Predictive factors of dropout from inpatient treatment for anorexia nervosa.

BACKGROUND: Patients with severe Anorexia Nervosa (AN) whose condition is life-threatening or who are not receiving adequate ambulatory care are hospitalized. However, 40 % of these patients leave the hospital prematurely, without reaching the target weight set in the treatment plan, and this can compromise outcome. This study set out to explore factors predictive of dropout from hospital treatment among patients with AN, in the hope of identifying relevant therapeutic targets. METHODS: From 2009 to 2011, 180 women hospitalized for AN (DSM-IV diagnosis) in 10 centres across France were divided into two groups: those under 18 years (when the decision to discharge belongs to the parents) and those aged 18 years and over (when the patient can legally decide to leave the hospital). Both groups underwent clinical assessment using the Morgan & Russell Global Outcome State questionnaire and the Eating Disorders Examination Questionnaire (EDE-Q) for assessment of eating disorder symptoms and outcome. Psychological aspects were assessed via the evaluation of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Socio-demographic data were also collected. A number of factors identified in previous research as predictive of dropout from hospital treatment were tested using stepwise descending Cox regressions. RESULTS: We found that factors predictive of dropout varied according to age groups (being under 18 as opposed to 18 and over). For participants under 18, predictive factors were living in a single-parent family, severe intake restriction as measured on the "dietary restriction" subscale of the Morgan & Russell scale, and a low patient-reported score on the EDE-Q "restraint concerns" subscale. For those over 18, dropout was predicted from a low depression score on the HADS, low level of concern about weight on the EDE-Q subscale, and lower educational status. CONCLUSION: To prevent dropout from hospitalization for AN, the appropriate therapeutic measures vary according to whether patients are under or over 18 years of age. Besides the therapeutic adjustments required in view of the factors identified, the high dropout rate raises the issue of resorting more frequently to compulsory care measures among adults.

Prostate Cancer at a regional hospital in South Africa: we are only seeing the tip of the iceberg.

OBJECTIVES: The objectives were to document the presentation of prostate cancer in the Zulu population of KwaZulu-Natal in South Africa, to identify this as a high-risk population, and to determine the potential for under-diagnosis in this population. METHOD: All histopathology results confirming prostatic adenocarcinoma from biopsies preformed at Edendale hospital from 01/11/2012 to 30/04/2014 were collected. A total of 81 participants were enrolled, and a review of their outpatient records was performed. Patient presentation was analysed, younger patients were compared to older patients, and observed incidence was compared to expected incidence. RESULTS: The majority of patients (66%, 95% confidence interval [CI]:54-76%) presented with radiographic evidence of metastatic disease or PSA greater than 100 ng/ml. The median PSA level at presentation was 154 ng/ml (Interquartile range [IQR] = 39-448). Clinically staged T4 disease was present in 44% of patients and only 10% of patients presented with PSA detected disease. Poorly differentiated tumours (Gleason grades 8, 9 and 10) were found in 43% of patients. Only 81 out of a maximum potential of 625 incident prostate cancer cases were diagnosed. CONCLUSION: Black South African men from a predominantly rural Zulu population present late and with advanced and aggressive disease. We are missing the opportunity for remission in most patients in this high risk population group. The establishment of a National Prostate Cancer Registry and further research into a prostate cancer screening programme may be beneficial to this community.

[Epidemiology of anorexia nervosa: a review]. / Épidémiologie de l'anorexie mentale : revue de la littérature.

UNLABELLED: A critical review of the literature was conducted to provide answers to three questions: firstly, are we facing a national and/or international epidemic of anorexia nervosa (AN) as claimed in the media by certain professionals? Secondly, is AN simply an ordinary crisis of adolescence? Thirdly, is it a pathology that solely affects the higher socio-professional categories? METHOD: A Medline search was conducted and backed up by a manual search to find all the studies or literature reviews published on prevalence, incidence rates, outcomes, morbidity and mortality in AN and its links with social class, covering the period 2000-2011. RESULTS: The differing methodologies of the studies on these themes have a considerable impact on the interpretation of results. For each indicator retained, the results observed in the different studies are detailed and commented in the light of these differences. The prevalence of AN in women aged 11 to 65 in non-clinical population ranges from 0 to 2.2 %. It varies in particular with the age of the studied subjects, the measurements used, and the definition criteria for AN. Among men, the lifetime prevalence is around 0.3%. The marked disparities in incidence rates observed are related to the nature of the samples considered: subjects consulting in hospital, whether in a specialised department or in any department, those consulting general practitioners (GPs), or subjects from general population samples recruited in different surveys (girls in schools for example). The incidence of female cases is low in general medicine or specialised consultation in town (whatever the speciality): from 4.2 and 8.3/100,000 individuals per year. It is much higher in the general population, ranging from 109 to 270/100,000 individuals per year. In fact, the studies reporting variations in the incidence of AN were conducted on samples from clinical populations in certain countries (United States and United Kingdom). They are probably more a reflection of variations in detection rates and use of healthcare, than of variations in the incidence in the general population. The mean duration of AN appears shorter in the general population than in clinical populations. On average, 47% of the individuals treated for AN recovered, 34% improved, 21% had a chronic eating disorder, and 5% died. The outcome is better for subjects treated during adolescence. Mortality is frequently expressed in crude mortality rate (CMR), which is not very informative on account of the heterogeneous natures of the cohorts followed; only the studies reporting standardised mortality rate (SMR) are informative. AN appears as having one of the highest mortality rates among psychiatric pathologies. Mortality varies according to the population considered. Rates observed are 6.2 to 10.6 times greater than that observed in the general population for a follow-up duration ranging respectively from 13 to 10 years. It is lower for longer follow-up periods, only 3.7 times more frequent than in the general population for follow-up periods of 20 to 40 years. It appears lower for subjects treated before the age of 20. The main causes of death are eating disorder complications, suicide and cancer. One review of the literature concluded in the absence of any significant link between this pathology and social class. DISCUSSION: There is nothing in the incidence and prevalence data to back up the notion of a recent "epidemic" of AN. AN is not simply a crisis of adolescence: morbidity and mortality are considerable in this pathology. The relationship between AN and social class is not established.

A Survey for 'Candidatus Liberibacter' Species in South Africa Confirms the Presence of Only 'Ca. L. africanus' in Commercial Citrus.

Greening disease of citrus is a serious disease known in South Africa since the late 1920s. In South Africa, it is associated with infection by 'Candidatus Liberibacter africanus', a heat sensitive, phloem-limited, noncultured alpha-proteobacterium. Huanglongbing (HLB), a similar, but more devastating disease that was described initially from China but which now occurs in several citrus producing countries, is associated with a different Liberibacter species, 'Ca. L. asiaticus'. A 'Ca. L. africanus' subspecies, 'Ca. L. africanus subsp. capensis', has been found only in South Africa infecting an indigenous Rutaceous species, Calodendrum capense (Cape Chestnut), in the Western Cape in 1995. The discovery of a new Liberibacter species in Brazil, 'Ca. L. americanus', and the spread of 'Ca. L. asiaticus' to a number of additional countries over the last few years prompted us to assess whether only 'Ca. L. africanus' is present in commercial citrus orchards in South Africa. Samples displaying greening or similar symptoms were collected from 249 citrus trees from 57 orchards distributed throughout the greening affected citrus production areas of South Africa. Multiplex polymerase chain reaction (PCR) was performed on DNA extracts to detect the known citrus Liberibacters. Amplicons were obtained from 197 samples. None of the samples yielded a 1,027-bp amplicon indicative of 'Ca. L. americanus' infection. The amplicons of 84 samples were sequenced, and all were identical to the cognate 'Ca. L. africanus' Nelspruit sequence in GenBank. No instance of 'Ca. L. asiaticus' or 'Ca. L. africanus subsp. capensis' sequence was found. Geographically representative samples that tested negative for Liberibacter also tested negative for phytoplasmas based on real-time PCR results. Based on the results of this survey, it is concluded that to date only 'Ca. L. africanus' is associated with citrus greening in commercial citrus in South Africa.

Croissance cranio-faciale des sujets masculins melano-africains agés de 8 à 20 ans

Les études téléradiographiques de la croissancesont nombreuses et représentent une contributionau domaine de la connaissance anthropologique desétapes du développement cranio-facial. Cependant, en Afrique noire il y a très peu d'études de ce genre. Danscette étude transversale, nous analysons la croissancede la base du crâne, du maxillaire et de la mandibule chez les jeunes garçons africains mélanodermes.L'échantillon d'étude est constitué de 516 garçons en période de croissance, âgés de 8 à 20 ans, non traitésorthodontiquement, supposées orthomorphiques etayant une téléradiographie de profil en occlusion deconvenance.La mandibule et le maxillaire présentent des rythmes de croissance différents tout en restant actifs jusqu'à 20ans mais la croissance de la base du crâne semble sestabiliser plus tôt, après 11 ans. La prise en compte de ces variations morphologiques sont déterminantes pour la conduite de traitements plus stables et adaptés à nos populations

[Cephalometric study of cranio-facial growth of 902 Black African children and adolescents aged 8 to 20]. / Etude céphalométrique de la croissance crânio-faciale de 902 enfants et adolescents mélano-africains agés de 8 a 20 ans.

Cephalometric studies of the growth are numerous and represent a contribution to the field of the anthropological knowledge of the stages of the cranio-facial growth and for a better adaptation of the orthodontic treatments. However, in Black Africa people there are very few studies of this kind. The purpose of this investigation is to analyze the growth of the cranial base, the maxillary skeletal region and mandibular skeletal region at the young African subjects. The sample of study consists of 386 girls and 516 boys in period of growth, old from 8 to 20 years, presumedly orthomorphic and having lateral cephalometric radiograph in occlusion. The statistical analysis of the data recorded on the layouts cephalometric (test U of Mann Whitney) announces the existence of a sexual dimorphism which is strongly significant around 9 years, 11 years and 17 years. Maxilla and mandible present different rates of growth while remaining active up to 20 years but the growth of the base of cranium seems to be stabilized earlier, after 11 years. The taking into account of these morphological variations are determining for the conduit of treatments more stable and adapted to our populations.

Antiphospholipid syndrome and factor V Leiden. Three cases with recurrent venous thrombosis.

Recurrent thrombosis is a common complication of various rheumatic disorders and is part of the definition of antiphospholipid syndrome. We report three cases of recurrent venous thrombosis due not only to antiphospholipid syndrome with a normal activated partial thromboplastin time but also to resistance to activated protein C caused by the factor V Leiden mutation. These three cases confirm that thrombotic disease is frequently multifactorial and suggest that resistance to activated protein C should be looked for routinely in patients with suggestive clinical manifestations, particularly when standard clotting tests are normal.

Genomic characterization of a liberibacter present in an ornamental rutaceous tree, Calodendrum capense, in the Western Cape Province of South Africa. Proposal of 'Candidatus Liberibacter africanus subsp. capensis'.

In 1994, the uncultured phloem-restricted bacteria of citrus huanglongbing (ex-greening) disease in Asia and Africa were characterized as 'Candidatus Liberobacter asiaticum' and 'Candidatus Liberobacter africanum', respectively. Following the rules of the International Code of Nomenclature of Bacteria, the two bacterial species have now been renamed 'Candidatus Liberibacter asiaticus' and 'Candidatus Liberibacter africanus'. A third liberibacter was detected by PCR in an ornamental rutaceous tree, Cape chestnut (Calodendrum capense), in South Africa. The new liberibacter was characterized by serology and from the sequences of its 16S rDNA, intergenic 16S/23S rDNA and ribosomal protein genes of the beta operon. Phylogenetic analysis showed that the liberibacter present in C. capense differed from the two previously described liberibacter species from citrus and that it was more closely related to 'Candidatus Liberibacter africanus' than to 'Candidatus Liberibacter asiaticus'. It is proposed that the liberibacter from C capense be assigned a subspecies status, 'Candidatus Liberibacter africanus subsp. capensis'.

[Evaluation of the facial esthetics in an Ivory Coast population]. / Appreciation de l'esthetique faciale dans une population ivoirienne.

Nowadays aesthetic standards reflect a generalisation of western ones. We propose to outline an aesthetic concept about Ivorian face. A selected jury will have to judge fifty-three Ivorian faces, through photographs and also, we'll make the cephalometric analysis of flabby and osseous tissues. We expect then, to provide orthodontists with basic references whenever they have to establish treatment objectives, for Negro-African, (particularly Ivorian), patients with facial disharmony evaluated according to western norms.

Operative dentistry: an alternative to orthodontics.

The purpose of this paper is to describe a clinical case, which highlights the role of Operative Dentistry in the treatment of Dento-alveolar Disproportion in an impoverished tropical environment. The patient had a diastema located between tooth 24 and tooth 25 due to an atypical position of his tongue while swallowing. The patient had been referred to because he could not afford Orthodontics. We suggested a conservative bridge compounded of 2 resin veneers and pontic bounded by the composite tetric ceram. The 0.5 mm teeth reduction concern lingual and proximal faces with retention form, starting at 0.3 mm from the incisal edge to 0.5 mm from the gingiva was performed with diamond burs (Shoulder and finishing). The result was satisfactory and leads us to conclude that Operative Dentistry is a good alternative to Orthodontics in a very specific social context.

Surgical management of calcific tendinitis of the shoulder: an analysis of 26 cases.

Chronic calcific tendinitis of the shoulder has good results after medical treatment in most cases. Around 10% of the patients resistant to medical treatment require surgery. We report 22 patients operated on using an open procedure. The operation included removal of the calcific deposit and an acromioplasty. The patients were rated preoperatively and postoperatively for pain, limitations in activities of daily living, range of movement and power according to a questionnaire and the Constant assessment. Globally the average score increased from 52.2 points out of 100 at the preoperative examination to 89.3 postoperatively with a mean follow up of 23 months. The most favourable results are obtained in patients with the longest interval between onset of disease and intervention (over 1 year) and with a progressive course of disease. Different techniques are discussed. Arthroscopically assisted procedures and open techniques are compared.

Healing of Charcot's joint by pamidronate infusion.

Treatment of Charcot's joints remains difficult, and involves prolonged periods without weightbearing, immobilization, and surgical salvage procedures to avoid amputation. We describe the efficacy of pamidronate in treating a patient with Charcot's joint, due to hereditary sensory neuropathy, that caused loss of pain sensation. The bone and joint destruction in our patient's left foot was stopped by bisphosphonate treatment, and signs of a reconstructive healing process were observed on the control radiographs. The treatment was administered intravenously every 4 months for 2 years, without restriction on weightbearing, since the patient had refused a plaster cast and an orthotic device. This observation suggests that treatment with bisphosphonates should be used before, or in combination with, other treatment in such cases.

HLA DRB1, DMA, and DMB gene polymorphisms in rheumatoid arthritis.

OBJECTIVE: To study the influence of DMA and DMB genes on susceptibility to Rheumatoid Arthritis (RA). METHODS: HLA-DRB1, DMA and DMB polymorphisms were defined by PCR SSOP in 203 European Mediterranean RA patients and 181 unrelated healthy controls. RESULTS: No significant difference in the phenotype frequencies of DMA and DMB alleles was observed between patients and controls. We found decreased frequencies of DMA*0102 and DMB*0104 in patients but this did not reach significance. These decreased frequencies could be due to a positive linkage disequilibrium with DRB1*0701, an allele which is underrepresented in RA patients. In stratified analysis with RA susceptibility Epitope positive (SE) DRB1 alleles, there was no significant difference in DMA and DMB phenotype frequencies between SE/SE, SE/X, and X/X patients versus controls. Among SE/X subjects, no significant difference in DM distribution frequencies was observed in DRB1*0101/X, 0102/X, 0401/X, 0404/X and 0405/X groups. CONCLUSION: DMA and DMB polymorphism does not seem to influence susceptibility to develop RA. Differences in DMA phenotype frequencies between patients and controls are secondary to linkage disequilibrium with DRB1 alleles.

Pubic pain in athletes: a case due to an abscess in the obturator muscle.

Pubic pain is a common symptom in soccer players. Its cause can be difficult to determine. We report a case in a 19-year-old soccer player who had an abscess in the obturator internus muscle. We are aware of only one similar report in the literature. Painful limitation of internal rotation of the hip and evidence of infection suggested the diagnosis, which was confirmed by magnetic resonance imaging. In a soccer player, a fever and groin pain do not always indicate osteitis pubis. Limitation of internal rotation of the hip should suggest a lesion in the obturator internus muscle.

Sex hormones in spondylarthropathies. A study in 57 patients.

Studies of the hormonal status of patients with spondylarthropathies are few in number, despite the predominantly male sex ratio characteristic of these diseases. Most suggested an elevation in androgen levels. We determined the following parameters in 57 men with spondylarthropathies: FSH, LH, prolactin, estradiol, total testosterone, free testosterone, delta-4-androstenedione, 17-OH-progesterone, estradiol over total testosterone ratio and estradiol over free testosterone ratio. Results were compared to those in a group of 100 healthy controls. Mean patient age was 41.9 years, and mean disease duration was one year. None of the patients were under corticosteroid therapy. The mean prolactin level was normal (8.4 +/- 4.5 ng/ml), whereas the mean 17-OH-progesterone level was significantly elevated (2.02 +/- 0.8 ng/ml). The estradiol over testosterone ratios were normal. This hormone profile is consistent with partial deficiency in the enzyme 21-hydroxylase, which is encoded by a gene located on chromosome 6 only 600 kb away from the HLA B locus. We suggest that some class I alleles may be associated with an alteration in 21-hydroxylase responsible for an increase in 17-OH-progesterone levels and for macrophage inhibition resulting in delayed elimination of antigens. This hypothesis is consistent with the possibility raised by others that macrophage inhibition may explain the increased prevalence of infections due to intracellular organisms in patients with spondylarthropathies.

[Three week stay at a height of 3700-4200 m. causes mild pulmonary hypertension in healthy men]. / Trzytygodniowy pobyt na wysokosci 3700-4200 m. wywoluje lagodne nadcisnienie plucne u zdrowych mezczyzn.

High altitude hypoxia leads to development of hypoxic pulmonary hypertension. We studied 27 healthy caucasian subjects aged 24 to 59 years, mean 41.6 +/- 9 y, working on 4 week shifts at the Kumtor gold mines at the altitude of 3700-4200 m. Pulmonary circulation was studied twice by Echo-Doppler using Toshiba SSD-160. The first investigation was performed at the level of 730 m at the end of 4 week holiday spent in the lowland, the second investigation on the 23rd day at altitude. Pulmonary artery acceleration time decreased from 131 +/- 14 ms to 105 +/- 14 ms (p < 0.001). Calculated pulmonary arterial mean pressure increased from 15.1 +/- 2 to 25.4 +/- 8 mmHg (p < 0.001). Right ventricular preejection period increased from 93 +/- 14 to 102 +/- 19 ms (p < 0.05). Other echo variable did not change. We conclude that healthy subjects submitted to 3 week exposure to high altitude hypoxia (oxygen pressure in the inspired air 82-88 mmHg), developed mild pulmonary hypertension, regressing after recovery at the lowland.

Comparative Efficacy of Preplant Fumigation and Postplant Chemical Treatment of Replant Citrus Trees in an Orchard Infested with Tylenchulus semipenetrans.

Preplant soil fumigation with methyl bromide at 49 and 98 g/m2 was compared with various postplant nematicide and fungicide programs in a replant citrus orchard infested with the citrus nematode Tylenchulus semipenetrans and the fungal pathogens Phytophthora nicotianae, Fusarium solani, and F. oxysporum. Postplant treatments comprised multiple applications of fenamiphos at 4.0 g a.i./m2 soil, aldicarb at 4.5 g a.i./m2 soil, metalaxyl at 4 g a.i./m2 soil, fose-tyl-Al stem painting at 400 g a.i./liter, and combinations of fenamiphos + fosetyl-Al and aldi-carb + fosetyl-Al at the same rates as for single treatments. P. nicotianae could not be detected in the entire experimental site after replanting, but populations of F. solani and F. oxysporum showed only a temporary decline following site preparation. T. semipenetrans did not re-establish in any of the treatments within the first 2 years. Numbers of juveniles remained low in most treatments during the third year, but thereafter both juveniles and females increased significantly in all except the fumigated plots. Female populations on roots of citrus trees planted in fumigated soil remained suppressed for 8 years and the trees developed more vigorously and produced higher yields and larger fruit than those in non-fumigated soil. Compared with the control, net income for the period 4 to 8 years after planting increased by 101 and 46% in plots fumigated with 49 and 98 g/m2, respectively. With the exception of aldicarb, all other treatments showed net losses.