[Correlation between ICIQ-UI-SF score and personality testing results over a urinary incontinent population]. / Corrélation entre le score de l'ICIQ-UI-SF et les résultats d'un test psychométrique de personnalité d'une population ayant une incontinence urinaire.

OBJECTIVE: We found out the personality pattern of an incontinent population and proceeded to a correlation between the personality inventory and the ICIQ-UI-SF (International Consultation Incontinence Questionnaire Urinary Incontinence Short Form) to demonstrate reliability and sincerity of the answers and to establish that a personality disturbance may impact the physiopathology of micturition. MATERIALS AND METHODS: We performed an observational prospective study. It included patient's answers to a computed questionnaire combining a double ICIQ-UI-SF questionnaire and the 71 questions of the Minimult questionnaire. Forty-seven patients were asked to participate. RESULTS: Over 37 patients included, Wilcoxon-Mann-Whitney non parametric test confirmed agreement of the two ICIQ-UI-SF questionnaires with P=0.1792. Twenty-three patients were validated to the Minimult inventory with F scale<70. We analysed variability of the two global ICIQ-UI-SF score in regard with the validity scale using ROC analysis. We observed an AUC of 0.559 with sensitivity 78.6% and specificity 43.5%. No L score was above 70 demonstrating absence of lie. No personality disturbance was found in 9 cases. We observed six cases with a high hypochondric value, five with a high depressive value, and four with a high hysteric value. This neurotic triad was found in two cases. We noticed five cases with psychopathic deviance relative to antisocial behaviour while values of paranoia and hypomania were high in one case without any association of these personality aspects, which demonstrated absence of behavioural problem. Psychotic profile associating schizophrenia, paranoia, depression and hypomania was not found. We outlined in half of the valid population a significant high psycho-asthenic pattern. CONCLUSION: We conclude that a correlation between the personality inventory and the ICIQ-UI-SF is feasible. The comparative study demonstrate reliability of answers. Sincerity is established by the Minimult L scale. We confirm and precise literature information over clinical personality pattern of this population and observe relevant elements concerning the psycho-asthenic pattern which depicts an anxious personality with an important feeling of the problem. These elements permit to suspect that a personality disturbance may impact the physiopathology of the micturition. LEVEL OF EVIDENCE: 4.

Hyponatremia at the Emergency Department: a case-control study.

BACKGROUND: Hyponatremia (HNA) is a common electrolyte disturbance associated with morbidity and mortality. The aim of this study was to assess incidence and prognosis value of HNA in the Emergency Department (ED). METHODS: A retrospective observational case-control study has been conducted in the ED during 10 months. Control patients (Na 135-145 mmol/L) were matched, in a 1:1 ratio, on age, gender and month of ED admission with hyponatremic patients (Na<130 mmol/L). RESULTS: Two hundred fifty-six patients (2.4% of patients with a blood analysis) had HNA among which 166 were matched with 166 normonatremic controls. HNA patients had more often a history of asthma/chronic obstructive pulmonary disease (P=0.002) and solid tumors (P=0.001), received more diuretics (P=0.026), and presented more often with vomiting (P=0.034). Admission to the hospital or to the ICU was more frequent in HNA patients (89% vs. 52%, P<0.001; 13% vs. 3%, P=0.003, respectively). Patients with HNA presented more frequently at least one complication (digestive, septic, respiratory, renal, and cardiovascular) during their hospital/ICU stay (40% vs. 4%, P<0.001). Mortality rate was higher in HNA than in controls (10% vs. 3%, P=0.021). The multivariable conditional logistic regression analysis showed an independent association of HNA with solid tumors (OR=4.12; 95% CI: 1.68 to 10.1) and hospital death (OR=2.90; 95% CI: 1.03 to 8.17). CONCLUSION: HNA was present in 2.4% of patients with a blood analysis and was associated independently with solid tumors and hospital death.

[Influence of sport on isoinertial trunk muscle performance development: a 2 years prospective study]. / Activités sportives et dévelop- pement de la force isoinertielle du tronc chez les adolescents: étude prospective sur deux ans.

In this study, we investigate the relationship between either regular sports practice or a non sportive way of life, development of trunk muscle performance and occurrence of lower back pain between male schoolchildren. 93 schoolchildren were recruited, then stratified in 4 groups, according to sport practice or sedentary way of life. Participants were evaluated twice at an interval of 2 years with an interview, a physical examination and an evaluation of trunk muscle performance. We identified that basketball players have significantly better results and perfomance concerning isometric and isoinertial tests of trunk muscles than the other groups. Differences in trunk muscle performance exist following the practice of different types of sport. We can deduce that trunk muscle performance has some sport specificity.

[Implementation of the therapeutic hypothermia recommendation after resuscitated cardiac arrest caused by ventricular fibrillation and tachycardia without pulse: a retrospective study in Saint-Pierre Hospital]. / Etude rétrospective au sein du C.H.U. Saint-Pierre sur l'application de la recommandation d'hypothermie post arrêt cardiaque par fibrillation et tachycardie ventriculaire sans pouls.

INTRODUCTION: Therapeutic hypothermia is an essential step for the neurological protection of comatose individuals after cardiorespiratory arrest (CA) and ventricular fibrillation (VF). The evaluation of the application of the Protocol thereto within the C.H.U. Saint-Pierre (SPH) is the subject of this study. METHOD: Retrospective analyzes of the SPH computerized records from 01/01/2005 to 31/12/2010 whose inclusion criteria are out-of-hospital CA admitted alive to the hospital with VF as initial rythm. Transferred patients or NTBR status are excluded. RESULTS: Of the 72 patients studied, 68% were discharged alive from the hospital, 84% of which has no neurologic sequelae. Hypothermia was used for 44 people, unduly in 5 cases and there were also 5 other cases for which it was needed, but not applied. Hypothermia (32-34 degrees C) was reached in 11 h 23 (+/- 144 min) and lasted an average of 19 h 51 (+/- 249 min). Hypothermic patient survival amounted to 72.4%, including 81% with good neurological outcome. CONCLUSION: The results of the protocol application are superior to those of several other studies. Few errors of inclusion and exclusion are present. The implementing of a common protocol for IC--Emergency Units--EMS to accelerate obtaining the target temperature and improve performance seems beneficial. The creation and implementation of a specific register with patients who had AC and were cooled seem interesting for a better medical follow-up, an assessment of the management and an enhancement of the current knowledge related to this technique.

[Evaluation of DCA vantage for rapid in-clinic measurement of HbA1c on capillary blood in young type 1 diabetic patients]. / Evaluation du DCA Vantage pour une mesure rapide de l'HbA1c au cabinet sur sang capillaire chez des jeunes patients diabétiques de type 1.

Rapid in clinic measurement of glycated hemoglogin (HbA1c) allows to determine the level of metabolic control within a few minutes on capillary blood. We have evaluated the new DCA Vantage (Siemens) based on an immunological technique, replacing the DCA 2000+ (Siemens). The study included 120 unselected young type 1 diabetic patients, with different degrees of metabolic control. The DCA Vantage was compared with the HPLC system (Menarini HA 8160) whose deviation from the DCCT was < 0.1% across the clinical range. The mean underestimation of the DCA Vantage was -0.40%. The agreement limits (+/- 1.96 SD) were between 0.14% and -0.93%; this means +/- 0.53% around -0.40%. In conclusion, the DCA Vantage underestimates HbA1c levels; however it met the acceptance criteria of having a coefficient of variation < 3%.

Risk markers for cardiovascular disease in young type 1 diabetic patients: lipoproteins, high-sensitivity C-reactive protein and adiponectin.

OBJECTIVES: Lipoproteins, high-sensitivity C-reactive protein (hs-CRP) and adiponectin have been studied as risk factors for cardiovascular disease (CVD). The aim of this study was to measure and analyze those risk markers in young type 1 diabetic patients and to evaluate the association between adiponectin and different parameters. METHODS: This cross-sectional study analyzed body mass index, subscapular skinfold thickness, physical activity, nutrition, glycated haemoglobin (HbA1c), total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, apolipoprotein B, hs-CRP and adiponectin in 148 young type 1 diabetic patients [age--median (interquartile range)--13.5 (10.3-16.0) yr]. Linear and multiple regression analysis were used. RESULTS: Median HbA1c was 7.5 (7.0-8.1)%. Median cholesterol and hs-CRP levels were normal. Adiponectin was 14.9 (10.8-19.0) microg/ml. There was no correlation between adiponectin and age, diabetes duration, body mass index, physical activity, protein, fat or carbohydrate intake, HbA1c, serum lipids or hs-CRP. But there was a negative correlation between serum adiponectin and skinfold thickness and a positive correlation between adiponectin and daily energy intake. Multiple linear regression analysis showed an independent positive correlation with daily energy intake, saturated fat intake and apolipoprotein B levels. CONCLUSIONS: In children and adolescents with relatively well controlled glycaemia, there are no abnormalities of risk markers for cardiovascular disease: lipoproteins, hs-CRP and adiponectin. Adiponectin levels are associated with daily energy intake, saturated fat intake and apolipoprotein B levels suggesting that increased levels of adiponectin could protect patients at increased risk of CVD. A longitudinal analysis is needed to follow up these factors and any occurrence of cardiovascular disease.

Environmental influences on activity patterns in altered states of consciousness.

BACKGROUND AND PURPOSE: To evaluate in disorders of consciousness (DOC) circadian variations in motor patterns and their possible synchronization with physiologically regulated light variations and/or a social environmental factor, i.e. presence and actions of other persons. METHODS: Actimetric and ambient light levels recordings were obtained during 4-9 days in two patients with traumatic brain injury (TB1 and TB2) in a minimally conscious state (MCS), one MCS (AI1) and one comatose (AI2) anoxic-ischaemic patients. Environmental changes were automatically recorded using a video system. RESULTS: Minute light variations correlated with motor activity in all patients. However, motor activity was significantly higher during day than nighttime and correlated with social environmental changes, in patients TB1 and TB2 only. CONCLUSIONS: Night-day circadian variations in motor activity patterns and influence of social stimulations were observed in traumatic MCS patients only. Nonetheless, rapid light variations may temporarily promote increased arousal, and consequently motor activity, in all DOCs.

Pulmonary vascular diseases.

Diseases of the pulmonary vasculature are a cause of increased pulmonary vascular resistance (PVR) in pulmonary embolism, chronic thromboembolic pulmonary hypertension (CTEPH), and pulmonary arterial hypertension or decreased PVR in pulmonary arteriovenous malformations on hereditary hemorrhagic telangiectasia, portal hypertension, or cavopulmonary anastomosis. All these conditions are associated with a decrease in both arterial PO2 and PCO2. Gas exchange in pulmonary vascular diseases with increased PVR is characterized by a shift of ventilation and perfusion to high ventilation-perfusion ratios, a mild to moderate increase in perfusion to low ventilation-perfusion ratios, and an increased physiologic dead space. Hypoxemia in these patients is essentially explained by altered ventilation-perfusion matching amplified by a decreased mixed venous PO2 caused by a low cardiac output. Hypocapnia is accounted for by hyperventilation, which is essentially related to an increased chemosensitivity. A cardiac shunt on a patent foramen ovale may be a cause of severe hypoxemia in a proportion of patients with pulmonary hypertension and an increase in right atrial pressure. Gas exchange in pulmonary arteriovenous malformations is characterized by variable degree of pulmonary shunting and/or diffusion-perfusion imbalance. Hypocapnia is caused by an increased ventilation in relation to an increased pulmonary blood flow with direct peripheral chemoreceptor stimulation by shunted mixed venous blood flow.

Osteoprotegerin and progression of coronary and aortic calcifications in chronic kidney disease.

Vascular calcifications (VCs) are important predictors of cardiovascular mortality in patients with chronic kidney disease (CKD). We have shown previously that osteoprotegerin (OPG), a potential early biomarker for VC, was an independent predictor of mortality in CKD patients. The aim of our study was to follow longitudinally coronary and aortic VCs. VCs were measured using Siemens 16 detector CT in a group of predialysis and hemodialyzed patients before and after a follow-up of 4 years. Some of these patients were transplanted in the meantime. Renal function, calcium, phosphate, iPTH, hs-CRP (high sensitive protein C reactive), and OPG serum levels were also compared. VCs progressed in predialysis, hemodialyzed, and transplanted patients but the progression was not the same in all arterial beds. A progression of coronary calcifications was observed in predialysis and transplanted patients, while aortic calcifications worsened significantly only in hemodialyzed patients. OPG serum levels and hs-CRP were significantly lower among transplanted patients. We concluded that VC depends on the severity of the kidney disease. Transplanted patients are not protected from VC, yet their OPG serum levels were significantly lower, suggesting that there is no link between between OPG levels and severity of VC. Longer follow-up of these patients would be necessary to assess whether a decline in OPG correlates with better survival.

Board certified physicians in health informatics a European precedent for professional recognition.

OBJECTIVE: To document the official recognition of a new specialty in health informatics in one European country, because a similar legal process may lead to professional equivalence for physicians in all member countries of the European Union and elsewhere. METHOD: In Belgium, a Ministerial Decree in 2001 established criteria for the certification of Physician Specialist in Health Data Management. Such recognition of a new competence is a natural complement to a University Master's degree and can have a major influence on the salary scale and on professional recognition and development in public and private sectors. RESULTS: Teaching and training programmes in Belgium were adapted according to the Decree. Ninety-seven physicians were certified in the French community and 72 in the Flemish community between 2002 and 2009, with a prerequisite of this title for engagement in several official and private positions, and a salary increase. DISCUSSION: In other countries, recognition of a specific competence in health informatics remains, at best, a voluntary registration process and University programs vary widely. The implications of this Decree, with recognition of Physician Specialist in Health Data Management as a special competence, rather than a medical specialty, are discussed. The extension of such recognition to health professions other than physicians is not yet envisaged. CONCLUSION: Although the title "Physician Specialist in Health Data Management" may appear rather old fashioned, recognition of this competence in a European Union country is a first step to help its diffusion to other countries.

Mild hyponatremia and risk of fracture in the ambulatory elderly.

BACKGROUND: Mild hyponatremia is the commonest electrolyte imbalance in the older population and has been shown to be associated with gait and attention deficits resulting in higher frequency of falls. The association of mild hyponatremia and bone fracture is still unknown. OBJECTIVE: To determine if mild hyponatremia is associated with increased risk of bone fracture in ambulatory elderly. DESIGN, SETTING AND PARTICIPANTS: Case control study of 513 cases of bone fracture after incidental fall in ambulatory patients aged 65 or more in general university hospital. Controls were age and sex matched randomly selected ambulatory patients without history of bone fracture. MAIN EXPOSURE MEASURES: Odds ratio (OR) of bone fracture after incidental fall associated with presence of hyponatremia. RESULTS: Prevalence of hyponatremia (serum sodium <135 mEq/l,) in patients with bone fracture and in controls patient was, respectively, 13.06% and 3.90%. Hyponatremia was mild and asymptomatic in all patients (mean serum sodium 131 mEq/l) and was found to be associated with bone fracture after incidental fall in ambulatory elderly (unadjusted OR: 3.47, 95% CI: 2.09-5.79, and adjusted OR: 4.16 95% CI: 2.24-7.71). Hyponatremia was either drug induced (36% diuretics, 17% selective serotonin reuptake inhibitors) or resulted from idiopathic syndrome of inappropriate antidiuretic hormone secretion (37%). Hyponatremia was associated with 9.20% of all bone fractures. CONCLUSION: Mild asymptomatic hyponatremia is associated with bone fracture in ambulatory elderly and avoiding iatrogenic hyponatremia or treating hyponatremia may decrease the number of bone fractures in this population.

[Critical reading and EBM : the LIFE trial]. / Lecture critique et EBM : l'etude LIFE.

For ten years, " evidence-based medicine " gradually invaded all the medical field : clinical practice but also research and teaching. More than being just a new paradigm, it constitutes one of the pillars of good medical practice beside experimentation, ethics and the requests of the patient. It gathers collective quantitative aspects (statistics, public health, epidemiology, biomedical research) applied to the individual reality of each patient in search of care. One of the methods used in " evidence-based medicine " is critical reading : in-depth analysis of the published trials in medical journals, to extract and validate the elements applicable to the daily clinical practice. The LIFE trial, designed to compare treatment with a sartan or a beta-blocker for hypertensive patients with left ventricular hypertrophy, is used as a model to concretely explicit the various steps and methodologies of critical reading.

Does a foamy-block mattress system prevent pressure sores ? A prospective randomised clinical trial in 1729 patients.

BACKGROUND: Pressure ulcers are a frequent complication of bed rest. The development of an efficient and low cost pressure relieving system for the prevention of bed-sores would be of considerable hospital health and economic interest. Our study was designed to determine the effectiveness in pressure-sore prevention of an interface pressure-decreasing mattress, the Kliniplot mattress, used in our institution since 1978. METHODS: In a prospective randomised controlled 7-month clinical trial we compared the Kliniplot mattress with our standard hospital mattress in 1729 patients admitted to medical and surgical departments (neurology, cardiology, oncology-haematology, neurosurgery, thoracic surgery and orthopaedic surgery). Two groups (Klinipot mattress and standard hospital mattress) were monitored for the prevention of pressure sores. The patients were evaluated on a daily basis from their admission until the eventual occurrence of a bed-sore. Patients' characteristics and pressure-sore risk factors were similar at the baseline in both groups. Patients presenting with a pressure sore at the time of admission were excluded. RESULTS: Forty-two of the 1729 patients (2.4%) who entered the study developed at least one pressure sore. Twenty-one of the 657 patients (3.2%) nursed on the Kliniplot mattress, and 21 of the 1072 patients (1.9%) on the standard mattress developed bed-sores (p = 0.154). The median time for the occurrence of pressure sores was 31 days (range 6-87) with the Kliniplot mattress and 18 days (range 2 to 38) with the standard mattress (p < 0.001). The risk categories for developing bed-sores using the modified Ek's scale were no different at the baseline between both groups (p = 0.764). The severity of the pressure sores was no different between both groups (p = 0.918). CONCLUSIONS: Our results show that the occurrence of pressure sores is not reduced but is delayed when patients are nursed on a Kliniplot pressure-decreasing mattress.

Weaning from mechanical ventilation.

Weaning covers the entire process of liberating the patient from mechanical support and from the endotracheal tube. Many controversial questions remain concerning the best methods for conducting this process. An International Consensus Conference was held in April 2005 to provide recommendations regarding the management of this process. An 11-member international jury answered five pre-defined questions. 1) What is known about the epidemiology of weaning problems? 2) What is the pathophysiology of weaning failure? 3) What is the usual process of initial weaning from the ventilator? 4) Is there a role for different ventilator modes in more difficult weaning? 5) How should patients with prolonged weaning failure be managed? The main recommendations were as follows. 1) Patients should be categorised into three groups based on the difficulty and duration of the weaning process. 2) Weaning should be considered as early as possible. 3) A spontaneous breathing trial is the major diagnostic test to determine whether patients can be successfully extubated. 4) The initial trial should last 30 min and consist of either T-tube breathing or low levels of pressure support. 5) Pressure support or assist-control ventilation modes should be favoured in patients failing an initial trial/trials. 6) Noninvasive ventilation techniques should be considered in selected patients to shorten the duration of intubation but should not be routinely used as a tool for extubation failure.

Are multiple blood transfusions really a cause of acute respiratory distress syndrome?

BACKGROUND AND OBJECTIVES: Multiple blood transfusions are considered a common cause of acute respiratory distress syndrome (ARDS). We hypothesized that ARDS is more a consequence of ARDS risk factors (in particular circulatory shock) requiring transfusions than a result of the transfusions themselves. METHODS: This retrospective study included 103 patients admitted during a 10-month period to an 858-bed university hospital who received multiple transfusions (more than six units of packed red blood cells in 24 h). RESULTS: Ten patients developed ARDS; they were more commonly admitted with circulatory shock (36 (38.7%) vs. 8 (80%), P = 0.01), polytrauma (7 (7.5%) vs. 4 (40%), P = 0.01) or thoracic trauma (3 (3.2%) vs. 4 (40%), P = 0.01). The sequential organ-failure assessment (SOFA) score at admission was higher in patients who developed ARDS than in those who did not (9.0 +/- 3.1 vs. 5.6 +/- 3.4, P < 0.005). The total amount of transfusion in the first 24 h was 14.0 +/- 6.8 U in the ARDS patients and 10.6 +/- 7.3 U in the other patients (P = 0.17); the differences remained non-significant in the following days. During the first 24 h, patients who developed ARDS received more fresh frozen plasma than those who did not (21.8 +/- 10.6 U vs. 10.7 +/- 14.7 U, P = 0.02). Patients who developed ARDS had lower PaO2/FiO2 ratios (114 +/- 61 mmHg vs. 276 +/- 108 mmHg, P = 0.01), lower arterial pH (7.27 +/- 0.10 vs. 7.34 +/- 0.11, P = 0.06) and higher minute volume (10.6 +/- 2.8 L min(-1) vs. 7.9 +/- 1.8 L min(-1), P = 0.03) than patients without ARDS. Multivariable analysis retained thoracic trauma and hypoxaemia during the first 24 h (but not multiple transfusions) as independent risk factors for ARDS. CONCLUSIONS: In this retrospective study, the development of ARDS in massively transfused patients was less related to poly-transfusion than to other factors related to circulatory shock, polytrauma or thoracic trauma. Thoracic trauma and a low PaO2 during the first 24 h were identified as independent risk factors for ARDS.

Three percent diclofenac in 2.5% hyaluronan gel in the treatment of actinic keratoses: a meta-analysis of the recent studies.

Three percent diclofenac in 2.5% hyaluronan gel (DHA) is approved by the Food and Drug Administration (FDA) in the treatment of actinic keratoses (AK). We conducted a meta-analysis of the few prospective studies that evaluated the effect of DHA on the target lesion number score TLNS0 (indicating complete resolution of all target lesions in the treatment area) and/or the cumulative target lesion number score CLNS0 (indicating resolution of the target and new lesions in the treatment area) with assessment 30 days after the end of treatment. A comprehensive search of the 1966-2005 MEDLINE database and review of the reference lists of relevant articles identified the published randomised trials. Three studies were included, with a total of 364 patients. The placebo was the hyaluronan vehicle gel (HAV). The intention-to-treat analyses show that DHA significantly improve the TLNS0 (OR= 3.72; 95% CI=2.05-6.74) and the CLNS0 (OR=4.09; 95% CI=2.55-6.56) compare to HAV. Overall, 42/106 (39.6% CI: 30.8- 49.1%) had a TLNS0 with mean treatment duration of 75 days +/- 21 [mean+/-standard deviation (SD)], and 70/179 (39.1% CI:32.3-46.4%) patients had a CLNS0 with a mean 78 days+/-16 treatment duration. DHA is effective compared to HAV in the treatment of AK. Further studies should establish subgroup analyses according to sites and severity of the AK lesions in order to determine if more patients could be improved in restricted indications. Biopsies, a longer follow-up evaluation, and comparisons with the other treatments of AK will also be helpful in the future to define the place of this treatment in the management of AK.