"When will I recover?" A national survey on patients' and physicians' expectations concerning the recovery time for acute back pain.

The objective of this study was to compare patients' and physicians' expectations concerning the recovery time for acute back pain, and their determinants. A French national observational survey was performed between October and December 2005. Each physician was asked to include the first three patients aged between 20 and 70 years presenting with acute back pain (VAS > 40 mm) of less than 1 month's duration. A total number of 1982 patients, with a mean age of 48.4 +/- 11.8 years (52.2% men), were enrolled by 834 physicians. Patients and their physicians expected recovery to take the same amount of time in 60.3% of cases (Kappa = 0.43). In 17.4% of cases, patients predicted a shorter recovery time than physicians, and in 22.4% of cases, patients predicted a longer recovery time. Both patients and physicians expected recovery time to be longer in women, and in older, unmarried, obese, and non working patients. Expected recovery time was also longer in patients with no sports activities, low back pain (as opposed to pain at other sites), a high level of disability, a history of back pain, and no triggering factor. The intensity of pain and the number of days of sick leave taken did not affect the patient's prediction of recovery time, but did affect the physicians' expectations. Physicians considered professional status, analgesic intake and previous sick leave to be independent predictive factors, whereas patients did not. Expected recovery time, assessed shortly after the onset of acute back pain is influenced by most of the clinical and demographic factors usually considered risk factors for chronic low back pain. Patients' predictions of recovery time should be assessed in acute back pain, to identify risks for expected chronicity.

Spreading and impact of the World Health Organization's Allergic Rhinitis and its impact on asthma guidelines in everyday medical practice in France. Ernani survey.

OBJECTIVES: The aim of this study was to determine the spreading level of the WHO-ARIA (World Health Organization's Allergic Rhinitis and its Impact on Asthma) guidelines among the medical community and their influence on medical practices. METHODS: A cross-sectional study based on a questionnaire was performed between April and July 2005 on randomly chosen general practitioners (GPs) (943) and ear, nose and throat (ENT) physicians (277). RESULTS: About 54.4% of the physicians claimed to know the WHO-ARIA guidelines and 49.7% said they followed them. These results vary significantly, mainly according to medical specialty (ENT vs. GP). In comparison to those who did not know the guidelines, their patients benefited more frequently (P<0.0001) from allergen search (42.2% vs. 31.7%), a nasal endoscopy (38.3% vs. 26.0%), a follow-up consultation (64.9% vs. 52.6%) and written information on rhinitis (30.7% vs. 14.1%). Paradoxically, they do not search more frequently for asthma and do not provide different first-line treatment strategy and duration.

[Efficacy of Derinox assessed with one PNIF (Peak Nasal Inspiratory Flow) in patients suffering from common cold]. / Efficacité de Dérinox chez des patients souffrant d'une rhinite virale évaluée par un PNIF (Peak Nasal Inspiratory Flow).

OBJECTIVES: The aim of this study was to compare the efficacy and tolerance of Dérinox (D) to Rhinofluimucil (R) and placebo (P) in the treatment of common cold, using an objective measure of nasal obstruction, the Peak Nasal Inspiratory Flow (PNIF--Clement Clarke International, Harlow, Angleterre). PATIENTS AND METHODS: This randomized, double-blind, double-dummy, parallel group study enrolled 354 patients (34 P, 165 D et 155 R) included by 85 general practitioners. The treatment duration was 5 days at usual recommended dosage regimens. PNIF measures were done before drug administration (T0) as well as 15 min and 3 h after each intake. Moreover, nasal obstruction, rhinorrhea and global discomfort were subjectively assessed. RESULTS: The efficacy of D was superior to that of P and R when comparing PNIF from T0 to T3 h after the first intake. At T15 min, rhinorrhea was significantly improved with both active treatments and global discomfort was significantly improved with D only. Treatment tolerance was satisfactory and comparable between the 3 groups. CONCLUSION: Efficacy of Dérinox(R) was superior to that of P and R for the improvement of the nasal obstruction (PNIF) between T0 and T3h (main criteria) after the first intake in patients suffering from common cold.

Endothelin has potent direct inotropic and chronotropic effects in cultured heart cells.

To determine whether endothelin, a highly potent vasoconstrictor peptide, may affect cardiac myocyte contractility directly, we studied the effects of synthetic porcine endothelin-1 in cultured chick embryo ventricular cells. Endothelin-1 had a potent chronotropic effect (EC50 0.17 nmol/l) in spontaneously beating cells. The increase in the beating rate was accompanied by a frequency-dependent decrease in the amplitude of contraction. In electrically driven cells (1 Hz), endothelin-1 increased the amplitude of contraction dose-dependently, with an EC50 of 0.3 nmol/l, smaller than that of the calcium channel blocker BAY K 8644 (EC50 3.3 nmol/l), and with an efficacy close to that of BAY K 8644 and isoproterenol. Nicardipine (100 nmol/l) shifted to the right, by two orders of magnitude, the dose-response curve of endothelin-1 for inotropism. These results indicate that endothelin-1 is one of the most potent inotropic agents in cultured cardiac myocytes, and suggest that this effect involves, at least in part, a calcium ion influx through voltage-sensitive calcium channels.