[Ocular syphilis, the rise of a forgotten disease: Retrospective study of 18 cases diagnosed at Amiens University Hospital]. / La syphilis oculaire, retour d'une maladie oubliée : étude rétrospective de 18 cas diagnostiqués au CHU d'Amiens.

OBJECTIVES: A disturbing resurgence of syphilis has been observed in the past few years. Ocular involvement of syphilis is infrequent. The goal of our study was to analyze the demographic data and clinical features and to analyze visual outcomes in cases of ocular syphilis at Amiens UH between January 1, 2015 and December 31, 2019. MATERIAL AND METHODS: This descriptive, observational, single-center study included a retrospective cohort of patients who were diagnosed with ocular syphilis. The data collected were demographic data (age, sex and sexual orientation), history of risky sexual behavior, HIV status and potential co-infections, stage of syphilis, chief complaint, initial and final logMAR visual acuity, biomicroscopic examination of the anterior segment, dilatated fundus examination, extraocular clinical manifestations and treatment initiated. RESULTS: Twenty-four eyes of eighteen patients (17 men and 1 woman) with a mean age of 48±12 were included in the study. 9 patients were homosexual, and 9 were heterosexual. A history of risky sexual behavior was noted in 6 patients (33.3%), and 4 patients (22%) were HIV positive. 2 patients (11.1%) had primary syphilis, 14 patients (77.7%) had secondary syphilis and 2 patients (11.1%) had tertiary syphilis. All patients were symptomatic, and vision loss was the main ophthalmologic symptom. The mean initial visual acuity was -0.55±0.56 logMAR, and the final visual acuity was 0.04±0.07 logMAR. Posterior uveitis was the predominant type of involvement (42%), and 9 patients presented with neurosyphilis. 11 patients (61.1%) showed extraocular clinical manifestations. 9 patients (50%) received subcutaneous ceftriaxone 2g, 6 patients (33.3%) received daily intravenous benzylpenicillin G, 2.4 million IU, and 3 patients (16.6%) were treated with oral doxycycline 200mg. CONCLUSION: Ocular syphilis remains a diagnostic and therapeutic challenge because of the various ocular manifestations it provokes. Since this pathology can result in severe damage, every clinician who diagnoses uveitis should consider the possibility of syphilis so as to avoid any delay in treatment. Even though ocular syphilis remains a rare clinical entity, it is a potentially devastating infection.

[Functional results and prognostic factors in open-globe ocular trauma with presenting visual acuity of no-light perception]. / Résultats fonctionnels et facteurs pronostiques des traumatismes oculaires à globe ouvert avec acuité visuelle initiale à perception lumineuse négative.

PURPOSE: To analyse the clinical ocular characteristics and determine prognostic factors for functional recovery in eyes presenting with no light perception (NLP) after open globe ocular trauma. MATERIALS AND METHODS: In this retrospective study were included all the patients with no light perception after open globe trauma who presented to Amiens University Hospital between October 2014 and June 2018. RESULTS: Fifteen eyes of 15 patients were included in this study. The main mechanism of the trauma was globe rupture (80 %, n=12). The most common location was zone III (66 %, n=10). The wound size was greater than 10mm in 9 patients (60 %). The ocular lesions included expulsion of the crystalline lens or posterior chamber intraocular lens, hyphema, retinal detachment, vitreous hemorrhage and ciliochoroidal lesions. Damage to the ciliary body was a negative prognostic factor for functional recovery (P=0.04). Nine patients remained with no light perception, whereas 6 patients experienced an improvement in visual acuity (2.3 logMAR in 3 patients, 0.7 logMAR in 1 patient, 0.4 logMAR in 1 patient and 0.2 logMAR in 1 patient). These 6 patients had undergone posterior vitrectomy due to vitreoretinal involvement (P<0.001). CONCLUSION: In the case of open globe trauma with no light perception on presentation, a functional recovery is possible if there is no irreversible anatomical damage.

[High plasmatic concentration of vitamin B12: an indicator of hepatic diseases or tumors]. / Concentration plasmatique élevée de la vitamine B12 : un indicateur des maladies hépatiques ou tumorales.

PURPOSE: To identify the diseases that are associated with a high plasma concentration of vitamin B12 and to measure the strength of this association. PATIENTS AND METHODS: Retrospective study including all admissions between 1st May, 2005 and 30th April, 2008 in the UMAG pole departments (emergency, internal medicine, acute geriatrics and medical intensive care) with a test for plasma vitamin B12. The association between each of medical information system codes (solid tumors, malignant hematologic process, and renal disease) and a high or low vitamin B12 concentration was measured by odds ratios (OR) from logistic models taking into account repeated admissions, with adjustment for age and the weighted Charlson index. RESULTS: Among 3702 admissions, 12% had a B12 more than 820pg/ml, 10.4% a B12 less than 180pg/ml and 77.6% a normal B12 concentration. After adjustment for age and the weighted Charlson index, high concentration of vitamin B12 was associated with interstitial renal diseases (OR 2.7; 95% CI: [1.7-4.2]), and cirrhosis or hepatitis (OR 4.3; [2.9-6.4]). After additional adjustment for these parameters, it was still associated with tumors (OR 1.8; [1.2-2.6]), malignant hematologic diseases (OR 2.1; [1.3-3.5]), metastasis (OR 2.9; [1.5-5.9]), liver metastasis (OR 6.2; [2.7-14.5]), liver carcinoma (LC) (OR 3.3; [1.1-10.4]), liver tumors other than LC (OR 4.7; [1.2-17.9]) and lymphoma (OR 3.2; [1.6-6.4]) but not with myeloma (OR 1.9; [0.6-1.4]). Low concentration of B12 was associated with myeloma (OR 2.9; [1.3-6.6]). CONCLUSION: Finding a high plasma concentration of vitamin B12 should lead to a systematic search for a hepatic disease or a tumor, and particularly for a hepatic localization of a tumor.

[Accelerated partial breast irradiation for early breast cancer]. / Irradiation partielle accélérée du cancer du sein : aspect théorique.

Hypofractionated and accelerated partial breast irradiation are more and more widely used for early breast cancer. Here, this short communication would expose the role of hypofractionated radiotherapy in adjuvant breast radiotherapy, rational, techniques and indications of accelerated partial breast irradiation.

[Hospital LOS, medical complexity and deprivation indicators]. / Lien précarité - durée et complexité des séjours hospitaliers en secteur de court séjour.

BACKGROUND: Several studies have shown that socioeconomic deprivation is associated with increased hospitalization lengths of stay (LOS) and costs. Yet, the French DRG-based information system (PMSI) does not take deprived situations into account. Hence, we aimed at extracting routinely available variables measuring deprivation from the Hospital Information System and at assessing their association with severity of illness and hospital LOS. METHODS: We performed record linkage between the PMSI database concerning stays of patients aged more than 16years in the short-stay sector of Assistance publique-Hôpitaux de Paris in 2007 and an administrative database which provided the following deprivation measures: recipients of Couverture Médicale Universelle (basic or complementary health insurances adapted for underprivileged French citizens) or Aide Médicale d'Etat (health and medical emergency insurances adapted for underprivileged non French citizens living in France) and homeless patients. We compared length of stays showing a deprivation measure to others after adjustment on morbidity, age and sex. RESULTS: Among 352,721 stays, the prevalence of the deprivation measures ranged from 0.71% for "homelessness" to 6.24% for complementary Couverture Médicale Universelle. Stays showing a deprivation measure had specific illnesses and had more frequently associated comorbidities or complications than others. After adjustment, deprivation measures were associated with significantly increased LOS (by 5% for Couverture Médicale Universelle to 48% for emergency Aide Médicale d'Etat. CONCLUSION: Routine extraction of deprivation measures from Hospital Information Systems is feasible. Age, sex and illness being equal, these deprivation measures were associated with more complicated cases and increased LOS. We recommend that case mix-based hospital prospective payment systems take socioeconomic deprivation into account.

[Tracheostomy in intensive care: impact on prognosis and the influence of underlying chronic respiratory insufficiency]. / Trachéotomie en réanimation: pronostic et rôle d'une insuffisance respiratoire chronique.

INTRODUCTION: Numerous uncertainties remain concerning the place of tracheostomy in intensive care. Reluctance to perform tracheostomy is common, particularly in the presence of pre-existing chronic respiratory insufficiency (CRI), but some data suggest there may be benefits. The objective of this study was to evaluate the influence of tracheostomy on mortality in both intensive care and hospital, and to study the role of pre-existing CRI. MATERIAL AND METHODS: In a retrospective study of the records of 2901 patients admitted over a period of 5 years 882 were identified who had been intubated and ventilated. 127 patients who had had tracheostomies (T+) were compared with 755 who had not (T-), and with a sub-group of T- patients (T-app) matched for severity on admission (SAPSII). RESULTS: ICU and hospital mortality were significantly less in the T+ than the T-patients (28 vs 52% and 42 vs 59%) and the duration of stay was longer. This was equally true when matched for severity on admission when T+ were compared with T app (28 vs 49% and 42 vs 59%). Pre-existing CRI did not influence the outcomes of the tracheostomised patients, regardless of whether the CRI was obstructive, restrictive or neuro-muscular. CONCLUSIONS: Tracheostomy can, in certain groups of artificially ventilated patients and in certain care settings, be associated with a reduction in hospital mortality.

[Quality of medical database to valorize the DRG model by ISA cost indicators]. / Qualité du recueil PMSI pour la valorisation par points ISA du modèle GHM.

BACKGROUND: The use of the French version of the DRG model is focused on cost allocation, based on the case-mix system and the use a weight called ISA (Synthetic Index of Activity) for each DRG. However, this administrative database is becoming more and more used by both researchers and health policy makers for health planning and benchmarking. In France, data abstraction and coding of medical records is done by physicians. The objective of this study was to determine the accuracy of a database of the discharge summaries used for DRGs and to compare consequences of inappropriate coding on budget estimation and risk adjustment. METHODS: Samples of discharge summaries from six cardiology units were recoded by trained physicians in data abstracting and coding. Comparison between initial and recoded diagnoses (errors on main diagnosis or on comorbidities) used by the DRG system algorithm, and the original and final case-mix were performed. The before and after abstracted data were stratified and compared by principal diagnosis (myocardial infarction or congestive heart failure) and discharge status (dead or alive). MAIN RESULTS: Comorbidities were underreported by physicians of cardiology units compared to reabstracted data (mean number of secondary diagnoses per summary: 2.1 vs. 3.6, p<0.001), especially those which had a minimal impact on the DRG classification. In spite of a 15% rate of wrong DRGs, there was no significant difference in the total amount of ISA after data reviewing. Underreporting of comorbidities is more important for medical records of dead patients at discharge but, without significant effect on rate of change in DRG and amount of ISA. CONCLUSION: Discharge summaries used in the French DRGs system consistently underestimate the presence of comorbid conditions, which has direct implications for policy-makers comparing performance between hospital units. Both clinical practitioners and policy makers should be aware of this bias when assessing patient's quality of care or performing health planning through discharge summaries.

Vitamin D status during puberty in French healthy male adolescents.

The vitamin D status was determined on one to four occasions either after summer (September-October) or after winter (March-April) in 175 male adolescents (13-17 years), resulting in 394 measurements of serum 25-hydroxyvitamin D (25(OH)D) and intact parathyroid hormone (iPTH). The subjects lived in a rural area to the north of Paris (49 degrees N). After summer the 25(OH)D concentration was 58.5 +/- 18.0 nmol/l (mean +/- SD), while after winter it had fallen to 20.6 +/-6.0 nmol/l (p = 0.0001). Meanwhile the iPTH concentration was 2.76 +/- 0.97 pmol/l (mean +/- SD) after summer and increased to 4.20 +/- 1.21 pmol/l after winter (p = 0. 0001). All the results were pooled and a nonlinear population model with random parameters was used to describe the relationship between serum iPTH and 25(OH)D. When the concentration of 25(OH)D was higher than 83 nmol/l, an iPTH mean 'plateau' level at 2.48 pmol/l was reached. When 25(OH)D concentrations fell below 83 nmol/l, the increase in iPTH concentration accelerates, and when the mean 25(OH)D concentration was equal to or lower than 10 nmol/l the mean iPTH level (4.97 pmol/l) was twice as high as the 'plateau' value.

[What is your diagnosis? Aneurysm of the abdominal aorta destroying the lumbar spine]. / Quel est votre diagnostic?

A 58 year old woman suffering from lumbalgia over 3 years is admitted for bilateral cruralgia. Ten years before, she was treated for cervix carcinoma by hysterectomy, pelvic and lumbo-aortic radiotherapy and chemotherapy. On admission, physical examination reveals L2 level hypoesthesia and abolition of deep tendon reflexes. Plain films and CT scan show a lysis of L3, L4 and L5 vertebral bodies and a cuneiform appearance of vertebral body of L2 due to a large abdominal aortic aneurysm.

Nonparametric estimation of population characteristics of the kinetics of lithium from observational and experimental data: individualization of chronic dosing regimen using a new Bayesian approach.

A population analysis of the kinetics of lithium was performed from experimental and observational data in 113 subjects in order to propose a new approach for lithium dosage individualization. The kinetics of lithium is described by a two-compartment model. Age, body weight, height, and serum creatinine are included as covariates. Population analysis was performed by the nonparametric maximum likelihood method, which provides an estimate of the distribution of the five kinetic parameters and covariates. Mean lithium clearance was 1.50 L/h with a coefficient of variation (CV) of 38%, and was found to increase with body weight. Results were consistent with those of earlier studies and confirm a large interindividual variability. Data from a separate group of 35 patients were used to validate results: the estimated a priori and on covariate conditional distributions of the measured 24-h serum lithium concentration following a single dose were consistent with the corresponding measurements. A Bayesian approach for individualizing dosing schemes is proposed. This approach is based on minimization of a risk function expressing the deviation of the trough concentration at steady-state from the therapeutic range.