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Grosbois J.-M.,FormAction Sante | Grosbois J.-M.,Center Hospitalier Of Bethune | Le Rouzic O.,Center des competences des maladies pulmonaires rares | Monge E.,Center des competences des maladies pulmonaires rares | And 3 more authors.
Revue de Pneumologie Clinique | Year: 2013

Introduction: The comprehensive care and personalized pulmonary rehabilitation (PR) of patients with chronic respiratory disease is effective regardless of the place of performance. The objective of this prospective observational study was to compare two types of care in an outpatient rehabilitation center, versus a home-based PR. Methods: Two hundred and eighty-six patients were supported : 137 patients were included in outpatients (age : 61.2. ±. 10.8. years, BMI: 28.7. ±. 7.1), 149 in home-based PR (age: 62.9. ±. 12. years, BMI: 26.1. ±. 6.6). The choice between outpatient and home was a function of distance from the center and the patient's wishes. The outpatient care was done in groups of six, four times a week for 6. weeks. At home she was single, once a week for 8. weeks with continued physical activity independently of the other days a week depending on individual action plan. The therapeutic education programs and psycho-social support were identical in both structures. The assessment included assessment of exercise tolerance test in 6. minutes stepper (TS6), anxiety and depression and quality of life. Results: There were no incidents or accidents during the PR in the two structures. The exercise intolerance was significantly higher in patients TS6 home (332.9. ±. 154.8 versus 460.2. ±. 137.9 counts, P<. 0.01). All the parameters studied, except for HAD score in the center, were improved significantly (. P<. 0.001) after the course. The evolution of the different scores was not significantly different between the ambulatory versus home. Conclusion: The PR of chronic respiratory unselected patients is as safe and effective at home or in outpatient center on exercise tolerance and quality of life. Home-based PR is an alternative to outpatient care as long as all activities, physical training, therapeutic education and psychosocial support, are achieved. © 2012 Elsevier Masson SAS.


Coquart J.B.,University of Rouen | Grosbois J.-M.,Center Hospitalier Of Bethune | Olivier C.,Lille 2 University of Health and Law | Bart F.,Center Hospitalier Of Bethune | And 2 more authors.
International Journal of COPD | Year: 2016

Background: This retrospective, observational study of a routine clinical practice reports the feasibility and efficiency of home-based pulmonary rehabilitation (PR), including transcutaneous neuromuscular electrical stimulation (NMES) or usual endurance physical exercise (UEPE), on exercise tolerance, anxiety/depression, and health-related quality of life (HRQoL) in patients with COPD. Methods: Seventy-one patients with COPD participated in home-based PR with NMES (Group NMES [GNMES]), while 117 patients participated in home-based PR with the UEPEs (Group UEPE [GUEPE]). NMES was applied for 30 minutes twice a day, every day. The endurance exercises in GUEPE began with a minimum 10-minute session at least 5 days a week, with the goal being 30–45 minutes per session. Three upper and lower limb muscle strengthening exercises lasting 10–15 minutes were also proposed to both the groups for daily practice. Moreover, PR in both the groups included a weekly 90-minute session based on an educational needs assessment. The sessions comprised endurance physical exercise for GUEPE, NMES for GNMES, resumption of physical daily living activities, therapeutic patient education, and psychosocial support to facilitate health behavior changes. Before and after PR, functional mobility and physical exercise capacity, anxiety, depression, and HRQoL were evaluated at home. Results: The study revealed that NMES significantly improved functional mobility (−18.8% in GNMES and −20.6% in GUEPE), exercise capacity (+20.8% in GNMES and +21.8% in GUEPE), depression (−15.8% in GNMES and −30.1% in GUEPE), and overall HRQoL (−7.0% in GNMES and −18.5% in GUEPE) in the patients with COPD, regardless of the group (GNMES or GUEPE) or severity of airflow obstruction. Moreover, no significant difference was observed between the groups with respect to these data (P>0.05). Conclusion: Home-based PR including self-monitored NMES seems feasible and effective for severely disabled COPD patients with severe exercise intolerance. © 2016 Coquart et al.


Dekeyser S.,Center Hospitalier Of Bethune | Bonnel C.,Center Hospitalier Of Bethune | Martinet A.,Center Hospitalier Of Bethune | Descamps D.,Center Hospitalier Of Bethune
Pathologie Biologie | Year: 2011

Subject: Molecular amplification (PCR) provides adequate rapid and specific diagnosis of Mycoplasma pneumoniae infection (first agent responsible for community-wide bacterial pneumonia in children above 5 years of age). Method: Positive (Chlamylège®, Argène) PCR in nasopharyngeal aspirate, respiratory samples and nasopharyngeal swab and/or positive serological test (ELISA). Results: Diagnosis of M. pneumoniae infection in 39 cases: 31 between September and December 2008 (30 children and one adult) and eight since June 2009 (three adults and five children). Children (mean age: 3.6. years) were hospitalized in 88.6% of cases, mean hospitalization duration was 2.9 days for respiratory tract infections, mainly due to lack of response to β-lactamines therapy (65.7%). Four adults (mean age: 29.5 years) presented a pneumonia, with hospitalization for three of them with one in intensive care unit. Twenty-eight PCR have proved positive (87%): without associated serology (13), eight negative serologies, IgG and IgM positive (five), and IgG alone (two). Seven patients had only serological test for diagnosis: IgM. ±. IgG. For two children, IgM positive only in isolation, with a PCR probably false negative. Conclusion: The sensitivity of the serology in the diagnosis of mycoplasma infection is limited: IgM, which appear traditionally 1 week after clinical signs are mostly inexistent for adults and IgG rise at a later stage. Early diagnosis of child pneumoniae by PCR helped rapidly characterize this epidemic phenomenon and adapt the treatment. © 2010 Elsevier Masson SAS.


Bouras A.F.,Center Hospitalier Of Bethune | Marin H.,Lille University Hospital Center | Bouzid C.,Center Pierre et Marie Curie | Pruvot F.-R.,Lille University Hospital Center | And 2 more authors.
Langenbeck's Archives of Surgery | Year: 2016

Background: Life-threatening postoperative pancreatic fistula (LTPOPF) is the most feared complication after pancreatoduodenectomy (PD). Although completion pancreatectomy (CP) is usually performed when radiological management fails, the associated morbidity and mortality rates remain high. Here, we reviewed pancreas-preserving alternatives to CP. Methods: The PubMed database was systematically searched for publications between 1983 and 2014, describing pancreas-preserving surgical treatment of the pancreas remnant (PR) after reintervention in a context of post-PD LTPOPF. Results: A total of 12 articles including 140 patients were reviewed. Six different types of pancreas-preserving treatment were described: external wirsungostomy, simple drainage of the PF, closure of pancreatic stump, internal wirsungostomy, partial CP, and salvage pancreatogastrostomy after major leakage of a pancreatojejunostomy. The overall median survival rate was 75 % but rose to 83 % when patients undergoing only surgical drainage of the fistula were excluded. The median complication rate was 75 %, and the median length of hospital stay was 41.5 days. Further reintervention was required for 25 % of the patients. The median incidence of late diabetes was 22.5 %. The incidence of exocrine insufficiency ranged from 0 to 100 % depending on the intervention. Conclusion: Pancreas-preserving surgical management of the PR after LTPOPF can be performed with acceptable mortality and morbidity. These data suggest that CP should have a more precisely specified role in the management algorithm and should not be performed systematically. © 2015, Springer-Verlag Berlin Heidelberg.


PubMed | Center Hospitalier Of Bethune, Center Pierre et Marie Curie and Lille University Hospital Center
Type: Journal Article | Journal: Langenbeck's archives of surgery | Year: 2016

Life-threatening postoperative pancreatic fistula (LTPOPF) is the most feared complication after pancreatoduodenectomy (PD). Although completion pancreatectomy (CP) is usually performed when radiological management fails, the associated morbidity and mortality rates remain high. Here, we reviewed pancreas-preserving alternatives to CP.The PubMed database was systematically searched for publications between 1983 and 2014, describing pancreas-preserving surgical treatment of the pancreas remnant (PR) after reintervention in a context of post-PD LTPOPF.A total of 12 articles including 140 patients were reviewed. Six different types of pancreas-preserving treatment were described: external wirsungostomy, simple drainage of the PF, closure of pancreatic stump, internal wirsungostomy, partial CP, and salvage pancreatogastrostomy after major leakage of a pancreatojejunostomy. The overall median survival rate was 75 % but rose to 83 % when patients undergoing only surgical drainage of the fistula were excluded. The median complication rate was 75 %, and the median length of hospital stay was 41.5 days. Further reintervention was required for 25 % of the patients. The median incidence of late diabetes was 22.5 %. The incidence of exocrine insufficiency ranged from 0 to 100 % depending on the intervention.Pancreas-preserving surgical management of the PR after LTPOPF can be performed with acceptable mortality and morbidity. These data suggest that CP should have a more precisely specified role in the management algorithm and should not be performed systematically.


PubMed | Polyclinique du Bois, Center Hospitalier Of Bethune, Center Hospitalier Of Dunkerque, Hopital Prive de Villeneuve dAscq and 2 more.
Type: Journal Article | Journal: European journal of preventive cardiology | Year: 2015

To assess the level of secondary prevention and the outcome of coronary artery disease (CAD) in patients who have a history of non-coronary vascular intervention.Patients with polyvascular disease have been reported to receive less evidence-based medications, with worse risk factor control and to be at higher risk than patients with single-bed disease. It is unknown whether these findings remain valid in the modern era of secondary prevention.We included 4184 patients with stable CAD. Two groups were formed according to the absence (n=3704) or presence (n=480) of a history of non-coronary vascular intervention. Treatments and risk factor control were recorded at inclusion. Follow-up was performed after 2 years.Antiplatelets, angiotensin system antagonists, beta-blockers and statins were widely prescribed in both groups. The number of antihypertensive drugs was higher in patients with non-coronary vascular intervention. Except for slight increases in the rate of current smokers and in systolic blood pressure, risk factor control was similar between groups. All-cause and cardiovascular mortality rates were higher in patients with non-coronary intervention with adjusted HR of 1.55 (1.13-2.13) (p=0.007), and 1.98 (1.24-3.15) (p=0.004), respectively.In modern practice and real life conditions, the higher risk of CAD patients with a history of non-coronary vascular intervention is taken into account, with more intense secondary prevention and similar risk factor control than patients without such history. In spite of the level of secondary prevention, patients with a history of non-coronary vascular intervention remain at high risk of cardiovascular events. This should be an incentive to discuss more stringent objectives for secondary prevention in patients with polyvascular disease.


PubMed | University of Lille Nord de France, Center Hospitalier Of Bethune, Center Hospitalier Of Valenciennes, Hopital Tenon and Paris West University Nanterre La Défense
Type: Journal Article | Journal: Human pathology | Year: 2015

Hantavirus nephropathy (HVN) is an uncommon etiology of acute renal failure due to hantavirus infection. Pathological features suggestive of HVN historically reported are medullary interstitial hemorrhages in a background of acute interstitial nephritis (AIN). However, interstitial hemorrhages may be lacking because of medullary sampling error. This emphasizes that other pathological criteria may be of interest. We performed a retrospective clinicopathological study of 17 serologically proven HVN cases with renal biopsy from 2 nephrology centers in northern France. Histologic analysis was completed by immunohistochemistry with anti-CD3, anti-CD68, and anti-CD34 antibodies. Three control groups were not related to hantavirus infection: acute tubular necrosis (ATN) of ischemic or toxic etiology and AIN were used for comparison. Renal biopsy analysis showed that almost all HVN cases with medullary sampling (9/10) displayed interstitial hemorrhages, whereas focal hemorrhages were detected in 2 of the 7 cortex-only specimens. ATN was common, as it was present in 15 (88.2%) of 17 HVN cases. By contrast, interstitial inflammation was scarce with no inflammation or only slight inflammation, representing 15 (88.2%) of 17 cases. Moreover, HVN showed inflammation of renal microvessels with cortical peritubular capillaritis and medullary vasa recta inflammation; peritubular capillaritis was significantly higher in HVN after comparison with ischemic and toxic ATN controls (P = .0001 and P = .003, respectively), but not with AIN controls. Immunohistochemical studies highlighted the involvement of T cells and macrophages in renal microvascular inflammation related to HVN. Our study showed that microvascular inflammation, especially cortical peritubular capillaritis, and ATN are important histologic features of HVN.


PubMed | Reseau de microbiologistes du Nord Pas de Calais, Center Hospitalier Of Bethune, Center Hospitalier Of Roubaix, Institut Universitaire de France and Center Hospitalier Of Valenciennes
Type: Journal Article | Journal: Medecine et maladies infectieuses | Year: 2016

Pivmecillinam is a safe beta-lactam for use in pregnancy. It has been widely used for the treatment of lower urinary tract infections (UTIs) in the Nordic countries where its efficacy, minor impact on the microbiota, and low level of resistance among the Escherichia coli strains have been proven. However, susceptibility data related to E.coli involved in asymptomatic bacteriuria and lower UTIs in pregnant women is lacking. We aimed to support the 2015 recommendations issued by the French Infectious Diseases Society (SPILF) on gestational UTI, with a particular focus on pivmecillinam.Antimicrobial susceptibility testing was performed by 12hospitals with a maternity department on 235 E.coli strains isolated from the urine of pregnant women. Susceptibility to mecillinam was tested by disk diffusion method using the 2015 recommendations of the antibiogram committee of the French microbiology society (CA-SFM).Global susceptibility to mecillinam was 86.4%. Susceptibility to mecillinam was 96.5% for strains susceptible to amoxicillin-clavulanic acid and 38.7% for resistant strains. All six extended-spectrum beta-lactamase-producing E.coli strains were susceptible to mecillinam.Given the efficacy and safety of pivmecillinam during pregnancy, it may be used for the documented treatment of asymptomatic bacteriuria and acute cystitis in pregnant women. It also represents an alternative for the treatment of multidrug-resistant bacterial infections.


PubMed | Institute Of Pharmacie, Reseau Nephronor, Center Hospitalier Of Boulogne Sur Mer, French Institute of Health and Medical Research and 7 more.
Type: | Journal: Nephrologie & therapeutique | Year: 2016

Chronic kidney disease (CKD) is a major concern of public health. The pharmacist is known as a health practitioner involved in prevention and therapeutic education. Our study aimed at defining the impact of community pharmacists interventions for preventing and screening CKD. In our observational prospective study of 5months conducted in 109community pharmacy, we included 2groups of patients: A (therapeutic optimization): CKD patients and B (CKD screening): population at risk. In groupA, we included 354patients, mainly women (51.2%), in stage3 of CKD, mean age 73years old, with hypertension alone (40.6%) or associated with diabetes (44%). About 70% of the patients had a follow up by a nephrologist and 45% of them were good adherent according to the Morisky-Green self-report. However, approximately 20% of patients did not have nephroprotective treatments in their regimen although they were on stage3 or 4 CKD patients, and about half of them were not aware of medical situations at risk. Concerning groupB, 532patients were included. The pharmaceutical interventions screened 10% of patients with a GFR<60mL/min/1.73m


PubMed | Center Hospitalier Of Boulogne Sur Mer, Center Hospitalier Of Bethune, Center Hospitalier Of Dunkerque, Polyclinique du Bois and 2 more.
Type: Journal Article | Journal: American heart journal | Year: 2014

The prevalence and correlates of dual-antiplatelet therapy (DAPT) use in stable coronary artery disease (CAD) are unknown. In addition, whether prolonged DAPT may impact prognosis in stable CAD has not been studied in real-life conditions.We studied 3,691 patients included in a prospective registry on stable CAD. The patients were divided in 2 groups according to their antiplatelet therapy regimen at inclusion: patients treated with DAPT were compared with those treated with single-antiplatelet therapy (SAPT). The primary outcome was a composite of cardiovascular death, myocardial infarction, or stroke.Altogether, 868 (24%) patients received DAPT. Factors positively associated with DAPT use were persistent angina at inclusion, body mass index, myocardial infarction since 1 to 3 years, myocardial revascularization since 1 to 3 years, multivessel CAD, prior drug-eluting stent implantation, and prior aortic or peripheral intervention. Factors negatively associated with DAPT use were age, prior coronary bypass, and left ventricular ejection fraction. The rate of the primary outcome at 2 years was similar whether patients were treated with SAPT (4.6%) or DAPT (5.5%) (P = .301). Similar rates were also observed after propensity score matching: 5.7% when treated with SAPT versus 5.5% when treated with DAPT (P = .886). The rate of bleeding was similar between groups.Our study shows that a significant proportion of stable CAD patients are treated with DAPT in modern practice. Several correlates of DAPT were identified. Although no increase in bleeding was observed, our results do not support the prescription of prolonged DAPT.

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