for practicing early relational health conversations.

A family- and culturally-centered approach to conversations about early relational health (ERH) can open up opportunities for universal family engagement. The appraisal of family-baby relational health is more trustworthy and useful when there is attunement to family voice and facilitator bias. Early Relational Health Conversations (ERH-C) is a model for ERH promotion and intervention. This model has eight components: preparing and entering the ERH-C space, accessing strength and knowledge in a healing-centered space, pausing and co-creating, storytelling, witnessing, mutual reflection, affirming, and claiming their relationship narrative, and mutual insight. It is a paradigm shift in working with African American families and possibly other historically marginalized families who are also impacted by structural racism. The eight components are explained, and examples are given from the perspective of an Africentric worldview. The importance of cultural humility, attuning to and honoring family culture is emphasized. Insights for implementation in primary care and other settings are provided. Healing-centered engagement practices embedded in ERH-C have the potential to move ERH work into the social justice arena. The ERH-C is a family reflection model. Ideas for future directions for ERH-C are discussed.

Un acercamiento a conversaciones sobre la salud de la temprana relación (ERH) con base en la familia y en el medio cultural puede abrir oportunidades para la participación familiar universal. La evaluación de la salud de la relación familia-bebé es más confiable y útil cuando hay un ajuste a la voz de la familia y a los prejuicios del mediador. Las Conversaciones de la Salud de la Temprana Relación (ERH-C) es un modelo para la promoción e intervención ERH. Este modelo tiene ocho componentes: preparar y entrar en el espacio de ERH-C, evaluar la fortaleza y el conocimiento en un espacio centrado en la sanación, detenerse y co-crear, contar historias, ser testigo, reflexión mutua, afirmar y reclamar la narrativa de su relación, mutuo aporte de ideas. Se trata de un cambio de paradigma cuando se trabaja con familias afroamericanas y posiblemente con otras familias históricamente marginalizadas que también reciben el impacto del racismo estructural. Se explican los ocho componentes y se dan ejemplos desde la perspectiva de una vista mundial afro-céntrica. Se enfatiza la importancia de la humildad cultural, estar en sintonía con y honrar la cultura familiar. Se aportan ideas para la implementación en el cuidado primario y otros escenarios. Las prácticas de participación centradas en la sanación que son parte de ERH-C tienen la posibilidad de incorporar ERH dentro del campo de la justicia social. ERH-C es un modelo de reflexión de familia. Se discuten ideas para directrices futuras de ERH-C.

Une approche aux conversations sur la Santé Relationnelle Précoce (SRP), centrée sur la famille et la culture, peut ouvrir de nouvelles portes pour l'engagement de la famille universel. L'appréciation de la santé relationnelle famille-bébé est plus digne de confiance et utile que lorsqu'il y a une harmonisation avec la voix de la famille et une partialité de la part du facilitateur. Les Conversations sur la Santé Relationnelle Précoce (C-SRP) est un modèle de promotion de ls SRP et d'intervention. Ce modèle comprend huit aspects: la préparation et l'entrée de l'espace C-SRP, l'accès aux forces et aux connaissances dans un espace centré sur la guérison, faire une pause et créer ensemble, la narration, le témoignage, la réflexion mutuelle, l'affirmation de la narration de la relation et sa revendication, et la perspicacité mutuelle. Ce modèle présente un changement de paradigme dans le travail avec les familles noires américaines et peut-être également d'autres familles marginalisées qui sont aussi impactées par le racisme structurel. Les huit composantes sont expliquées et des exemples sont données de la perspective d'une vision du monde africentrique. L'importance de l'humilité culturelle, d'être à l'écoute de la culture de la famille et d'honorer la culture familiale est également soulignée. Des idées pour la mise en pratique au sein des soins primaires et d'autres contextes sont offertes. Des pratiques d'engagement centrées sur la guérison encastrées dans la C-SRP peuvent faire progresser le travail de SRP vers le domaine de la justice sociale. La C-SRP est un modèle de réflexion de la famille. Des idées de directions futures pour la C-SRP sont discutées.

[The psychological impact of cancer in the medium and long term]. / L'impact psychologique du cancer à moyen et long terme.

More than one in two people recover from cancer after five years. But before claiming victory, they go through a period of remission, a time of uncertainty and convalescence during which they will have to learn to reinvest their body and their identity in order to fully take charge of their life by integrating the awareness of their fragility.

[Pulmonary rehabilitation, return home: the issues of psychic care for severe Covid-19 patients]. / Réadaptation pulmonaire, retour au domicile : les enjeux du soin psychique des patients Covid-19 sévère.

Upon discharge from the ICU, most severe post-Covid-19 patients are considered out of danger and on the mend. A large proportion of these patients are able to go home, but some continue to be frail and suffer from the side effects of the disease and the past heavy hospitalization. Others do not have the necessary support at home. Pulmonary rehabilitation is becoming a critical step in prognosis and a comfortable return home. It allows many patients to regain confidence in their body and its potential, to bridge the gap between a medically safe passive position and daily life, which should become as independent as possible, and to optimally reduce the risks of regression or relapse.

Achieving a high cure rate with direct-acting antivirals for chronic Hepatitis C virus infection in Cameroon: a multi-clinic demonstration project.

OBJECTIVES: Highly effective direct-acting antivirals (DAAs) for Hepatitis C treatment are largely inaccessible in sub-Saharan Africa. Data on treatment feasibility and outcomes in clinical settings are limited. We assessed the feasibility of achieving a high (≥90%) cure rate with DAAs in six gastroenterology clinics in Cameroon. METHODS: Patients with chronic Hepatitis C virus (HCV) infection were treated for 12 or 24 weeks with ledipasvir/sofosbuvir, ledipasvir/sofosbuvir/ribavirin or sofosbuvir/ribavirin, depending on the stage of liver disease and HCV genotype. The cure rate was defined as the proportion of patients with a sustained virological response 12 weeks after treatment completion (SVR12) among all treatment completers. RESULTS: We identified 190 HCV RNA positive patients between September-2017 and August-2018, 161 (84.7%) of whom started treatment. 105 (65.2%) were female, median age was 61.3 years [IQR = 55.9-66.9] and 11 (6.8%) were HIV-positive. Median plasma HCV RNA was 6.0 log10 IU/mL [IQR = 5.6-6.4]. HCV genotypes identified were 1 (34.8%), 2 (13.7%), 4 (50.9%), 1 and 4 (0.6%); 46 (28.6%) strains of 160 single-genotype infections were non-subtypeable. Of 158 treatment completers, 152 (96.2%, 95%CI = 91.9-98.6%) achieved SVR12. Six patients did not achieve SVR12: five carried HCV with NS5A resistance mutations and one with NS5B resistance mutations. Three patients died before and two after treatment completion. The most common adverse events were asthenia (12.0%), headache (11.4%) and dizziness (18.9%). CONCLUSION: High cure rates of Hepatitis C with DAAs are achievable in clinical settings of Cameroon. However, the accessibility and provision of HCV screening, diagnosis, treatment, monitoring and care should be addressed for large-scale implementation.

OBJECTIFS: Les antiviraux à action directe (AAD) hautement efficaces pour le traitement de l'hépatite C sont largement inaccessibles en Afrique subsaharienne. Les données sur la faisabilité du traitement et les résultats en milieu clinique sont limités. Nous avons évalué la faisabilité d'atteindre un taux de guérison élevé (≥90%) avec les AAD dans six cliniques de gastro-entérologie au Cameroun. MÉTHODES: Les patients atteints d'une infection chronique par le virus de l'hépatite C (VHC) ont été traités pendant 12 ou 24 semaines avec le ledipasvir/sofosbuvir, le ledipasvir/sofosbuvir/ribavirine ou le sofosbuvir/ribavirine, selon le stade de la maladie du foie et le génotype du VHC. Le taux de guérison a été défini comme la proportion de patients présentant une réponse virologique soutenue 12 semaines après la fin du traitement (SVR12) parmi tous les patients ayant terminé le traitement. RÉSULTATS: Nous avons identifié 190 patients positifs pour l'ARN du VHC entre septembre 2017 et août 2018, dont 161 (84,7%) ont commencé le traitement. 105 (65,2%) étaient des femmes, l'âge médian était de 61,3 ans [IQR = 55,9-66,9] et 11 (6,8%) étaient positifs pour le VIH. L'ARN plasmatique médian était de 6,0 log10 UI/mL [IQR = 5,6-6,4]. Les génotypes du VHC identifiés étaient 1 (34,8%), 2 (13,7%), 4 (50,9%), 1 et 4 (0,6%); 46 (28,6%) souches provenant de 160 infections à génotype unique n'étaient pas sous-typables. Sur 158 patients ayant terminé le traitement, 152 (96,2%, IC95%: 91,9-98,6%) ont atteint la RVS12. Six patients n'ont pas atteint la RVS12: cinq portaient le VHC avec des mutations de résistance NS5A et un avec des mutations de résistance NS5B. Trois patients sont décédés avant et deux après la fin du traitement. Les événements indésirables les plus courants étaient l'asthénie (12,0%), les céphalées (11,4%) et les étourdissements (18,9%). CONCLUSION: Des taux élevés de guérison de l'hépatite C avec les AAD sont réalisables dans les milieux cliniques du Cameroun. Cependant, l'accessibilité et la fourniture du dépistage, le diagnostic, du traitement, de la surveillance et des soins du VHC devraient être adressés pour une mise en œuvre à grande échelle.

Tuberculosis treatment outcomes and associated factors in two states in Nigeria.

OBJECTIVE: To determine the treatment success rate among TB patients and associated factors in Anambra and Oyo, the two states with the largest burden of tuberculosis in Nigeria. METHODS: A health facility record review for 2016 was conducted in the two states (Anambra and Oyo). A checklist was used to extract relevant information from the records kept in each of the selected DOTS facilities to determine TB treatment success rates. Treatment success rate was defined as the proportion of new smear-positive TB cases registered under DOTS in a given year that successfully completed treatment, whether with bacteriologic evidence of success ('cured') or without ('treatment completed'). Treatment success rate was classified into good (≥85%) and poor (<85%) success rates using the 85% national target for TB treatment outcome. Data were analysed using descriptive statistics and chi-square at P < 0.05. RESULTS: There were 1281 TB treatment enrollees in 2016 in Anambra and 3809 in Oyo (total = 4835). An overall treatment success rate of 75.8% was achieved (Anambra-57.5%; Oyo-82.0%). The percentage cure rates were 61.5% for Anambra and 85.2% for Oyo. Overall, only 28.6% of the facilities in both states (Anambra-0.0%; Oyo-60.0%) had a good treatment success rate. More facilities in Anambra (100.0%) than Oyo (40.0%) had a poor treatment success rate (p < 0.001), as did more private/FBO (100.0%) than public health facilities (60.0%) (p = 0.009). All tertiary facilities had a poor treatment success rate followed by 87.5% of secondary health facilities and 56.5% of primary healthcare facilities (P = 0.035). CONCLUSION: Treatment success and cure rates in Anambra state were below the 85.0% of the recommended target set by the WHO. Geographical location, and level/tier and type of facility were factors associated with this. Interventions are recommended to address these problems.

OBJECTIF: Déterminer le taux de succès du traitement chez les patients TB et les facteurs associés à Anambra et Oyo, les deux Etats avec la plus grande charge de TB au Nigéria. MÉTHODES: Un examen des dossiers des établissements de santé pour 2016 a été réalisé dans les deux Etats (Anambra et Oyo). Une liste de contrôle a été utilisée pour extraire les informations pertinentes des registres conservés dans chacun des établissements DOTS sélectionnés afin de déterminer les taux de succès du traitement antituberculeux. Le taux de succès du traitement a été défini comme la proportion de nouveaux cas de TB à frottis positif enregistrés dans le cadre du DOTS au cours d'une année donnée qui ont terminé le traitement avec succès, que ce soit avec des preuves bactériologiques de succès («guéri¼) ou sans («traitement terminé¼) . Le taux de succès du traitement a été classé en bons (≥ 85%) et mauvais (<85%) taux de réussite en utilisant l'objectif national de 85% pour l'issue du traitement de la TB. Les données ont été analysées à l'aide de statistiques descriptives et du Chi carré à p <0,05. RÉSULTATS: Il y avait 1.281 personnes inscrites au traitement antituberculeux en 2016 à Anambra et 3.809 à Oyo (total = 4835). Un taux de succès global du traitement de 75,8% a été atteint (Anambra, 57,5%; Oyo, 82,0%). Les taux de guérison en pourcentage étaient de 61,5% pour Anambra et de 85,2% pour Oyo. Dans l'ensemble, seuls 28,6% des établissements des deux Etats (Anambra, 0,0%; Oyo, 60,0%) avaient un bon taux de réussite du traitement. Plus d'établissements à Anambra (100,0%) qu'à Oyo (40,0%) avaient un faible taux de réussite du traitement (p <0,001), tout comme plus d'établissements de santé privés/FBO (100,0%) que publics (60,0%) (p = 0,009). Tous les établissements tertiaires avaient un faible taux de réussite du traitement, suivis de 87,5% des établissements de santé secondaires et 56,5% des établissements de soins de santé primaires (p = 0,035). CONCLUSION: Le succès du traitement et les taux de guérison dans l'Etat d'Anambra étaient inférieurs aux 85,0% de l'objectif recommandé fixé par l'OMS. L'emplacement géographique, le niveau et le type d'établissement étaient des facteurs associés à cela. Des interventions sont recommandées pour résoudre ces problèmes.

Accelerated gastric ulcer healing in thyroxine-treated rats: roles of gastric acid, mucus, and inflammatory response.

The roles of gastric acid, mucus, and inflammation on the pro-ulcer-healing effect of thyroid hormone were investigated. Male Wistar rats were randomly divided into four groups: control, thyroidectomised, thyroidectomised with thyroxine treatment (100 µg·kg-1·day-1), and sham-operated animals treated with thyroxine. Thirty-five days after thyroidectomy, sham surgery, or thyroxine treatment, an ulcer was experimentally induced. Healing was assessed 3, 7, and 10 days post-ulceration by measurement of the ulcer area, gastric mucus and acid secretion, and neutrophil lymphocyte ratio (NLR) as an index of inflammation. By day 10, the ulcer area had decreased in all groups. Recovery was significantly greater (P < 0.05) in thyroxine-treated rats (78.5% ± 1.6% reduction in ulcer area) than in controls (72.3% ± 1.2% reduction) or thyroidectomised rats (63.3% ± 1.9% reduction). Thyroxine-treated animals also had the highest reduction in NLR (65.0% ± 2.5%). Mucus secretion was significantly lower (P < 0.05) in thyroidectomised rats by days 3 and 7. Furthermore, by day 10, the concentration of basal acid decreased by 77.4% ± 2.6% in thyroxine-treated, 65.0% ± 0.0% in control, and 51.5% ± 3.3% in thyroidectomised rats. We conclude that thyroxine accelerates gastric ulcer healing by altering mucus and acid secretion and reducing NLR.

The effect of midkine on growth factors and oxidative status in an experimental wound model in diabetic and healthy rats.

Wound healing is important for longevity. Midkine is a cytokine involved in controlling tissue repair and new tissue development, and in regulating inflammation. We investigated the effect of midkine on wound healing in rats. In total, 108 Wistar albino rats were used: 12 as healthy and diabetic controls; 96 were split into 4 groups: healthy, saline treated; healthy, midkine (10 ng/kg, 48 h intervals) treated; diabetic, saline treated; and diabetic, midkine treated. Following wound creation, 6 rats per group were euthanized on days 3, 7, 14, and 28; the wounded skin was removed. Levels of epidermal growth factor (EGF), matrix metalloproteinase-8 (MMP-8), transforming growth factor beta (TGF-ß), platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and thiobarbituric acid reactive substances (TBARS) were measured. MMP-8 and PDGF levels fluctuated in all groups; TGF-ß fluctuated in the diabetic groups and was significantly higher in the HM group than other groups after 14 days. EGF and VEGF levels were increased in the HM group after 3 days. TBARS levels were highest in the diabetic groups. Macroscopically, the midkine-treated groups healed better. Midkine can accelerate wound healing by influencing growth factors and oxidative status in wound tissues.

[The meaning of recovery in analytical psychotherapy]. / Le sens de la guérison dans une psychothérapie analytique.

Analytical psychotherapy offers a treatment framework which takes a very specific stance. It is based on the principle of not attacking the symptom head on, but seeing it as an event conveying meaning and a function. This approach still fulfils a therapeutic objective, that of supporting patients with regard to the psychological side of their life and helping them to deploy their own potentialities.

[Towards the definition of cure]. / Guérison, vers une définition.

Is the term cure adapted to psychiatry? Firstly, it is important to establish what this status represents. What is immediately clear is that the term cure cannot be addressed in isolation. Considering the term leads us to question notions such as those of disease and the norm, without forgetting the actual purpose of care. Cure can then be envisaged more as a 'possible' for caregivers.

[Severe mental disorders: cure? What an idea!] / Troubles mentaux sévères : guérir ? quelle idée !

The evolution of mental disorders, notably the most severe forms such as schizophrenia, is a constant concern in terms of the necessary assessment of treatments and their efficiency, and to the human and economic cost of the 'chronicity' of the disorders. Many patients experience a positive evolution, evaluated in terms of subjective quality of life. However, the concept of recovery does not seem appropriate. The field of representations which the patient and the caregiver form with regard to the disease and its curability is an important element. The co-construction of the patient's future, in an approach centred on the patient, on their freedom and their autonomy, opens up the way towards recovery.

Transforming growth factor-ß (TGF-ß) activation in cutaneous wounds after topical application of aloe vera gel.

Aloe vera is a medicinal plant used to treat various skin diseases. The effects of using aloe vera gel on the healing process were investigated by microscopic methods, cell counting, and TGF-ß gene expression in the wound bed. Sixty Wistar rats weighing 200-250 g were placed under anesthesia in sterile conditions. A square 1.5 cm × 1.5 cm wound was made on the back of the neck. The rats were divided into control and 2 experimental groups. Additionally, the control and experimental groups were separated into 3 subgroups corresponding to 4, 7, and 14 days of study. In the first experimental group, aloe vera was used twice on the wound. The second experimental group received aloe vera overtreatment once on the wound. The positive control group received daily application of 1% phenytoein cream following surgical wound creation. The control group did not receive any treatment. This tissue was examined using histological staining (H&E) and Masson's Trichrome. Wound surface and wound healing were evaluated separately. TGF-ß gene expression was analyzed by RT-PCR. Results showed that fibroblasts in both experimental groups were significantly increased, thereby acceleration wound healing. Application of aloe vera gel will increase TGF-ß gene expression, ultimately accelerating the wound healing process.

Traditional vs. non-traditional healing for minor and major morbidities in India: uses, cost and quality comparisons.

OBJECTIVES: To examine the uses, cost and quality of care of traditional healing for short-term morbidities and major morbidities in India and to compare them with the non-traditional healing. METHODS: We used data from a nationally representative survey, the India Human Development Survey (2004-2005) and descriptive as well as bivariate analyses for the examination. RESULTS: Use of traditional healing is much less common than use of non-traditional healing in both rural and urban areas and across all socio-economic and demographic characteristics; it is slightly more common in rural than urban areas for short-term morbidities. Use of traditional healing is relatively more frequent for cataract (especially in rural areas), leprosy, asthma, polio, paralysis, epilepsy and mental illnesses; its total cost of care and mean waiting time (in the health facility) are substantially lower than for non-traditional healing. Among patients who use both traditional and non-traditional healing, a relatively higher proportion use traditional healing complemented by non-traditional healing for short-term illnesses, but vice versa for major morbidities. CONCLUSION: This is the first study which has investigated at the national level the uses, complementarities, cost and quality aspects of traditional and non-traditional healing in India. Traditional healing is more affordable and pro-poor. Relatively higher use of traditional healing in patients from poorly educated as well as poor households and suffering from diseases, such as, epilepsy and mental illnesses; and higher demand for traditional healing for the above diseases highlight the need for research/policy reorientation in India.

Knowledge, attitudes and practices concerning self-medication with antibiotics among university students in western China.

OBJECTIVES: To evaluate the knowledge, attitude and behaviours of university students on the use of antibiotics. METHODS: A knowledge-attitude-practice questionnaire was developed and distributed to undergraduate students of Xi'an Jiaotong University, comprising 18 schools/colleges in Shaanxi Province, western China. Chi-square test and logistic regression analysis were applied to identify risk factors associated with self-medication with antibiotics. RESULTS: Of the 731 respondents (response rate = 73.1%), 294 (40.2%) had self-medicated with antibiotics in the past 6 months. Most of the antibiotics (59.2%) for self-medication were purchased without prescription in retail pharmacies. The median score of students' knowledge about antibiotics was 4 (IQR: 3-6) of a maximum possible score of 10. Students had moderately accurate beliefs towards antibiotics. More than half of the students (56.5%) were storing antibiotics frequently. During self-medication, 16.7% of students claimed to have experienced adverse reactions, and 30.6% had used antibiotics to prevent common colds. The majority preferred to use broad-spectrum antibiotics, and nearly half preferred intravenous antibiotics. Over 44% of students had changed antibiotic dosage, and 36.5% had switched to another antibiotic during the treatment course. Logistic regression analysis identified college and home town as independent risk factors for self-medication with antibiotics (P < 0.01). CONCLUSIONS: Undergraduate students had inadequate knowledge, moderately accurate beliefs and inappropriate practices concerning antibiotics, and a high rate of self-medication. This highlights the need for focused educational intervention and stricter governmental regulation concerning antibiotic use and sale in retail pharmacies.

[A late onset diagnosis of giant cell arteritis in remission]. / Diagnostic tardif d'une artérite à cellules géantes en rémission.

Giant-cell arteritis (GCA) is a classical cause of chronical inflammation (CI) in the elderly, causing headaches, scalp hypersensitivity and jaw claudication. We describe a patient with a GCA revealed with a year-long biological inflammation and weight loss. Diagnosis was performed on a systematic temporal artery biopsy showing typical histological features. No treatment was intended as the patient had a spontaneous remission, maintained at one year of follow-up. This case highlights the benefit of a systematic temporal artery biopsy to explore CI and reminds us that GCA may undergo spontaneous remission.

[Outcome of women younger than 30 years of age followed for untreated high-grade cervical intraepithelial lesion]. / Devenir des femmes de moins de 30 ans prises en charge pour une lésion intra-épithéliale de haut grade du col utérin non traitée.

OBJECTIVES: To assess the probability of spontaneous regression of high grade cervical intraepithelial neoplasia (HGCIN) in women under 30 and the predictive factors for such evolution. METHODS: We conducted a bicentric retrospective study. A total of 98 patients under 30 and with untreated HGCIN were included from 01/01/2010 to 31/12/2019. For each patient, the initial clinical and colposcopic characteristics were systematically documented. In compliance with French guidelines, these patients were offered repeated 6-months colposcopic follow-up for 2years. The endpoint was the occurrence of spontaneous regression of the HGCIN defined by normalization of colposcopy, and/or a negative biopsy and/or a negative HPV test or histological regression to low grade CIN, or a colposcopy showing simple minor abnormalities requiring no biopsy. RESULTS: Spontaneous HGCIN regression was observed in 37/98 patients. The median follow-up was of 16 (10.5-24.3) months. Predictive factors for spontaneous regression were: minor initial cytological abnormalities (HR=3.4; 95% CI: 1.02-11.05) and grade 1 atypical transformation at initial colposcopy (TAG1) (HR=2.3; 95% CI: 1.1-4.7). CONCLUSION: Before 30, the probability of spontaneous regression of HGCIN exists but remains low. Predictive factors for such evolution are minor initial cytological abnormalities and TAG1 colposcopic impression.

A Feasibility and Safety Study of a Novel Human Decellularized Dermal Matrix to Accelerate Healing of Neuropathic Diabetic Foot Ulcers in People With Type 1 and Type 2 Diabetes.

OBJECTIVES: The purpose of this study was to determine the feasibility and safety of a novel decellularized dermal matrix (DDM) for the treatment of chronic diabetic foot ulcers (DFUs). METHODS: An interventional, single-arm, prospective study of DDM for DFU treatment was conducted in 2 Canadian centres from July 1, 2016 to May 30, 2017. Individuals ≥18 years of age, with an active DFU of ≥2 weeks and ulcer area ≥1 cm2 before debridement and who consented to participate, were enrolled in this clinical trial. RESULTS: A total of 11 patients were enrolled, with 9 patients (82%) having achieved 100% closure between 2 and 8 weeks. The mean and median times to wound closure for these patients were 3.3 and 2.5 weeks, respectively. The mean and median reductions in wound area at 4 weeks posttreatment were 87% and 100%, respectively. The proportion of patients having achieved complete healing at 12 weeks was 82%. All patients received only 1 DDM application to achieve these results. There were no adverse events related to use of the product. No cases of recurrence during a 1-year follow up after completion of the study were reported for patients who achieved wound closure. CONCLUSIONS: These findings provide evidence that this DDM may be safe and effective for the treatment of chronic, hard-to-heal neuropathic DFUs. Specifically, DDM demonstrated the potential to accelerate healing of DFUs when compared with reported times of 8 to 12 weeks required to achieve closure using the current standard of care.

[Patient expectations in asthma care]. / Attentes des patients asthmatiques vis-à-vis de leur prise en charge.

Asthma, a common chronic disease characterized by variable levels of severity, requires patient-centered management to achieve the best health outcomes. Studies have highlighted the gap between consensus management recommendations and patient goals, which represent a potential source of therapeutic wandering and of poor compliance. Patient expectations are continually evolving and are dependent on knowledge, feelings and individual experience. From this perspective, listening carefully to patients and caregivers makes it easier to exchange views and define common goals. The active participation of patients at all levels of decision-making and transmission of information may improve asthma control and other quality of life parameters.

In Vivo Type 2 Diabetes and Wound-Healing Effects of Antioxidant Gold Nanoparticles Synthesized Using the Insulin Plant Chamaecostus cuspidatus in Albino Rats.

BACKGROUND: Gold nanoparticles are known for their many applications in the fields of therapeutics and diagnosis. METHODS: This article focuses mainly on the green method of synthesizing gold nanoparticles by using the leaf powder extract of the insulin plant Chamaecostus cuspidatus and on the characterization of developed plant-mediated synthesis of gold nanoparticles. Furthermore, we investigated the free-radical scavenging activity of green-synthesized gold nanoparticles. RESULTS: The free radicals were exhibited in a dose-dependent manner. The 50% inhibition of free radicals by gold nanoparticles showed that it was similar to that of the standard inhibition. Toxicity studies generally examine changes in blood serum chemistry and cell populations in tissue morphology through histologic analysis without inducing any lethal effects in the mouse model, thereby accomplishing sustained control over the progression of diabetes mellitus, which plays a leading role in vascular complications in patients. The treatment by gold nanoparticles of the mice with diabetes for a period of 21 days restored their blood glucose, glycogen and insulin levels. CONCLUSIONS: The use of gold nanoparticles as antidiabetes materials has been achieved. Further studies are required before gold nanoparticle-based drugs are more widely used.

[Can medical oncologists talk about cure to their patient after localized breast cancer treatment?] / Pouvons-nous à l'heure actuelle parler de guérison après le traitement d'un cancer du sein localisé ?

INTRODUCTION: Despite ongoing therapeutic advances in oncology, the use of the term cure in front of patients remains controversial. The word remission is often preferred in clinical practice. The purpose of this research is to explore how oncologists vary in their usage and definition of the word cure when talking to patients. METHODS: Qualitative and exploratory pilot study conducted by semi structured interviews with a group of French oncologists about a clinical vignette of localized breast cancer treated by surgery and complete adjuvant treatment. RESULTS: Thirteen oncologists participated in this study between January and March 2016. They were divided into two groups according to whether or not they use the term cure in their clinical practice. A first group of five doctors define the word cure as the lasting absence of relapse of the disease. Because of their duty of transparency and the uncertainty of post-therapeutic relapse, these five doctors tend to never use the word cure. The analysis of the second group of eight doctors, who do use of the word cure in their practice, highlighted an absence of consensus on its definition. However, all of them justify their use of it with the importance of expressing positive emotions such as hope to patients. DISCUSSION: Our findings confirm that there are divergent understandings of the concept of cure between oncologists and how they manage prognosis uncertainty. Medical language is thus influenced by scientific knowledge, but also by doctors' personal values and ways of thinking, perhaps influencing the doctor-patient relationship in turn. This exploratory study will be extended on a wider scale to explore the coexistence of other elements of diversity.