Prevalence of multiple sclerosis in France in 2021: Data from the French health insurance database.

BACKGROUND: France is among the countries with high prevalence of multiple sclerosis (MS). The most recent estimates are from 2012 and need to be updated because MS prevalence has increased worldwide. OBJECTIVE: To estimate MS prevalence in France on December 31, 2021 and to describe the characteristics of the French MS population using data from the French national health insurance database (SNDS). MATERIAL AND METHODS: Persons with MS (PwMS) were identified in the SNDS database (99% of national coverage) using an algorithm with three criteria: long-term disease status, hospitalizations, and MS-specific drug reimbursements. Crude and sex- and age-stratified prevalence rates were calculated with their 95% confidence intervals as well as the standardized prevalence stratified on the region of residence. RESULTS: In total, 134,062 PwMS were identified (71.8% of women, median age 53.0±14.8years) yielding a prevalence of 197.6 per 100,000 (95% CI [196.5-198.7]). Prevalence rates in women and men were respectively 274.9 (95% CI [273.2-276.6]) and 115.2 (95% CI [114.0-116.4]). In metropolitan France, the highest prevalence rates were observed in the northeastern regions (e.g.>230 PwMS per 100,000 in Grand Est and Hauts-de-France), and the lowest rates in the southwestern regions (∼180 PwMS per 100,000 in Nouvelle-Aquitaine and Occitanie). Overall, 32.1% of PwMS had another long-term disease and 51.8% received at least one MS-specific drug in 2021. CONCLUSION: MS prevalence in France has increased by ∼30% in the last 10years. This increase is probably linked to population ageing, longer survival of PwMS, and the long observation period. The part attributable to a possible increase in MS risk remains to be determined with incidence studies.

Fever of unknown origin: Importance of 18F-FDG PET/CT in the diagnosis of a late infectious complication after aneurysm bypass.

Persistent blood flow in aneurysmal sac after bypass-exclusion is well documented in the literature. Aneurysm enlargement, local compressive symptoms and even sac rupture are commonly described complications. Late secondary infection of popliteal artery aneurysm (PAA) following ligation and venous bypass is exceptional. We report the case of late PAA infection six years after bypass-exclusion in a 75 year-old man which was diagnosed by 18F-FDG PET/CT. The patient was successfully treated by aneurysm resection and antibiotics. The diagnosis of popliteal aneurysm infection is often clinical, echographic and sonographic, but computed tomography scan can be false negative in chronic low-grade infection. 18F-FDG PET/CT is able to accurately diagnose and localize infection with high sensibility and specificity.

[Temporary vascular shunt technique for resource scarce environments]. / Shunt artériel temporaire en situation précaire.

The purpose of this report is to describe a simple and reproducible technique for temporary vascular shunting. This technique is appropriate only for exceptional situations involving scant resource availability. It is not intended to replace conventional vascular shunting techniques.

Preliminary results of the ion extraction simulations applied to the MONO1000 and SUPERSHyPIE electron cyclotron resonance ion sources.

The goal of this article is to present simulations on the extraction from an electron cyclotron resonance ion source (ECRIS). The aim of this work is to find out an extraction system, which allows one to reduce the emittances and to increase the current of the extracted ion beam at the focal point of the analyzing dipole. But first, we should locate the correct software which is able to reproduce the specific physics of an ion beam. To perform the simulations, the following softwares have been tested: SIMION 3D, AXCEL, CPO 3D, and especially, for the magnetic field calculation, MATHEMATICA coupled with the RADIA module. Emittance calculations have been done with two types of ECRIS: one with a hexapole and one without a hexapole, and the difference will be discussed.

Development of a 1+/N+ setup for the production of multicharged radioactive alkali ions in SPIRAL.

In the framework of the production of radioactive ion beams by the isotope separator online method, a new system has been developed at GANIL/SPIRAL I to produce multicharged alkali ions. The principle, referred to as the "direct 1+/N+ method," consists of a surface ionization source associated with a multicharged electron-cyclotron-resonance ion source without an intermediate mass separator. This new system has been tested online using a (48)Ca primary beam at 60.3 A MeV. The experimental evidence of the direct 1+/N+ process has been obtained for a potential difference between the two sources of 11 V and with a 1+/N+ charge breeding efficiency of 0.04% for (47)K(5+). This value is significantly lower than the value of 6% obtained for stable K ions with the standard 1+/N+ method. A possible explanation is given in the text.

Promotion of Influenza Prevention Beliefs and Behaviors through Primary School Science Education.

BACKGROUND: School-based campaigns to improve student health have demonstrated short-term success across various health topics. However, evidence of the effectiveness of programs in promoting healthy beliefs and behaviors is limited. We hypothesized that educational curricula teaching the science behind health promotion would increase student knowledge, beliefs and adherence to healthy behaviors, in this case related to influenza. METHODS: Integrated Science Education Outreach is a successful education intervention in Rochester, Minnesota public schools that has demonstrated improvements in student learning. Within this program, we designed novel curricula and assessments to determine if gains in knowledge extended to influenza prevention. Further, we coupled InSciEd Out programming with a clinical intervention, Influenza Prevention Prescription Education (IPPE), to compare students' attitudes, intentions and healthy behaviors utilizing surveys and hand hygiene monitoring equipment. RESULTS: 95 students participated in (IPPE) in the intervention school. Talking drawings captured improvement in influenza prevention understanding related to hand washing [pre n=17(43%); post n=30(77%)] and vaccination [pre n=2(5%); post n=15(38%)]. Findings from 1024 surveys from 566 students revealed strong baseline understanding and attitudes related to hand washing and cough etiquette (74% or greater positive responses). Automated hand hygiene monitoring in school bathrooms and classrooms estimated compliance for both soap (overall median 63%, IQR 38% to 100%) and hand sanitizer use (0.04 to 0.24 uses per student per day) but did not show significant pre/ post IPPE differences. CONCLUSIONS: Student understanding of principles of influenza prevention was reasonably high. Even with this baseline, InSciEd Out and IPPE improved students' unprompted knowledge of behaviors to prevent influenza, as reflected by talking drawings. This novel metric may be more sensitive in capturing knowledge among students than traditional assessment methods. However, IPPE did not produce further significant differences in student attitudes and behaviors regarding the flu.

[Hypothenar hammer syndrome: case report and review of the literature]. / Syndrome du marteau hypothénarien : cas clinique et revue de la littérature.

INTRODUCTION: Hypothenar hammer syndrome is a rare cause of upper extremity digital ischemia or Raynaud phenomenon, a diagnosis which should be considered in cases of iterative palmar trauma. Its treatment can be medical or surgical and should not suffer any delay. The best options remain controversial. METHODS: A 65-year-old patient presented with an ischemia of the last three fingers of the left hand. A partially thrombosed aneurysm of the left ulnar artery was diagnosed at imaging. After a partially effective medical treatment, a surgical treatment was performed with resection of the aneurysm and a vascular reconstruction with an autologous vein graft. The postoperative course was uneventful with disappearance of the symptoms and revascularization of the hypothenar area. CONCLUSION: Appropriate treatment for hypothenar hammer syndrome is controversial but whould always begin with medical care. The decision to perform surgery should be based on evidence of ulnar artery lesions and the associated symptoms.

Total thyroidectomy for amiodarone-associated thyrotoxicosis: should surgery always be delayed for pre-operative medical preparation?

OBJECTIVE: Amiodarone can induce severe hyperthyroidism that justifies its withdrawal and the introduction of antithyroid drugs. Continuing amiodarone use, failure to control hyperthyroidism and poor clinical progress may require thyroidectomy. This study aimed to evaluate patients' post-operative development and mid-term outcome after thyroidectomy for amiodarone-associated thyrotoxicosis. STUDY DESIGN: Prospective case series. SETTING: Tertiary care centre. SUBJECTS AND METHODS: We prospectively collected cases of amiodarone-associated thyrotoxicosis requiring thyroidectomy due to failure of antithyroid treatment, despite amiodarone discontinuation. Post-thyroidectomy complications were compared immediately, 30 days and one year post-operatively, and also for scheduled versus emergency surgery cases. RESULTS: Of 11 total cases, nine scheduled thyroidectomy cases had no morbidity after elective surgery. Two cases required emergency surgery for multiple organ failure and cardiac problems. Immediate post-operative complications (mostly haemodynamic) occurred in both cases (emergency vs routine surgery, p = 0.018). CONCLUSION: In such cases, pre-operative medical treatment is vital to limit peri- and post-operative complications, but surgery should not be delayed if the haemodynamic status deteriorates. Surgery, with careful anaesthesia, is the cornerstone of the treatment.

Double Sigmoid colon perforation due to migration of a biliary stent.

Migration of pancreatico-biliary stents is a rare event, usually benign, but which can lead to severe complications such as digestive tube perforation. We report the case of a patient with double sigmoid perforation due to distal migration of a biliary stent placed to decompress a pancreatic head carcinoma.

[Chronic compartmental syndrome. a review of 234 patients]. / Le syndrome chronique des loges. À propos d'une série de 234 patients opérés.

OBJECTIVE: Diagnosis of chronic compartment syndrome of the lower leg, which occurs in a young and athletic population, is often delayed. We studied postoperative outcomes after fasciotomy in patients with compartment syndrome in order to identify specific postoperative complications. Long-term functional outcomes were also evaluated. METHODS: All patients with a diagnosis of chronic exercise-related compartment syndrome of the lower leg who underwent surgery from January 1985 to August 2009 were studied prospectively. The type of compartment and whether surgery was uni or bilateral was recorded. One year after surgery, patients completed a questionnaire to evaluate their functional outcome. RESULTS: Two hundred and thirty-six compartment procedures were performed in 234 patients. Only one compartment (constantly the superficial posterior compartment) was treated in 56/236 (23.7%) procedures. Two compartments (anterior and lateral) were involved in 90/236 procedures (38.1%). Three compartments (anterolateral and superficial posterior) were noted in 74/236 procedures (31.4%) and four compartments (anterolateral and superficial and deep posterior) were described in 6.8%. Involvement of the deep posterior compartment was always associated with another compartment. Surgery was bilateral in 70% of patients. The questionnaire response rate was 65%. The success rate of fasciotomy was 68.4% and a significant improvement was reported by 23.9% of responders; outcome was unsatisfactory for 7.7%. CONCLUSIONS: The diagnostic criteria used to confirm chronic exercise-related compartment syndrome of the lower leg were based on the compartment pressure measurement after exercise. In this study, all patients underwent fasciotomy. The surgical technique was standardized. Outcomes have been satisfactory with few surgical complications.

Comparison of a biphasic medium plus routine early subculture with a slide blood culture system.

The accuracy of a biphasic medium plus routine early subculture on chocolate agar was compared with that of a slide blood culture system for detecting facultatively anaerobic bacteria in blood cultures. Over a three month period 2,745 pairs of blood cultures were examined. Bacteremia was diagnosed in 91 patients. Twelve cases would have been missed by using the slide blood culture system alone, in contrast to only three by the biphasic medium alone. The two techniques detected the same amount of contaminant bacteria. Although the slide blood culture system required less time in general, the biphasic medium proved more accurate for isolating Staphylococcus aureus (p = 0.005) and detected gram-positive bacteria more rapidly (p = 0.002).