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Abnormality in field physical test predicts a reduced quadriceps strength in patients with hip- or knee-osteoarthritis. A prospective observational study
No full textInternational audienceBackground In osteoarthritis quadriceps strength is an important outcome to assess exercise capacity and recovery after arthroplasty. However, its measurement is limited due to lack of time and the need for trained personnel and equipment whose accuracy is verified. Objectives To find out the determinants of a reduced quadriceps strength and to establish a score to screen for it. Methods In an observational prospective study, we evaluated patients presenting with an unilateral knee (KOA) or a hip (HOA) osteoarthritis before a scheduled arthroplasty. We measured body composition, exercise capacity, muscle strength, balance, WOMAC score, quality of life and physical activity. Isometric maximal voluntary quadriceps force (MVCq) was determined on both lower limbs and a reduced strength was retained when at least one measurement was lower than 1 standard deviation of normal value. Results We included 376 patients, 247 (66%) with KOA and 129 (34%) with HOA. Their mean age was 67±8 years, and mean BMI 31.4±6.9 kg/m 2 . MVCq was reduced in 217 (58%). Compared those with a preserved MVCq, these patients had a significant higher BMI and lean mass, a sex ratio (more men), an altered field physical tests and WOMAC score. The best logistic regression model for a decreased quadriceps force included pathology, age, sex, BMI, five sit to stand test (FTSST) and maximal gait speed (AUC was 0.87 [95%CI 0.83–0.90]). We developed a predictive equation for a reduced MVCq as follows: Y = 1/1+ exp[-(-0.051*age -1.25*max gait speed + 0.09*FTSST + 0.16*BMI + 1.1 (for KOA) + 2.41 (for male) -1.79]. Conclusion MVCq is reduced with a high prevalence on patients with KOA or HOA. A low performance in one the selected field physical test associated with age and BMI allows to screen for those in whom a measurement of MVCq could be of interest before arthroplasty
Morts maternelles par embolie amniotique, résultats de l’ENCMM, France 2016–2018
No full textInternational audienceAmniotic embolism remains the 3rd leading cause of maternal death in France, with 21 maternal deaths over the 2016–2018 triennium. The women who died were more likely to be obese (25%), to benefit from induction of labor (71%) and be cared in a maternity hospital < 1500 deliveries/year (45%), compared with the reference population (ENP 2016). The symptom occurred mainly during labor (95%) and the course was rapid, with a symptom-to-fatality interval of 4 hours 45 minutes (min: 25 minutes – max: 8 days). Preventability was proposed for 35% of the deaths assessed, with areas for improvement identified in terms of technical skills (haemostasis procedures, management of polytransfusion), non-technical skills (communication) and health care organization (human resources, vital emergency plan, wide access to PSL). An autopsy was performed in 38% of deaths.L'embolie amniotique reste la 3e cause de mort maternelle en France avec 21 décès maternels sur le triennium 2016–2018. Parmi les dossiers de femmes décédées on relevait plus souvent des patientes obèses (25 %), un travail déclenché (71 %) et une survenue dans une maternité de taille < 1500 accouchements/an (45 %), comparativement à la population de référence (ENP 2016). L'évènement survenait majoritairement au cours du travail (95 %) et l'évolution était foudroyante avec un délai symptômes–décès de 4 h 45 (min : 25 min – max : 8 j). Une évitabilité était proposée pour 35 % des décès expertisés avec des pistes d'amélioration relevées concernant les compétences techniques (gestes d'hémostase, gestion de la polytransfusion), les compétences non techniques (communication) et l'organisation des. soins (ressources humaines, plan urgence vitale, accès large aux PSL). Une autopsie était réalisée dans 38 % des décès
Anthracycline‐induced cardiotoxicity on regional myocardial work and left ventricular mechanical dispersion in adolescents and young adults in post‐lymphoma remission
No full textInternational audienceBackground: Myocardial work (MW) is a new echocardiographic tool with a high sensitivity to detect early and subtle alterations of myocardial function. We aimed to evaluate the late effects of anthracyclines by assessing the global and segmental MW and intraventricular mechanical dispersion from speckle tracking echocardiography in childhood lymphoma survivors (CLS).Methods: Thirty‐one young adults including CLS and age‐matched healthy controls were enrolled. All underwent echocardiography including an evaluation of left ventricular (LV) morphology and regional function. We assessed LV longitudinal (differentiating sub‐endocardial and sub‐epicardial layers), circumferential strains and twist, global and regional MW index (MWI). LV mechanical dispersion was assessed from the time dispersion of LV longitudinal strain, from myocardial wasted work (MWW) and myocardial work efficiency (MWE).Results: The longitudinal strains both at the level of the sub‐endocardium and sub‐epicardium were reduced in CLS compared to controls. The global MWI was also decreased (1668 ± 266 vs 1870 264%.mmHg in CLS patients and controls, respectively, p < 0.05), especially on the apical segments. An increase of LV intraventricular mechanical dispersion was observed in CLS. MWW and MWE remained unchanged compared to controls.Conclusion: Our results strongly support that cardiac remodeling is observed in CLS, characterized by a decrease in MW and an increase in LV mechanical dispersion. The apex is specifically altered, but its clinical significance remains uncertain. MW as a complement to strain seems interesting in cancer survivors to detect myocardial dysfunction at early stage and adapt their follow‐up
Fumagillin Shortage: How to Treat Enterocytozoon bieneusi Microsporidiosis in Solid Organ Transplant Recipients in 2024?
No full textInternational audienceIntestinal microsporidiosis caused by is an opportunistic infection that especially affects solid organ transplant (SOT) recipients. Management revolves around tapering the immunosuppressive regimen and/or using a specific anti-microsporidia treatment, but only fumagillin has demonstrated efficacy for treatment of this infection. Since fumagillin has been commercially discontinued, nitazoxanide is increasingly being used in this indication. We aimed to describe therapeutic management of infections in this context. We conducted a French nationwide observational retrospective study on reported cases of infections in SOT recipients. We identified 154 cases: 64 (41.6%) were managed by simply modifying the immunosuppressive regimen, 54 (35.1%) were given fumagillin, and 36 (23.4%) were given nitazoxanide. Clinical remission rate ranged from 77.8% to 90.7% and was not significantly different between therapeutic strategies but tended to be lower with nitazoxanide. Stool negativization rate was highest with fumagillin (91.7%) and lowest with nitazoxanide (28.6%). Relapses occurred in 6.9% of cases and were more frequent with nitazoxanide (14.3%). This study shows that tapering immunosuppression can result in a satisfactory remission rate but is sometimes accompanied by relapses. Nitazoxanide had limited effectiveness, whereas fumagillin had good results that provide a solid rationale for bringing fumagillin back to market. Trial registration number - ClinicalTrials.gov ID: NCT05417815
Analysis of a pituitary tumour with histological features of central neurocytoma points towards the emergence of a new entity recognisable by a specific epigenetic signature
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Un panneau limitant l’accès aux salles d’intervention permet-il une réduction de la circulation du personnel dans le bloc opératoire ?
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