Monocentric Cross-sectional Study Research Articles

Évaluation du questionnaire de tri infirmier aux urgences ophtalmologiques de l’hôpital Pierre-Paul-Riquet au CHU de Toulouse

The steady increase in the number of visits to the various emergency services combined with the decrease in medical demographics, make it necessary to optimize triage of patients to improve their care. The purpose of this study was to evaluate the pertinence of our triage questionnaire in the classification of ophthalmologic emergencies by severity. We used a monocentric cross-sectional study. From September 5 through September 25 2017, 858 patients who had all been seen in the ophthalmology emergency department of Pierre Paul Riquet Hospital of Toulouse university medical center and had responded to the triage nurse questionnaire were included. According to the symptoms presented or not by the patient, a color code was attributed (GREEN, ORANGE or RED) in order of increasing level of emergency. For each patient, we compared the severity of the final diagnosis by Base Score with the level of emergency established by our questionnaire. There were 118 "GREEN" patients, 606 "ORANGE" patients and 134 "RED." We were able to analyze 822 patients. 21.65% of patients were correctly classified, 73.36% were overestimated (of which 87.06% by one level and 12.94% by two levels of severity), and 4.99% were underestimated (of which 90.24% by one level and 9.76% by two levels). Our current triage questionnaire is not sufficiently discriminating for effective triage of ophthalmologic emergencies. It often overestimates minor emergencies, causing a delay in treating other emergencies. We propose a new questionnaire modified according to the results obtained during our study.

Aggressive rare T cell lymphomas with manifestation in the skin: A monocentric cross-sectional case study

Rare T- or NK-cell lymphomas with cutaneous manifestation may display a highly aggressive clinical course and major diagnostic/therapeutic challenges. This report describes our experiences with different lymphomas of this rare category and the therapeutic options used. This retrospective, descriptive, monocentric, cross-sectional case study, identified 4 rare aggressive T-/NK-cell lymphomas with manifestation in the skin, which were diagnosed in a tertiary care centre over a period of 4 years. Two patients had an Epstein-Barr virus-associated extranodal NK/T-cell lymphoma and 2 patients had a primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma. Concomitant extracutaneous involvement was observed in 2 of all 4 patients. Two patients had fulminant disease progression and resistance to chemotherapy. Two patients underwent allogeneic haematopoietic stem cell transplantation, which resulted in one complete remission and one partial remission. This report emphasizes the importance of an early diagnostic work-up and a prompt aggressive therapeutic approach.

Quality of life in long-term botulinum toxin treatment of cervical dystonia: Results of a cross sectional study

IntroductionPatients' rating of the effectiveness of and quality of life after long-term botulinum toxin (BoNT) injection therapy up to 22 years and treating physician's rating of the therapy effect in patients with idiopathic cervical dystonia (CD) are analysed in a large monocentric cross-sectional study. Patients and methodsPatients (n = 221) who received uninterrupted, long-term treatment for CD (≥10 BoNT injection cycles) in a BoNT outpatient clinic underwent detailed clinical investigation, Tsui scoring, rated post-treatment CD severity as a percentage of CD severity prior to BoNT injection (patient's subjective scoring of the treatment effect (PSSTE)), and completed the CDQ-24 quality of life (QoL) questionnaire. Correlations between demographics, treatment-related data and QoL were analysed by linear regression, analysis of variance and pairwise single comparisons. ResultsTreating physicians and patients rated mean ongoing treatment effect as >50%. There was high variability of duration of treatment, PSSTE, Tsui score and CDQ-24 across all patients. PSSTE was significantly correlated with Tsui score (p < .001) and all CDQ-24 subscores (p < .003). Tsui score and CDQ-24 were significantly correlated (p < .001), but the correlation was lower than between PSSTE and total CDQ24. CDQ-24 revealed a significant improvement with duration of therapy. PSSTE and Tsui score did not change with duration of BoNT treatment. ConclusionPatients with CD who receive up to 22 years' continuous BoNT treatment experience a >50% mean reduction of symptoms and a significant improvement of QoL with duration of treatment. A highly significant correlation exists between patients' and physicians' rating of treatment effectiveness.

Predictive value of left atrial appendage lobes on left atrial thrombus or spontaneous echo contrast in patients with non-valvular atrial fibrillation

BackgroundLeft atrial appendage morphology has been proved to be an important predictor of left atrial thrombus (LAT) and left atrial spontaneous echo contrast (LASEC) and stroke in patients with non-valvular atrial fibrillation (NVAF). However, the relation between left atrial appendage (LAA) lobes and LAT or LASEC is still unknown. The aim of this study is to investigate the correlation between the number of left atrial appendage lobes and LAT/LASEC in patients with NVAF.MethodsThis monocentric cross-sectional study enrolled 472 consecutive patients with non-valvular atrial fibrillation, who had transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) prior to cardioversion or left atrial appendage closure (LAAC) from July 2009 to August 2015 in department of cardiology of Shanghai Tenth People’s Hospital. Patients who had significant mitral or aortic valve disease, previous cardiac valvular surgery and other complicated cardiac diseases were excluded. Individuals were divided into two groups:the LAT/LASEC group (16.95%), which comprised patients with LAT or LASEC, as confirmed by TEE; and a negative control group (83.05%).Baseline overall group characterization with demographic, clinical, laboratory data and echocardiographic parameters, alongside with information on medication was obtained for all patients. Subgroup analysis with line chart was applied for exploring the association between LAA lobes and LAT/LAESC. Receptor-operating curves (ROC) were used to test the value of LA anteroposterior diameter detected by different echocardiography methods predicting LAT or LASEC. Multivariable logistic regression analysis was used to investigate independent predictors of LAT/LASEC.ResultsAmong 472 patients, 23 (4.87%) had LA/LAA thrombus and 57 (12.1%) had LA spontaneous echo contrast. Compared to the negative group, patients in LAT/LASEC group had higher CHA2DS2-VASc score (3.79 ± 1.75 vs 2.65 ± 1.76, p < 0.001), larger LAD (measured by TTE, 48.1 ± 7.7 vs 44.6 ± 6.5, P < 0.001; measured by TEE, 52.2 ± 6.2 vs 46.7 ± 7.1, P < 0.001), lower left upper pulmonary venous flow velocity (LUPVFV) (0.54 ± 0.17 m/s vs 0.67 ± 0.26 m/s, CI 95% 0.05–0.22, P = 0.003), more left atrial appendage lobes (1.67 ± 0.77 vs 1.25 ± 0.50, p < 0.001). There was a good discriminative capacity for LAD detected by TTE (area under the curve (AUC), 0.67, CI 95% 0.61–0.73, p < 0.001) and LAD detected by TEE (AUC, 0.73, CI 95% 0.67–0.79, p < 0.001). The subgroup analysis based on gender and different LAA lobes yielded similar results (male group: p < 0.001;female group: p = 0.004) that the number of LAA lobes were significantly associated with LA thrombus or SEC. In multivariable logistic regression analysis, both the number of LAA lobes (odds ratio: 2.37; CI 95% 1.37–4.09; p = 0.002) and the persistent AF (odds ratio: 3.57; CI 95% 1.68–7.57; p = 0.001) provided independent and incremental predictive value beyond CHA2DS2-VASc score.ConclusionThe number of LAA lobes is an independent risk factor and has a moderate predictive value for LAT/LASEC among NVAF patients in China.

Depressive Symptoms in Dialysis: Prevalence and Relationship with Uremia-Related Biochemical Parameters

Background: Depression is the most common psychiatric disorder in long-term dialysis patients and a risk factor for morbidity and mortality. Although there is a relevance of the issue in the dialysis setting, we still know little about possible relationships between depression and uraemia-related biochemical abnormalities. Our aims were to evaluate (1) the prevalence of depression in our haemodialysis (HD) and peritoneal dialysis (PD) population using a validated and easy-to-implement screening tool and (2) the association between depression and the main uraemia-related clinical and biochemical parameter changes. Methods: In this monocentric cross-sectional study, all patients of our centre with at least 3 months of dialysis were screened by Patient Health Questionnaire-9 (PHQ-9), a self-administered depression-screening questionnaire validated in dialysis setting. The impact of depressive symptoms on daily life was also assessed. We then analysed relationships between the PHQ-9-derived depressive score, functional impairment score, demographic, clinical and laboratory variables. Results: In our cohort of 145 patients, depressive symptoms were found in 69 patients (46%). Stratifying for severity, mild, moderate and severe grade accounted for 31, 13 and 2% respectively. Depressive symptoms affected 36% of patients on PD versus 52% of patients on HD. Moreover, the PD patients had significantly less functional impairment derived from depressive symptoms than the HD patients. Simple and multiple regression analysis identified serum phosphorus as the only uraemia-related laboratory parameter that was high statistically associated with depressive score. Conclusions: Using a reliable, simple and fast tool, we found that depressive symptoms affect almost half of dialysis patients, particularly so the HD cohort. Severity of depressive symptoms seems related to serum levels of phosphorus possibly because depression affects compliance to therapy.

Caractéristiques des patients examinés en urgence par un ophtalmologiste dans un CHU : résultats d’une étude transversale analytique identifiant des facteurs associés au caractère de véritable urgence

To describe epidemiological characteristics of outpatients examined by university medical center ophthalmologists in emergency rooms (ER), and to determine factors associated with true emergencies. A monocentric cross-sectional study including all patients examined by an ophthalmologist in the ER of in the university hospital of Nancy over a two-month period was conducted. Demographics and medical characteristics were assessed. The visits were categorized by ophthalmologists as true emergencies or not. Among the 1,308patients included, the median (IQR) age was 49 (32-64) years, and 56% were males. The main reasons for seeking care were eye redness (32.6%), eye pain (30.0%), eye trauma (26.1%), and visual loss (23.3%). Nearly 40% of the consultations were judged as not truly emergent. Factors significantly associated with true emergencies were: age under 60, male gender, some reasons for seeking care (visual loss, eye redness, eye pain), and a period of less than 3days between symptom occurrence and the ER visit. The proportion of non-emergent ER visits was relatively high, and factors associated with true emergencies have been identified in our study. Standardized protocols may be useful to help emergency physicians and nurses to determine when to refer a patient to an ophthalmologist.

Diagnostic accuracy of new and old cognitive screening tools for HIV-associated neurocognitive disorders.

Considering the similarities between HIV-associated neurocognitive disorders (HAND) and neurodegenerative dementias and the frequency of executive dysfunctions among HIV-positive patients, we evaluated the accuracy of the Frontal Assessment Battery and Clock-Drawing Test together with the Three Questions Test and International HIV Dementia Scale to screen for HAND. A cross-sectional monocentric study was conducted from 2010 to 2017. The index tests were represented by the four screening tools; the reference standard was represented by a comprehensive neurocognitive battery used to investigate 10 cognitive domains. Patients were screened by a trained infectious diseases physician and those showing International HIV Dementia Scale scores ≤10 and/or complaining of neurocognitive symptoms were then evaluated by a trained neuropsychologist. A total of 650 patients were screened and 281 received the full neurocognitive evaluation. HAND was diagnosed in 140 individuals. The sensitivity, specificity, correct classification rate and area under the receiver operating characteristic curve (AUROC) were, respectively, as follows: Frontal Assessment Battery, 40.7%, 95.1%, 68.3% and 0.81; International HIV Dementia Scale, 74.4%, 56.8%, 65.4% and 0.73; Clock-Drawing Test, 30.9%, 73.4%, 53.8% and 0.56; and Three Questions Test, 37.3%, 54.1% and 45.7%. Raising the Frontal Assessment Battery's cut-off to ≤16 improved its sensitivity, specificity and correct classification rate to 78.0%, 63.9% and 70.8%, respectively. We observed poor screening performances of the Three Questions and Clock-Drawing Tests. While the International HIV Dementia Scale showed a poor specificity, the Frontal Assessment Battery showed the highest correct classification rate and a promising performance at different exploratory cut-offs.

Health status of Afro-Asian refugees in an Italian urban area: a cross-sectional monocentric study

ObjectivesThe recent sociopolitical events in the Mediterranean and Middle Eastern areas have significantly impacted international migration flows. As disease prevalence and type are different among western and Afro-Asian countries, physicians dealing with refugees should be aware of their specific health needs. We aimed at evaluating the health status and disease history of refugees at their arrival in the urban area of L'Aquila (Italy). Study designThis is a monocentric cross-sectional study. MethodsRefugees hosted at the local reception center in L'Aquila (Italy) between July 2014 and December 2014 were cross-sectionally evaluated for anamnestic, clinical, and laboratory features. A subset of randomly selected participants underwent further assessments (screening for tuberculosis, hepatitis B/C, human immunodeficiency virus, syphilis; ambulatory blood pressure measurement [ABPM]) to better define their health status. ResultsNinety-three adult male refugees (27.34 ± 7.41 years) from Africa (76%) and Asia (24%) were enrolled. Overall, the most prevalent diseases according to the International Statistical Classification of Diseases and Related Health Problems 10th revision affected the digestive tract (15.6%) and musculoskeletal apparatus (14.4%). The analysis by continent of origin did not show significant differences in the distribution of diseases, although a trend toward some differences was observed. African refugees had a significantly greater prevalence of viral hepatitis (hepatitis B virus, P = 0.004; hepatitis C virus, P = 0.007) compared with Asians. Hypertension, as detected by ABPM, was uncommon. No written vaccination history was available. ConclusionsHealth issues of our sample of Afro-Asian refugees span both non-communicable and communicable diseases, requiring attention for the safety of the individual and the community. National health systems should provide adequate information and shared guidelines for health professionals regarding identification and management of refugees' health needs.

Predictive Factors for Viral B and C Infection in Health Workers in a University Hospital in Ivory Cost

Purpose: To evaluate the serological status of hepatitis B and C and to identify the risk factors for viral B and C infection in health workers at the university hospital. Material and Method: Mono-centric cross-sectional study carried out at Bouaké University Hospital from March 2nd to May 16th, 2016, concerning the health staff of the Bouaké University Hospital. Cross-sectional study mono-centric concerning the serological status of viral hepatitis B and C from the period from March 2nd to May 16th, 2016 of the health staff of the University Hospital of Bouaké. It has benefited from data from PNLHVi (national program against viral hepatitis) as part of its awareness campaign. The data were analyzed by SPSS software version 20.0. Results: Of the 1107 health workers, 632 had been included, representing a participation rate of 57.1%. The average age of the staff was 37.8 years with extremes ranging from 18 to 66 years. The sex ratio (H/F) was 0.8. Accidents with blood exposure were noted in 52.4% of cases. The maximum vaccine coverage was 16.1%. The prevalence of HBsAg was 8.4%. Contact with HBV was present in 3/4 of the staff. Anti HCV Ab was positive in 1.4% of the staff. Males, age over 50 and over 20 years of seniority were associated with HBV. Also, HBV infection was significantly higher in boys and girls (81.7%), nurses (78.3%) and nursing aides (73.8%), (p = 0.022). HCV infection was significantly correlated with emergency services. Conclusion: Age, gender, seniority, paramedic qualification, and high risk of exposure to body fluids were correlated with viral B infection while emergency department membership was a factor risk of HCV infection.

Assessing the prevalence of protein-energy wasting in haemodialysis patients: A cross-sectional monocentric study

IntroductionProtein-energy wasting (PEW) is a strong predictive factor for morbidity and mortality in haemodialysis (HD) patients. However, there is no consensus for its assessment. The present study aimed to assess the nutritional status of patients on chronic HD by use of different nutritional assessment parameters, and at verifying which can identify the greatest number of HD patients with PEW. Also, to investigate predictors of nutritional status in a haemodialysis center in Morocco. Patients and methodsThis is a cross-sectional analysis performed on 126 patients aged 44.82±14.01 years, undergoing maintenance HD in the Department of nephrology of the university hospital centre of Casablanca, Morocco. Energy and nutrients intake assessment was obtained by a three-day period food recall. Biochemical parameters, bioelectric impedance analysis, and subjective global assessment (SGA), have been performed to assess nutritional status. ResultsAccording to SGA the prevalence of PEW was 74.62%. However, when using the ISRMN malnutrition criteria only 36.50% of the patients were diagnosed with PEW. Pearson correlation showed a negative association between the degree of malnutrition evaluated by SGA and serum prealbumin (r=−0.54; P=0.0001), serum albumin (r=−0.50; P=0.001), energy (r=−0.34; P=0.002), protein intake (r=−0.41; P=0.0001), and a significant positive correlation with CRP (r=0.65; P=0.0001) was determined, but not with anthropometric measurements nor lipids profile. The areas under the receiver operating characteristic curve were 0.841 (95% CI: 0.751–0.932) for serum prealbumin, and 0.737 (95% CI: 0.634–0.840) for serum albumin. ConclusionOur results showed a high prevalence of PEW among Haemodialysis patients. Also, our findings suggest that SGA, serum albumin and prealbumin may be relative appropriate and practical markers for assessing nutritional status in HD patients.

FV 1 In vivo staging in ALS – A mono-centric cross-sectional and longitudinal DTI-based study

Introduction Neuropathological studies in amyotrophic lateral sclerosis (ALS) have shown that ALS may disseminate in a regional sequence in four disease-related patterns ( Braak et al., 2013 ). Recently, our group reported the diffusion tensor imaging (DTI)-based analysis of sequential spreading of disease in ALS ( Kassubek et al., 2014 , Muller et al., 2016 ). The aim of this study was to show that longitudinal data support the pathological findings and to establish DTI as an in vivo tool to image pathological ALS stages by testing for longitudinal consistency of the categorization results. Methods The application of in vivo DTI analysis to fiber structures that are prone to be involved at each neuropathological pattern of ALS was performed in a large-scale monocentre sample of ALS patients. A total of 584DTI datasets from ALS patients (N = 425) and controls (N = 159) were analyzed by tract of interest (TOI)-based fiber tracking; 52 ALS patients and 22 controls obtained at least one follow-ups can with different time-intervals of 10 months ( ± 9 months) in average. Results At the individual level, a categorization into ALS staging patterns was possible. At the group level, longitudinal ALS data showed significant differences for the stage-related tract systems (p Conclusion In summary, in vivo imaging of the disease patterns in ALS has become feasible cross-sectionally and longitudinally and has potential to be used as a non-invasive readout in ALS trials.

Chronically ill adolescents are also incompletely vaccinated: A cross-sectional study in France.

Adolescent vaccination coverage tends to be suboptimal, leading to resurgent infectious pathologies and vulnerability to various pathogens. The low frequency of medical consultations and missed opportunities for vaccination are often used to explain the low rate of vaccination. The aim of this study was to assess if the vaccination coverage rate is higher in chronically ill adolescents (CIA) who require a close pediatric specialized follow-up versus the rate in healthy adolescents (HA). A monocentric cross-sectional study was conducted in the Nantes University Hospital. We included 114 CIA and 266 HA. The vaccination coverage rate and the up-to-date immunization status were compared between ill versus healthy adolescents for each of the following vaccines: diphtheria, tetanus, acellular pertussis, inactivated poliovirus (DTaP/IPV), measles-mumps-rubella (MMR), hepatitis B (HepB), meningococcal C conjugate (MnC), human papillomavirus (HPV) and composite combinations (e.g. DTaP/IPV-MMR-HepB-MnC). The overall immunization rate for DTaP/IPV-MMR-HepB-MnC was very low, with no significant difference between CIA and HA (9.6% versus 13.5%; p=0.28). Most of the investigated vaccines exhibited similar immunization patterns for the two groups: DTaP/IPV (77.2vs. 76.7%; p=0.97), MMR (92.1vs. 95.9%; p=0.14), HepB (51.8vs. 48.5%; p=0.51) with the exception of the MnC (18.4vs. 27.8%; p=0.05) and HPV (28.6vs. 16.1%; p=0.04). Despite undergoing specialized and close medical follow-up, we found that the vaccination coverage rate for the CIA remained suboptimal. This indicates that pediatricians need to check the vaccination status and, when required, ensure that the vaccination schedules for these fragile patients are up-to-date.

Workability and Muscle Strength in Patients With Seropositive Rheumatoid Arthritis: Survey Study Protocol.

BackgroundRheumatoid arthritis (RA) and other rheumatic conditions not only fundamentally affect patients’ quality of life and physiological needs but are also negatively associated with work ability. The costs of poor work ability, which, in sum, are more than treatment costs, pose an economic burden to society and patients. Work ability in RA appears to be multifactorial; symptoms such as pain, swelling, and stiffness play a major role, as these directly affect functional disability. Also, RA patients typically suffer from reduced muscle strength. Lower extremity function and grip strengths especially impair their quality of life. However, the role of muscle strength and disease activity as determinants of work ability have not yet been studied.ObjectiveThe primary objective of this study is to compare work ability in working-age participants with seropositive RA and with high and low disease activity; the secondary objective is to evaluate the association of muscle strength, functional ability, and frailty with work ability.MethodsThis monocentric cross-sectional study will be conducted at a rheumatologic outpatient clinic and day hospital with approximately 100 seropositive RA patients aged <65 years. A clinical disease activity index as a measure for rheumatoid disease activity will be assessed during the patients’ routine visits at the clinic. Work ability, frailty, and functional disability will be evaluated with (self-reported) questionnaires as well as with physical tests (Work Ability Index/Score; Health Assessment Questionnaire Disability Index; Survey of Health, Ageing, and Retirement in Europe Frailty Instrument; Short Physical Performance Battery). Muscle strength will be determined with dynamometer measurements of isometric hand grip strength and quadriceps femoris muscle contraction strength. Sleep quality (Medical Outcomes Study Sleep Scale) and sexual functioning as physiological needs will additionally be determined with self-reported questionnaires.ResultsFor this study funding has already been awarded and enrollment has been completed. Data are currently being evaluated.ConclusionsThis study will evaluate the association of work ability with modifiable parameters such as muscle strength and functional ability. It will provide further insights into work ability in RA and its associated risk factors. Any evidence of association will motivate further research, and the findings might encourage interventions focused specifically on improving muscle strength and lower extremity function to positively affect work ability.Trial RegistrationClinicalTrials.gov (NCT02581852); https://clinicaltrials.gov/ct2/show/NCT02581852 (Archived by WebCite at http://www.webcitation.org/6oNcelHtQ)

Post-dexamethasone serum copeptin corresponds to HPA axis responsiveness in human obesity

ContextIncreased activities of the arginine-vasopressin (AVP) system and the hypothalamic-pituitary-adrenal (HPA) axis were shown to be associated with human obesity, but relationships between these systems in obesity remain unclear. ObjectivesTo assess HPA axis responsiveness and its relation to serum concentrations of the AVP-surrogate copeptin in subjects with obesity (OB) in comparison to non-obesity controls (NOC). MethodsIn a cross-sectional monocentric study, thirty-nine OB (f/m 25/14; age 36.5±10.0years; body mass index, BMI, 41.5±4.7kg/m2) were compared to twenty-two NOC (f/m 12/10; age 35.3±8.5years; BMI 23.1±2.4kg/m2), matched for age and sex. All individuals underwent the combined dexamethasone/CRH test. Main outcome measuresPlasma ACTH and cortisol curve indicators derived from the dex/CRH test (post-CRH concentrations 30min after 100μg CRH; maximum concentration, MAX; area-under-the-curve, AUC; ACTH/cortisol ratios). Copeptin was assessed in 1500h samples of the dex/CRH test (after 1.5mg of oral dexamethasone, prior to CRH administration). ResultsCopeptin serum concentrations were higher in OB (median [IQR]: OB 4.62 [2.60–5.88] vs. NOC 3.04 [2.52–4.29] pmol/l, P=0.04). Correspondingly, OB showed higher post-CRH cortisol concentrations (OB: 51.5 [25.9–159.3] vs. NOC: 28.6 [20.0–41.6] nmol/l, P=0.01) and a lower post-CRH ACTH/cortisol ratio (OB: 0.028 [0.016–0.053] vs. NOC: 0.048 [0.034–0.070] pmol/nmol, P<0.01). Serum copeptin was significantly associated with HPA responsiveness in OB (post-CRH ACTH: R=0.42, P<0.01), driven by OB men (post-CRH ACTH: R=0.76, P<0.01, post-CRH cortisol: R=0.64, P=0.02). All associations withstand adjustments for BMI and age. ConclusionsThe association between increased copeptin with ACTH and cortisol release suggests a potential mechanistic interaction of the AVP system with HPA activation in human obesity. The relation of copeptin and HPA responsiveness should be further validated in situations with pronounced HPA activation, such as depression or multiple sclerosis.

Serum prolactin as a biomarker for the study of intracerebral dopamine effect in adult patients with phenylketonuria: a cross-sectional monocentric study.

BackgroundIt has been previously postulated that high phenylalanine (Phe) might disturb intracerebral dopamine production, which is the main regulator of prolactin secretion in the pituitary gland. Previously, various associations between Phe and hyperprolactinemia were revealed in studies performed in phenylketonuria (PKU) children and adolescents. The aim of the present study was to clarify whether any relation between serum phenylalanine and prolactin levels can be found in adult PKU patients.Patients and methodsWe conducted a cross-sectional, monocentric study including 158 adult patients (male n = 68, female n = 90) with PKU. All patients were diagnosed during newborn screening and were treated since birth. Serum Phe, tyrosine (Tyr), prolactin (PRL), and thyroid-stimulating hormone (TSH) levels were measured, and Phe/Tyr ratio was calculated. Males and females were analyzed separately because the serum prolactin level is gender-dependent.ResultsNo significant correlations were found between serum phenylalanine, tyrosine, or the Phe/Tyr ratio and serum prolactin level either in the male or in the female group.ConclusionsIn treated adult PKU patients, the serum prolactin level may not be significantly influenced by Phe or Tyr serum levels.

Overdose in Vitamin K antagonists administration in Dakar: epidemiological, clinical and evolutionary aspects

Les antivitamines K (AVK) sont largement utilisées dans la prévention et le traitement curatif des accidents thromboemboliques. Les objectifs de ce travail étaient de décrire les aspects épidémiologiques, cliniques et évolutifs des surdosages en AVK et d’en déterminer les facteurs hémorragiques. Il s’agit d’une étude descriptive, transversale monocentrique réalisée à l’Hôpital Principal de Dakar. Tous les patients qui présentaient un INR supérieur à 5 étaient inclus. Etaient étudiés le sexe, l’âge du patient, l’AVK utilisé, l’ancienneté de sa prise, les indications, la valeur de l’INR, les médicaments associés, la présence d’hémorragie, la prise en charge immédiate et l’évolution. Nous avons inclus 154 patients. L’acénocoumarol était l’AVK le plus prescrit. Le sexe ratio était en faveur des femmes. L’âge moyen était de 63 ans. Le surdosage était asymptomatique chez 43% des patients. Les hémorragies étaient représentées principalement par des gingivorragies, épistaxis. Des hémorragies majeures étaient présentes chez 8,6% des patients représentées par des mélénas chez 6 patients (3,9%), un hématome musculaire profond chez 2 patients (1,3%) et des hématomes cérébraux intra-parenchymateux chez 2 autres. Deux patients présentaient un collapsus cardiovasculaire avec déglobulisation. Une prise d’AINS était notée chez 21% des patients. Les AVK ont été transitoirement arrêtés chez tous les patients. La mortalité était de 2% par hémorragie intracrânienne. La réduction des surdosages aux AVK passe par une maitrise par le personnel soignant des facteurs de surdosage et par bonne éducation thérapeutique des patients.

Prevalence of Impulse Control Disorders and Obsessive Compulsive Disorder in Elderly Patients with Parkinson's Disease

Aim The aim of the present study is to estimate the prevalence of impulse control disorders (ICDs) and obsessive compulsive disorder (OCD) in a population of elderly patients with Parkinson's Disease living in the community. Methods This is a monocentric cross sectional study in which a total of 250 subjects with Parkinson's Disease aged 65 or more will be selected during a period of one year, from all the outpatients referring to the Geriatric Day Hospital of Policlinico A. Gemelli in Rome. An age matched reference group will be selected from all the subjects without Parkinson's Disease attending the Elderly Fitness Center in the same hospital. During a preliminary phase, a linguistic validation of the Italian version of the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP) will be conducted. Afterwards, every enrolled patient will be evaluated through a clinical interview in order to obtain socio-demographic and clinical data and to assess mood status and quality of life. ICDs and OCD will be assessed respectively, using the Italian versions of self reported scales QUIP and OCI-R. Results Enrollment should end in July 2015. Preliminary results from ad interim analyses will be presented. Conclusion Data on the prevalence of ICDs and OCD in elderly population, particularly in subjects with Parkinson's Disease, are still lacking in medical literature. Nevertheless, they can be clinically relevant and may have implications on the specific approach to this subgroup of patients.

Assessment of heart rate turbulence in hypertensive patients: rationale, perspectives, and insight into autonomic nervous system dysfunction.

Background:Heart rhythm turbulence is classically impaired in patients with previous myocardial infarction and congestive heart failure and is poorly investigated in patients with essential hypertension.Objective:To evaluate heart rhythm turbulence parameters (turbulence onset, (TO); turbulence slope, (TS) in a series of hypertensive patients while gaining insight into autonomic nervous system dysfunction.Setting and Design:University hospital, cross-sectional monocentric study.Materials and Methods:Heart rhythm turbulence was assessed in 50 hypertensive (case group) and 40 normotensive patients (control group).Results:TO and TS were found independently correlated with hypertension. The mean TO was found at -1.64% ± 2.85% in the normotensive patients compared to 1.21% ± 1.95% in the hypertensive patients; the mean TS was found at 4.29 ± 3.18 ms/RR in the normotensive patients compared to 2.27 ± 0.93 ms/RR in the hypertensive patients. Hypertension has a predictive value on heart rhythm turbulence impairment (OR 4.99, 95% CI 1.28-19.41, P = 0.02). Insights into the role of autonomic nervous system dysfunction for the management of hypertensive patients and prevention of malignant ventricular arrhythmia are presented and discussed with regard to heart rhythm turbulence.Conclusion:Essential hypertension is correlated with blunted heart rhythm turbulence parameters.

Soziodemografische Aspekte stehen im Zusammenhang mit dem Brustkrebsscreeningverhalten von Patientinnen: Ergebnisse einer Querschnittsuntersuchung

In Austria, opportunistic mammography screening for detection of early-stages breast cancer is offered for women older than 40 years. In spite of public discussions on the effectiveness of mammography screening, evidence-based educative information material for female patients available online and in print is lacking. The present study describes the influence of the 3 sociodemographic characteristics migration background, education, and age on the individual's breast cancer screening behaviour as well as on the usage of various information sources on breast cancer for patients. In total, 333 outpatients of the Department of Obstetrics and Gynaecology, General Hospital, Vienna, Austria, participated in a monocentric cross-sectional study. Regarding breast cancer screening, 93.4% (n=282) of the female patients had at least one previous mammogram. Furthermore, 86.3% of the participants regularly consulted their gynaecologist, while women with migration background reported less frequent (p=0.02), and well-educated as well as older patients reported more frequent (p<0.02) gynaecological consultations. Higher-educated women (p=0.04) and participants aged between 50 and 69 years (p<0.05) felt better informed on breast cancer-related topics, whereas a migration background was not associated with the perceived level of information. Medical doctors (67.9%) as well as pertinent folders (33%) were the most relevant information sources on breast cancer. Mass media (22.8%) were also a relevant information source on this issue, whereas the Internet (10.5%) was quite rarely referred to for this purpose. The results of the present study show that female patients perceived the medical doctor as the most important source of medical information on breast cancer. The public health-care system could facilitate positive health communication in the doctors/patient relationship by providing homogenous, quality assured educative information material.

AB0395 Evaluation of the organ damage detected by systemic lupus international collaborating clinics/american college of rheumatology (slicc/acr) damage index. a monocentric cross-sectional study on 349 patients affected by systemic lupus erythematosus.

BackgroundThe survival and outcome of patients affected by Systemic Lupus Erythematosus (SLE) have improved dramatically over the past 50 years in terms of mortality and morbidity rates. However, the activity...