Liver elastometry and alcohol withdrawal: Median-term follow-up in a psychiatric unit

The measurement of liver stiffness (LS) shows promise as a follow-up tool after alcohol withdrawal, but it has mainly been studied in the early phase or in patients with severe liver disease. A 6-month ancillary study of a specific psychiatric cohort of alcoholic patients without known liver disease followed after withdrawal was conducted (Clinical Trial NCT01491347). Clinical and biological data and LS values were collected every 2 months. A total of 129 patients were included in the study; 93 had an LS assessment within the first 7 days, and 37 had all four LS measurements. Only seven (7.5%) patients had an initial LS > 12.1 kPa, the threshold used to define severe fibrosis. Abstinence was not associated with changes in LS at the various median-term follow-up periods. However, LS of abstinent subjects decreased significantly relative to that of non-abstinent subjects between M0 and M2. CAP™ values were not associated with abstinence. The systematic median-term follow-up of withdrawn patients does not appear to be contributory. However, LS could help to detect relapse in the first 2 months after withdrawal for subjects treated in a psychiatric hospital for dependence. It thus could serve as a motivation tool. Prospective studies with various and higher baseline LS values are warranted for simultaneous longitudinal assessment, including for very short- and long-term LS after withdrawal.

Comparison of reported symptoms to those produced by treadmill testing in patients with claudication suspected of arterial origin

AIM

We aimed at comparing lower limb symptoms reported by history to those observed during a standard treadmill test.

METHODS

We retrospectively studied symptomatic patients referred over a three years period for suspected arterial claudication and used the Edinburgh claudication questionnaire before exercise and symptoms observed on a treadmill. We confronted, right and left, proximal (lower-back thigh or buttocks) and distal (leg or foot) lower-limb symptoms before and during treadmill exercise. Results are reported as mean ± standard deviation for percentage and 95% confidence interval and Kappa statistics are performed.

RESULTS

Of 795 patients with claudication, aged 63 ± 12 years, treadmill test resulted in 715 reporting lower-limb symptoms on treadmill. Cohen's Kappa for the site-specific analysis of symptoms by history vs. symptoms on treadmill was 0.509 ± 0.21 (P < 0.01), showing a moderate agreement. Nevertheless, symptoms on treadmill reproduced, at least partly, symptoms by history in 675 (84.9% 95CI: 82.3-87.2) of patients, although symptoms on treadmill were strictly of the same localizations as symptoms by history in only 378 (47.6% 95CI: 44.1-51.0) of all studied patients. Last, 279 patients (35.1% of all patients) reported non limb symptoms on treadmill.

CONCLUSION

Although on a site by site basis the concordance of symptoms by history to symptoms by treadmill is moderate, most patients reproduced their usual symptoms on treadmill. Age does not seem to impair the concordance. Last, beyond the sole measurement of maximal walking capacity, treadmill frequently unmasks non-limb limiting symptoms that may require clinical attention.

[Assessment of knowledge and pain management by traumatological emergencies staff of the teaching hospital of Ouagadougou]

INTRODUCTION

Pain is a frequent reason of consultation in traumatological emergencies. Its management is characterized by oligoanalgesia whose causes are multiple. The purpose of this study is to assess the knowledge and practices of pain management by traumatological emergencies staff of the teaching hospital Yalgado Ouedraogo of Ouagadougou.

MATERIALS AND METHODS

A questionnaire survey of health workers performing in traumatological emergencies has been conducted. Two different questionnaires, one for medical staff and one for the paramedics were administered.

RESULTS

A total of 67 health workers participated in the study with a participation rate of 98% and 100%, respectively, for the medical and paramedical staff. According to their report, 65.3% of medical and 77.7% of paramedical staff had never received training on pain and its management. For 85.7% of physicians, pain should be assessed before treatment, but 79.6% of them didn't know any conventional pain assessment method. All the nurses and 40.8% of physicians felt that pain in the emergency services should not be treated immediately to prevent misdiagnosis. Morphine and regional anesthesia were not used for pain treatment in the emergency room. 10.2% of medical staff and 27.8% of the paramedics said that they systematically search for the analgesicsside effects.

CONCLUSION

The knowledge of health workers about pain and its management is insufficient. The lack of training of health workers on the management of pain is the cause and contributes to explain the oligoanalgesia in this service.

Exercise treadmill testing in patients with claudication, with and without diabetes

AIM

To compare symptoms and walking capacities of patients with and without diabetes reporting vascular-type claudication.

METHODS

We recorded self-reported maximal walking distance, maximal walking distance on treadmill test (3.2 km h(-1) , 10% slope), exercise transcutaneous oxygen pressure DROP index [limb transcutaneous oxygen pressure (TcpO2) changes from rest minus chest TcpO2 changes from rest] and symptoms on treadmill in 230 patients with diabetes and 982 patients without diabetes. Exercise-induced proximal and distal symptoms were analysed in the perspective of underlying proximal and distal ischaemia (DROP value < negative 15 mmHg).

RESULTS

Self-reported maximal walking distance did not differ between groups, whereas maximal walking distance on treadmill test was lower in patients with diabetes vs. patients without diabetes (261 ± 257 and 339 ± 326 m, respectively; P < 0.05 when adjusted for potential confounders). In patients with ischaemia, the number of ischaemic areas (proximal and/or distal on right and/or left) was comparable between the two groups. Patients with diabetes had more distal ischaemia than patients without diabetes (38 vs. 29%, respectively; P < 0.01), whereas proximal ischaemia was similar between groups. The prevalence of lower-limb exercise-related symptoms without ischaemia was comparable between groups. There were more symptoms other than lower-limb pain in patients with diabetes than patients without diabetes (29.6 vs. 18.3%, respectively; P < 0.01).

CONCLUSIONS

Patients with diabetes show more severe limitation on the treadmill and more non-limb symptoms than patients without diabetes, although self-reported walking capacity is comparable between the two groups. Using TcpO2, we confirm that patients with diabetes reporting claudication show more distal ischaemia than patients without diabetes, with no difference at the buttock level. Treadmill testing is of interest in patients with peripheral artery disease and diabetes.

[Abdominal aortic aneurysm manifested by hematemesis in a 32 year old patient infected by HIV]

Aortic aneurysm is an uncommon in young patients. The purpose of this report is to describe a case of dissecting aortic aneurysm in a 32-year-old man with human immunodeficiency virus (HIV) infection. The presenting symptom was recurrent massive hematemesis. Diagnosis was suspected on the basis of clinical cardiovascular assessment and confirmed by ultrasonography and computed tomography. The clinical course was complicated by superior vena cava syndrome and kidney failure. Outcome in the absence of surgical treatment was fatal. Perusal of the literature indicates a rising incidence of large vessel disease in young patients with HIV infection. The underlying pathophysiological mechanisms is unclear. Assessment for arterial lesions should be performed in all patients with HIV infection since clinical signs may be misleading. Definitive diagnosis can be achieved by ultrasonography, Doppler ultrasound or computed tomography.

In vitro effect of air pollutants on human bronchi

A useful approach for constructing dose-response relationships and for studying the underlying mechanisms by which a xenobiotic agent enhances airway reactivity is to measure the response of an isolated airway following ex vivo exposure to a pollutant. We have in this way determined the dose-response relationship between ex vivo exposure to pollutants such as nitrogen dioxide (NO2), the aldehyde acrolein, and ozone (O3) and the reactivity to agonists in human isolated bronchial smooth muscle. We have also investigated the underlying alteration in the cellular mechanisms of airway smooth-muscle contraction induced by such exposure and found that it is related to alteration in calcium signaling at the site of the airway smooth-muscle cell. Finally, although there is epidemiological evidence that an increase in allergic diseases such as asthma may be linked to air pollution, there are few experimental data to address this issue. The final aim of this study was therefore to investigate the interaction between passive sensitization and exposure to pollutants in human isolated airways. We have examined (i) the effect of a pre-exposure to pollutants on the contraction of sensitized bronchi in response to a specific antigen and (ii) the effect of passive sensitization on the contraction in response to nonspecific agonists in bronchi pre-exposed to pollutants. The results indicate a combined effect of immunological sensitization and exposure to pollutants; that is, passive sensitization and exposure to pollutants act in a synergistic manner on human bronchial smooth-muscle reactivity in response to both specific antigens and nonspecific agonists.

[Febrile coma and multiple organ failure: suspected hemoglobinopathy SC]

We report the case of febrile fatal coma in a 51-year-old man from Burkina Faso. Magnetic resonance imaging (MRI) shows cerebral fat embolism. Haemoglobin electrophoresis shows probably haemoglobinopathy SC. A short review of the literature demonstrate the need to consider this complication in patients with neurological or respiratory disorders, in areas where this disease is highly prevalent, irrespective of age. It also emphasizes the diagnostic contribution of MRI and discusses the mechanism, the diagnosis as well as the difficulty of choosing the appropriate therapeutic course.

Effects of intravenous anesthetics on normal and passively sensitized human isolated airway smooth muscle

BACKGROUND

General anesthetics may modify airway responsiveness. The authors investigated the effect of thiopental, propofol, and etomidate on airway smooth muscle.

METHODS

Contraction experiments were done in human airway rings that were either normal or passively sensitized with asthmatic serum. The effect of propofol and etomidate was also studied on both [Ca2+]i increase measured by microspectrofluorimetry in isolated myocytes and isometric contraction in the rat trachea.

RESULTS

In human bronchi, thiopental (10[-7] to 10[-4] M) induced a concentration-dependent contraction. Neither propofol nor etomidate altered baseline tone, but both anesthetics reduced histamine-induced contraction. In human immunologically sensitized isolated bronchi, propofol (3 x 10[-4] M) reduced histamine reactivity (deltaFmax in %) to a greater degree than in nonsensitized tissues (64.4 +/- 15.7% and 16.4 +/- 8.5%, respectively; n = 6, P < 0.05), whereas the effect of etomidate (10[-4] M) was similar in both types of tissue (24.1 +/- 6% and 22.3 +/- 15%, respectively, n = 6). In rat isolated tracheal myocytes, propofol (3 x 10[-4] M) and etomidate (10[-4] M) altered the [Ca2+]i signal in response to the depolarizing agent potassium chloride and the muscarinic agonist acetylcholine. Accordingly, the two anesthetics also reduced the mechanical response of rat tracheal rings to these agonists.

CONCLUSIONS

Whereas thiopental contracts human isolated bronchi, propofol and etomidate reduce histamine-induced contraction in human isolated airway smooth muscle that were either not sensitized or passively sensitized with asthmatic serum. This effect involves inhibition of both electro- and pharmacomechanical coupling.