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Saint-Sauveur-en-Rue, France

Lefrant J.-Y.,University of Nimes | Lefrant J.-Y.,Montpellier University | Muller L.,University of Nimes | Muller L.,Montpellier University | And 14 more authors.
Annales Francaises d'Anesthesie et de Reanimation | Year: 2010

Introduction: We determined whether the implementation of a bundle of 10 recommendations leads to the reduction of mortality in ICU patients with severe sepsis or septic shock. Methods: All patients with severe sepsis or septic shock during two consecutive phases: a 6-month quality control period (observational) and secondly a 6-month intervention period based on the implementation of a bundle of 10 recommendations adapted from the Surviving Sepsis Campaign guidelines (initial bacteriological samples and initiating antibiotics, measurement of arterial lactate, volume expansion ≥20ml/kg, targeted mean arterial pressure ≥65mmHg and the assessments of central venous pressure and ScvO2; glucose control, low doses of corticosteroids, a tidal volume ≤8ml/kg in mechanically ventilated patients with ALI; adequate use of recombinant human activated protein C) were evaluated in 15 ICUs. The primary endpoint was the 28-day mortality rate and the secondary endpoint was the compliance with the recommendations of the care bundle. Measurement and results: Four hundred and forty-five patients (230 and 215 in the observational and intervention periods, respectively) were included. In the two periods, the patients had similar characteristics. The 28-day mortality rate significantly decreased from 40% in the observational period to 27% in the intervention period (P=0.02). According to each recommendation, compliance with the care bundle was achieved in 9 to 100% of patients. Conclusion: The implementation of a care bundle adapted from the Surviving Sepsis Campaign guidelines decreases the 28-day mortality rate in patients with severe sepsis and/or septic shock. © 2010 Elsevier Masson SAS. Source


Khemissa F.,Center Hospitalier Of Perpignan | Mineur L.,Oncology and Radiotherapy Institute | Amsellem C.,University of Rouen | Assenat E.,Institute Regional Du Cancer Of Montpellier Icm | And 10 more authors.
Digestive and Liver Disease | Year: 2016

Background: Patients with gastrointestinal (GI) cancer are exposed to cachexia, which is highly correlated with chemotherapy-induced side effects. Research suggests that specific immunonutrients could prevent such toxicities. Aims: The primary objective of this phase III study was to evaluate the efficacy of glutamine and transforming growth factor-β2 (TGF-β2) in the prevention of grade 3-4 non-hematological toxicities induced by chemotherapy in patients with GI cancer. Patients and methods: We designed a double-blind, randomized, controlled and multicenter trial stratified according to center, type of chemotherapy, presence of cachexia, and age. Patients were randomized to receive either Clinutren Protect® (CP) or a control isocaloric diet (without TGF-β2 or glutamine). Results: Between November 2007 and October 2011, 210 patients were enrolled in the study, of which 201 were included in the intention-to-treat analysis. Grade 3-4 non-hematological toxicities were not significantly different between the CP and control groups when evaluated by univariate and multivariate analyses. Likewise, no difference was observed regarding grade 3-4 hematological toxicities or reasons for treatment interruption. Conclusion: This randomized study does not support the hypothesis that oral glutamine and TGF-β2 supplementation is effective to reduce grade 3 or 4 non-hematological toxicities induced by chemotherapy in patients with GI neoplasm. © 2015 Editrice Gastroenterologica Italiana S.r.l. Source


Obiols J.,Center Hospitalier Of Beziers | Bardo P.,Pharmacie | Garnier J.-P.,Service de biochimie | Brouard B.,Pharmacie
Annales de Biologie Clinique | Year: 2013

Ninety four per cent of health professionals use their smartphone for business purposes and more than 50% has medical applications. The «Blood Gas» application was created to be part of this dynamic and participate to e-health development in France. The «Blood Gas» application facilitates interpretation of the results of blood gas analysis using an algorithm developed with reference to a medical bibliography. It can detect some complex or intricate acid-base disorders in evaluating the effectiveness of the secondary response. The application also studied the respiratory status of the patient by calculating the PaO2/FiO2 ratio and the alveol-arterial gradient. It also indicates the presence of a shunt effect. Finally, a specific module to calculate the SID (strong ion difference) depending on the model of Stewart can detect complex acid-base disorders. Source


Corlobe A.,Montpellier University Hospital Center | Charif M.,Montpellier University Hospital Center | Mania A.,Center Hospitalier Of Beziers | Outteryck O.,University of Lille Nord de France | And 2 more authors.
Revue Neurologique | Year: 2014

Background Current treatment options for first-line immunotherapy in relapsing-remitting multiple sclerosis (MS) are recombinant interferon-β and glatiramer acetate. However, these therapies are only partially effective and certain patients may fail to respond. For this reason, it is important to elaborate alternative treatment strategies. Induction therapy represents a more aggressive approach in which powerful drugs are used right from the beginning to tackle the disease process hard and early. Natalizumab is a powerful monoclonal antibody approved for the treatment of relapsing-remitting MS and is known to silence disease activity. Methods We describe here the early outcome at 1 month and at 6 months of three patients treated with natalizumab for relapsing-remitting MS. Results All three patients had a high disease activity before the initiation of natalizumab, with 4, 8 and 5 gadolinium-enhancing lesions on brain MRI respectively. On the MRI scans made at 1 month after the first infusion, and at 6 months, there was no more gadolinium-enhancement and no new T2-lesion. Clinically, they did not experience any relapse. Discussion In these three cases, natalizumab showed a dramatic efficacy: the patients became "disease activity free" right from the first infusion. To our knowledge, natalizumab is not classically used as an induction therapy, unlike mitoxantrone. However, this treatment has potential hematological and cardiac toxicity and its use can be limited. Thus, in JC virus negative patients, natalizumab could be an interesting alternative treatment. Conclusion Our report suggests that induction strategy with natalizumab may be applicable in patients with aggressive multiple sclerosis. A study of more similar cases may be interesting to confirm these preliminary results. © 2013 Elsevier Masson SAS. Tous droits reserve s. Source


Amara W.,GHI Le Raincy Montfermeil | Fromentin S.,Center Hospitalier Of Belfort Montbeliard | Dompnier A.,Annecy Hospital | Nguyen C.,Center Hospitalier William Morey | And 4 more authors.
Future Cardiology | Year: 2014

Aim: Atrial flutter (AFL) ablation requires optimal periprocedural anticoagulation in order to minimize thromboembolic events/bleeding risk. This study describes the characteristics of patients receiving new oral anticoagulants before AFL ablation and assesses complications. Methods: This multicenter, retrospective study reports ischemic and hemorrhagic predischarge, postprocedural complications. Results: We evaluated 60 patients (62.3% male; mean age: 69.2 ± 9.7 years; CHA2DS2-VASc score: 2.44 ± 1.46, HAS-BLED score: 1.14 ± 0.7). Twenty-one (35.0%) and 23 patients (38.3%) received twice-daily dabigatran 110 or 150 mg; 16 patients (26.6%) received once-daily rivaroxaban (15 mg [n = 5] or 20 mg [n = 11]). Four cases of postprocedural minor bleeding were reported. Conclusion: This is the first study assessing new oral anticoagulants for periprocedural anticoagulation, specifically in patients undergoing AFL ablation. No major bleeding was reported. Further prospective investigation is warranted. © 2014 Future Medicine Ltd. Source

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