[Measuring the emergency psychiatric units activity: An experimental application of the Delphi Method]. / Évaluation de l'activité dans les unités d'urgence psychiatrique : une application de la méthode Delphi.

Psychiatric emergency units (UUP) are nowadays important gateways to healthcare. Whether integrated into general emergency departments or not, these units have very heterogeneous resources and organisations which are not always in line with a populations' needs. The increasing activity of emergency departments in recent years and the recurrent psychiatric bed shortages have shed light upon the weaknesses of this key link in the mental healthcare process. The Seine-Saint-Denis is a department of France located in the Grand Paris metropolis in the Île-de-France region. Ranked third in terms of population size in France, it is marked by social precariousness. With regard to mental health, it has one of the lowest rates of psychiatric beds per capita in France. A great deal of thought has been ongoing for five years on how best to upgrade the offer of unscheduled psychiatric care, particularly the management of emergencies. The growing imbalance between demand and supply depending on living areas urges a rapid equalization of resources. This operation requires an accurate activity characterization, allowing more effective organizations and adequate resource allocation. We sought to characterize the activity of psychiatric emergencies by selecting quantitative and qualitative indicators by means of a consensus method, the Delphi Method, which consists of iterative questioning of an expert group. We first submitted 36 potential criteria to twenty-five experts. Twenty obtained a weak to a strong consensus. Seventeen were then selected as potentially useful for activity characterization. In a second time, we tested the consensus on selected indicators by interviewing a panel of 19 experts. A strong consensus was found on four criteria: "Number of visits for psychiatric advice>2000/year", "Number of emergency room visits>40,000/year", "Density of adult hospital beds<150 per 100,000 inhabitants", "Passage rate for homeless patients and/or outside the sector>10%". Using these criteria in the classification of UUPs would test their validity and provide a potentially helpful tool for improving organizations and resource allocation.

[The role of maxillofacial prosthodontics in the prevention of radiation]. / Place de la prosthodontie maxillo-faciale dans la prévention du patient irradié.

Tumors of the upper aerodigestive tract (ADT) are the most frequent tumors in the world, and among the tumors of the ENT sphere, the frequency of cancers of the oral cavity occupies the third place after that of the larynx and oropharynx. The treatment of these pathologies is heavy and complex. It is the result of a combination of several interventions, namely surgery, radiotherapy and chemotherapy. Among the consequences of radiotherapy, we can mention the embrittlement of dental tissues, osteoradionecrosis, stenosis of muscular tissues or radiomucitis of oral mucosal tissues. All these complications encourage the preparation of the patient before radiotherapy in order to mitigate the consequences and prevent complications. Through this work, we illustrate the place of maxillofacial prosthodontics in the prevention of the irradiated patient, through several prosthetic, medical or medicinal means.

[Characteristics of cardiac involvement in eosinophilic granulomatosis with polyangiitis]. / Caractéristiques de l'atteinte cardiaque au cours de la granulomatose éosinophilique avec polyangéite.

AIM OF THE STUDY: Our study aimed to identify the characteristics of cardiac involvement in eosinophilic granulomatosis with polyangiitis (EGPA). METHODS: We conducted a retrospective analytic study including EGPA cases diagnosed between 2000 and 2019 in an internal medicine department. Diagnosis was made according to the 1990 American College of Rheumatology criteria and the 2012 Chapel Hill Concensus. RESULTS: Eleven EGPA cases were included, 64% of patients were female. Median age at diagnosis was 52 years [42-58]. Heart damage revealed EGPA in 55% of cases with a significant predominance of women (p=0.015). The main cardiac manifestations were myocarditis, ischemic cardiomyopathy due to small vessel vasculitis, cardiac tamponade and intracardiac thrombus. Cardiac magnetic resonance imaging (MRI) mainly showed subendocardial hyposignal in early infusion and late enhancement in the same areas, nodular by locations, associated with impaired left ventricle function and micro-infarctions by distal vasculitis. Cardiac damage was associated to ANCA negativity in 83.3% of cases. The median Birmingham Vasculitis Activity Score version3 (BVAS v3) was 16 [10-17]. Under conventional treatment, no relapses had occurred. The median vasculitis damage index (VDI) was 2 [1-2.3] and the mortality rate was zero after a mean follow-up of 43 months. CONCLUSION: Cardiomyopathy is a frequent revealing mode of EGPA. A late onset asthma and hypereosinophilia should guide the diagnosis. As ANCA research often turns out to be negative, histological evidence is recommended in this context. The contribution of cardiac MRI in the diagnosis of EGPA remains to be defined.

[A rare cause of pulmonary arterial hypertension: Thoracic amyloidosis]. / Une cause rare d'hypertension artérielle pulmonaire : l'amylose thoracique.

Isolated thoracic involvement in amyloidosis is a rare and serious condition. Its association with pulmonary arterial hypertension (PAH) usually weakens the prognosis. We report the case of a 40-year-old man with a smoking history, hospitalized for chest pain, abdominal pain and acute respiratory distress. The cardiac ultrasound revealed a circumferential pericardial effusion as well as a pulmonary artery systolic pressure (PAPS) at 80mmHg. Chest imaging (computed tomography scan and magnetic resonance imaging) showed a tissue process developed in the pericardial sheath (60×45mm) sheathing the ascending aorta and infiltrating the trunk of the pulmonary artery and its right branch. Anatomopathological and immunohistochemical study of the process revealed AL amyloidosis. Note that the patient had no signs of extrathoracic amyloidosis. Blood and urine electrophoresis and immunoelectrophoresis as well as bone marrow mylogram and biopsy were normal. The patient was put on oral anticoagulant as he presented with PAH. A therapeutic protocol with thalidomide and dexamethasone has been initiated. The course of the disease was marked by total regression of the clinical signs, a marked decrease in the amyloid process on imaging and a normalization of the PAPS; our follow-up being three years.

Pheochromocytoma presenting as an authentic small vessel vasculitis and complicated with pulmonary embolism: An original presentation.

Diagnosis of pheochromocytoma can be simple when classic manifestations are present. It can also be challenging and complicated in some cases because of its wide array of faces and presentations. We present a case of a 30-year-old female patient who came with acute respiratory distress, chest pain, hemoptysis, asthenia, anorexia, weight loss of 20kg, and paresthesia in her lower limbs. Clinical examination found high blood pressure, accelerated heart and respiratory rates, signs of acute right heart failure with jugular venous distention and ankle edema, reticularis livedo in the four limbs, ulcers in both knees and in the 3rd metacarpo-phalangeal articulations and necrotic lesions in both calcaneal tendons and in the right toes. Further investigations concluded on myocarditis associated with alveolar hemorrhage, pericardic and pleuritic effusions and a segmental pulmonary embolism of the right inferior lobe. Neuro-muscular biopsy was suggestive of myositis. Cutaneous biopsy found nonspecific chronic dermatitis. ANCA antibodies were tested twice and were negative. Cryoglobulinemia was also negative. Thoraco-abdomino-pelvic scan was performed showing a large right adrenal mass suggestive of pheochromocytoma. Diagnosis of right adrenal pheochromocytoma was confirmed by MIBG-I123 hyperfixation findings and urinary normetanephrin levels. The patient was treated surgically. Postoperative outcomes were remarkably favorable with a complete regression of the cutaneous lesions and normalization of the blood pressure. Paresthesia significantly decreased. Control echocardiography at 3 months showed an improved heart function with a persistent apical and septal akinesis.

Technical note: Method for isolation of the bovine sweat gland and conditions for in vitro culture.

Apocrine sweat glands in bovine skin are involved in thermoregulation. Human, horse, and sheep sweat gland epithelial cells have been isolated and grown in vitro. The present study was conducted to identify a method to isolate bovine sweat glands and culture apocrine bovine sweat gland epithelial cells in vitro. Mechanical shearing, collagenase digestion, centrifugation, and neutral red staining were used to identify and isolate the apocrine glands from skin. Bovine sweat glands in situ and after isolation comprised 2 major cell types consisting of a single layer of cuboidal epithelial cells resting on a layer of myoepithelial cells. In situ, the glands were embedded in a collagen matrix primarily comprising fibroblasts, and some of these cells were also present in the isolated material. The isolated material was transferred to complete medium (keratinocyte serum-free medium, bovine pituitary extract, and human recombinant epidermal growth factor + 2.5% fetal bovine serum) in a T 25 flask (Falcon, Franklin Lakes, NJ) with media film and then incubated at 37°C for 24 h. After sweat glands adhered to the bottom of the flask, an additional 2 mL of complete medium was added and the medium was changed every 3 d. Isolated apocrine sweat glands and bovine sweat gland epithelial cells were immunostained for cytokeratin and fibroblast specific protein, indicating fibroblast-free cultures.

[Venous thromboembolism: What other risk factors in a North African population? A study of 276 cases]. / La maladie veineuse thromboembolique : quels autres facteurs de risque dans une population nord-africaine ? Une étude de 276 cas.

INTRODUCTION: Venous thromboembolism is a multicausal disease. Understanding interactions between risk factors is the key to advance knowledge about the etiology of venous thrombosis. These interactions are still unclear. In addition to traditional risk factors, there is data about many other risk factors, recorded with few populations based prospective epidemiologic studies or punctually reported. Interactions between these risk factors remain unclear. The aim of our work is to identify and analyze combinations of risk factors. METHODS: This is a retrospective, single-center study, which investigates the etiology of venous thromboembolism, on the records of patients hospitalized in internal medicine for venous thrombosis, over a period of 12 years. RESULTS: We selected 276 cases. The average age was 51 years. At least, we found one traditional risk factors in 87 % of cases, 34 patients had no traditional risk factors. Suspected risk factors were found in 81 % of cases and there was at least one punctually reported factor in 34 % of cases. The combination of risk factors mostly found was association of traditional and suspected risk factors. In more than 50 % of patients, we noted at least, more than one traditional or one suspected risk factors. Among 18 patients presenting only suspected risk factors, there was at least combination of 3 risk factors per patient. CONCLUSION: The role of suspected risk factors in the occurrence of venous thrombosis was not negligible in this work. Our data suggest a hypothesis that it's through their association that suspected risk factors might be able becoming comparable to traditional risk factors.

Platelet satellitism in autoimmune hemolytic anemia.

Platelet satellitism is a rare phenomenon observed in blood smears obtained from blood anticoagulated with EDTA with an estimated frequency at 0.008%. It is characterized by platelet rosetting around neutrophils and in rare cases around other blood cells, which may causes pseudothrombocytopenia. Our case involves a 26-year-old female patient with autoimmune hemolytic anemia (AIHA). Blood smear with EDTA as an anticoagulant had platelet satellitism whereas the phenomenon was not observed in tubes with different anticoagulants (citrate, heparin) and capillary blood. This phenomenon was still observed four weeks after the patient's discharge. Furthermore, we discuss the possible pathophysiological mechanisms of platelet satellitism proposed in the literature. To our knowledge, this is the first case of platelet satellitism reported in AIHA.

[Epidemiology of burn wound infection in Rabat, Morocco: Three-year review]. / Épidémiologie de l'infection des plaies des brûlés de Rabat, Maroc : expérience de trois ans.

OBJECTIVE: To determine the bacteriological profile of burn wounds in patients hospitalized in the burn unit of the Military Hospital in Rabat and describe their sensitivity to antibiotics. MATERIAL AND METHODS: This prospective study was conducted from July, 2009, through March, 2011, in the hospital bacteriology laboratory, in collaboration with the burn unit. At each admission, a questionnaire was completed to collect the patient's data. Bacteriological samples were collected from burn wounds at admission and every time the bandage was changed. Identification of bacteria was based on their culture, morphological, and biochemical characteristics. Antibiotic susceptibility was determined with the agar diffusion method, in accordance with the recommendations of the French Society of Microbiology. Statistical analysis was performed with SPSS Version 13 (Statistical Package for the Social Sciences) software. RESULTS: The study included 58 burn patients. Their mean age was 38.2 ± 15.5 years; the mortality rate was 13.8%, and the prevalence of infection 43.1%. We identified 126 non-redundant bacterial strains from the 112 samples collected, most often Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterobacter cloacae, and Staphylococcus spp. CONCLUSION: Heightened vigilance and rigorous application of hygiene rules, together with continuous epidemiological surveillance of burn wound bacteria, are essential to optimize empiric antibiotic therapy.

Physiological responses and lactational performances of late-lactation dairy goats under heat stress conditions.

Eight Murciano-Granadina dairy goats in late lactation were exposed to different ambient conditions, using metabolic cages in a climatic chamber. The experimental design was a crossover (2 periods of 35 d and 4 goats each) and conditions were (1) thermal neutral (TN; 15 to 20 °C day-night) and (2) heat stress (HS; 12-h day at 37 °C and 12-h night at 30.5 °C). Humidity was maintained at 40% and light-dark was constant (12-12h). The forage:concentrate ratio was adjusted daily for maintaining similar value in TN and HS goats (70:30). Water was freely available at ambient temperature. Rectal temperature and respiratory rate (0800, 1200 and 1700 h) and milk yield were recorded daily, whereas milk composition, nonesterified fatty acids and haptoglobin in blood were analyzed weekly. At d 25, additional blood samples were taken for analysis of metabolites and indicators of the acid-base balance. Digestibility coefficients and N balance were determined (d 31 to 35) and body weight was recorded (d 35). Compared with TN goats, HS goats experienced greater rectal temperature (+0.58 °C), respiratory rate (+48 breaths/min), water intake (+77%) and water evaporation (+207%). Intake of HS goats rapidly declined until d 7 (-40%), partially recovered from d 7 to 19, and steadied thereafter (-14%). No changes in digestibility or N balance were detected. Blood nonesterified fatty acids and haptoglobin peaked at d 7 in HS goats but did not vary thereafter. Although milk yield did not vary by treatment, milk of HS goats contained -12.5% protein and -11.5% casein than TN goats. Panting reduced concentration and pressure of CO2 in the blood of HS goats, but they were able to maintain their blood pH similar to the TN group by lowering HCO3(-) and increasing Cl(-) concentrations in their blood. In conclusion, HS dairy goats showed dramatic physiological changes during the first week of treatment and partially recovered thereafter. They were able to maintain milk yield by losing body mass, but milk protein content and protein yield were depressed. Further research is needed to assess the response of dairy goats to HS at earlier stages of lactation.

[Nosocomial multidrug-resistant Acinetobacter baumannii meningitis in postoperative neurosurgery: a case study]. / Méningite nosocomiale postopératoire à Acinetobacter baumannii multirésistant en neurochirurgie : à propos d'un cas.

Acinetobacter baumannii is a prolific nosocomial pathogen renowned for its multidrug-resistant nature. However, A. baumannii is a rare cause of nosocomial meningitis, and is an even rarer cause of meningitis outbreaks in neurosurgical units. We report a case of nosocomial meningitis due to multidrug resistant A. baumannii in a postoperative neurosurgery. The diagnosis was retained on a beam of arguments clinical, biochemical and bacteriological. The evolution was unfavourable, and the patient died of multiple complications.

Quantitative analysis of pathological nails using laser-induced breakdown spectroscopy (LIBS) technique.

Laser-induced breakdown spectroscopy (LIBS) has been used as a potential method for simultaneous measurement of the elements Ca, Na, and K, for normal and pathological nails. We compared the measured LIBS spectra of these elements for normal and pathological nails. The B²∑+ --> X²∑+ violet band emission spectrum of CN was used for the estimation of the transient temperature of the plasma plume and consequently of the sample surface considering thermodynamic equilibrium.

[Abdominal tuberculosis: a retrospective series of 90 cases]. / Tuberculose abdominale : étude rétrospective de 90 cas.

PURPOSE: The aim of this study was to analyze the clinical, bacteriological, radiological and therapeutic features of abdominal tuberculosis in a series of 90 patients. METHODS: This was a retrospective and descriptive multicentre study of 90 cases of abdominal tuberculosis conducted from June 1997 to June 2008. Diagnosis of tuberculosis was based on bacteriologic evidence in 12 cases, histological evidence in 55 cases and on clinical and radiologic features with favorable outcomes under specific treatment in the 23 remaining cases. RESULTS: Thirty-one patients were male and 59 were female. The mean age of the patients was 41.5 years. Family history of tuberculosis was reported in three cases. Associated risk factors were: diabetes mellitus (five cases), ethylism (one case), post-hepatitis C cirrhosis (one case), systemic lupus erythematosus treated by corticosteroids (one case). Sites of involvement were: peritoneum (78 cases), liver (14 cases), gut (nine cases) and spleen (eight cases). Forty-eight patients (53,3%) had only an abdominal involvement, nine others patients (10%) had an abdominal involvement associated with intra-abdominal lymph nodes, 16 patients (17,8%) had a respiratory involvement (pulmonary, pleural and mediastinal lymph nodes), eight patients (8,8%) presented with an extra-abdominal and extra-respiratory involvement and 10 patients (11,1%) had respiratory and extra-respiratory disease associated with abdominal involvement. Among the 54 patients who underwent laparoscopy or laparotomy, diagnosis was evoked on macroscopic examination in 51. CONCLUSION: Laparoscopy and laparotomy are still helpful for the diagnosis of abdominal tuberculosis, especially in the presence of peritoneal involvement.

[Eosinophilic fasciitis (Shulman's disease): a case series of 11 patients]. / Fasciite avec éosinophilie (syndrome de Shulman): à propos de 11 patients.

PURPOSE: Eosinophilic fasciitis or Shulman's disease is a rare condition of unknown etiology. METHODS: We report a retrospective case series of 11 patients with eosinophilic fasciitis (seven men and four women, including a single pediatric case) and perform a systematic literature review to determine the main features of this disease. RESULTS: Mean age of the patients was 46 years. Subcutaneous induration of limbs observed in all the patients was the major presenting symptom. The induration was atypically located in the chest area in two patients. Blood eosinophilia was absent in five cases. Histological fasciitis was demonstrated in all patients and eosinophilic infiltration was present in seven patients. Relapse of subcutaneous induration was observed in only one patient who gradually developed systemic sclerosis. CONCLUSION: Diagnosis of eosinophilic fasciitis should be considered in the presence myalgia and subcutaneous induration of limbs, blood eosinophilia and hypergammaglobulinemia. Treatment is based on systemic corticosteroids.

[McDuffie hypocomplementemic urticarial vasculitis associated with Sjögren's syndrome]. / Vascularite urticarienne hypocomplémentémique de McDuffie associée à un syndrome de Gougerot Sjögren.

We report a patient with Sjögren's syndrome who presented with urticarial hypocomplementemic vasculitis. A 46-year-old female was admitted for assessment of ascitis. Clinical examination and computed tomographic scan disclosed evidence of multiple peripheral and intra abdominal lymph nodes. During her admission, she developed several bouts of acute angioedema and urticarial skin lesions. Minor salivary gland biopsy showed focal sialadenitis, stage IV of Chisholm. Schirmer's test was positive. Laboratory examination found low levels of C1q and high levels of C1q antibodies. Therapy with prednisone and hydroxychloroquine was initiated. Six months later, the patient presented with lower limb oedema. Urinalysis showed proteinuria (1g/day) and renal biopsy revealed membranous nephropathy with favorable outcome with corticosteroids.

[Etiological profile of digital necrosis of the upper limbs: analysis of 25 cases]. / Profil étiologique des nécroses digitales des membres supérieurs : analyse de 25 observations.

AIM: To investigate the etiologies of the upper limb digital necrosis based on a retrospective analysis of 25 cases. PATIENTS AND METHODS: We retrospectively reviewed the medical records of patients treated for digital necrosis of the upper limb in four departments of internal medicine from January 1997 to December 2003. RESULTS: There were 16 women and nine men, mean age 55 years. Eleven patients were smokers. Raynaud's phenomenon was noted in 12 cases. Connective tissue diseases were the most common cause (nine cases), all of them were women. The second cause was atherosclerosis (five cases) and Buerger's disease (five cases). In the other cases, the following diagnoses were found: vasculitis (three cases) and neoplasm (two cases). No cause could be identified in one female smoker. CONCLUSION: Digital necrosis is a common symptom, revealing a vascular pathology. Its causes are diverse. In women, it first suggests a connective tissue disease whereas in men, a diffuse arteriopathy. The etiological diagnosis strategy should consider drug intake, anamnesis and Raynaud's phenomenon history. However, in all cases the etiology investigations should not delay the treatment in order to preserve functional prognosis.