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Montmasson H.,Center Hospitalier Of Blois | Bertrand P.,Pole dImagerie | Perrotin F.,Center Olympe Of Gouges | Perrotin F.,University of Tours | El-Hage W.,University of Tours
Journal de Gynecologie Obstetrique et Biologie de la Reproduction

Objectives: Identify the potential predictors of postpartum post-traumatic stress disorder (PTSD) in primiparous mothers. Materials and methods: This longitudinal prospective study evaluated the prevalence of obstetric complications and psychiatric disorders (anxiety, depression, psychic dissociation, PTSD, personality) in the immediate postpartum and after 3-6 months. Results: Among 456 hospitalized primiparous mothers, 314 were recruited and 212 followed-up prospectively. The prevalence of PTSD symptoms was high and stable through the postpartum (12.7% versus 13.6%). Significant risk factors were associated with postpartum PTSD: social isolation, celibacy or divorce (OR = 6.6; P < 0.02), history of abortion (OR = 6.2; P < 0.01) or of infertility (OR = 10.4; P < 0.007), too long subjective length of labour (OR = 3.5; P < 0.03), mothers' perceptions of obstetric complications (OR = 18.5; P < 0.003), high anxiety level at the maternity hospital (OR = 3.9; P < 0.03), PTSD symptoms after childbirth (OR = 6.7; P < 0.01) and dependent personality disorder (OR = 23.2; P < 0.001). Conclusion: Subjective experience of childbirth, history of obstetric complications, social isolation and dependent personality disorder and high level of stress-anxiety after childbirth are significant predictive factors of postpartum PTSD (3-6 months). The early identification of these factors should lead to early therapeutic intervention in the mothers at risk of PTSD. © 2012 Elsevier Masson SAS. Source

Denis-Delpierre N.,Nantes University Hospital Center | Denis-Delpierre N.,University of Nantes | Mallet D.,Center Hospitalier Of Luynes | Mallet D.,University of Tours | And 3 more authors.
Medecine Palliative

Purpose: In a national context where one seeks to develop palliative care through training, we conducted an experiment on the development of the resident's interpersonal skills when they performed their clinical rotation in a palliative care's structure. Methods: Initially, we sought to understand conceptually and practically the various roles of interpersonal skills in palliative care. Then, we identified typical situations in which the relational dimension is sought. Thirdly, we analyzed the relational competencies and categorized them by skills. Results: Once this work completed, we defined educational tools and developed an identification guide of development of these relational competencies. Conclusion: Upon this experimentation, we reread our entire journey by releasing four benchmarks. It seems particularly important for the resident to develop his/her capabilities by exchanging with peers or relying on pedagogy research. These reflections have no normative value proposals or recommendations. They are to be considered as an educational experience in a field so far little explored. © 2016 Elsevier Masson SAS. Source

Friocourt P.,Center Hospitalier Of Blois
NPG Neurologie - Psychiatrie - Geriatrie

The treatment of heart failure is the subject of guidelines issued by scientific societies and organizations. It uses a combination of non-pharmacological management, including education and influenza and pneumococcal vaccinations, and pharmacological therapy. Pharmacological treatment of heart failure with systolic dysfunction is well codified. It must include an angiotensin converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB) and a betablocker, sometimes in combination with a diuretic, digoxin or an aldosterone antagonist. Too often, the titration of ACE inhibitors and betablockers is insufficient and recommended dosages are not met even in the absence of contraindication. This illustrates the concept of underuse in the elderly. Regular reassessment of treatment is necessary to try to achieve the target doses of betablockers, ACE inhibitors or angiotensin receptor antagonists, while avoiding adverse effects of therapy. The treatment of heart failure with preserved systolic function is poorly codified in the absence of convincing results of the studies. It is based on the use of diuretics in case of decompensation and the active management of risk factors and etiological disease (hypertension). © 2011 Elsevier Masson SAS. Source

Dion F.,University of Tours | Saudeau D.,University of Tours | Bonnaud I.,University of Tours | Friocourt P.,Center Hospitalier Of Blois | And 6 more authors.
Journal of Interventional Cardiac Electrophysiology

Purpose: Ischemic stroke is a frequent pathology with high rate of recurrence and significant morbidity and mortality. There are several causes of stroke, affecting prognosis, outcomes, and management, but in many cases, the etiology remains undetermined. We hypothesized that atrial fibrillation was involved in this pathology but underdiagnosed by standard methods. The aim of the study was to determine the incidence of atrial fibrillation in cryptogenic ischemic stroke by using continuous monitoring of the heart rate over several months. The secondary objective was to test the value of atrial vulnerability assessment in predicting spontaneous atrial fibrillation. Methods and results: We prospectively enrolled 24 patients under 75 years of age, 15 men and 9 women of mean age 49 years, who within the last 4 months had experienced cryptogenic stroke diagnosed by clinical presentation and brain imaging and presumed to be of cardioembolic mechanism. All causes of stroke were excluded by normal 12-lead ECG, 24-h Holter monitoring, echocardiography, cervical Doppler, hematological, and inflammatory tests. All patients underwent electrophysiological study. Of the patients, 37.5% had latent atrial vulnerability, and 33.3% had inducible sustained arrhythmia. Patients were secondarily implanted with an implantable loop recorder to look for spontaneous atrial fibrillation over a mean follow-up interval of 14.5 months. No sustained arrhythmia was found. Only one patient had non-significant episodes of atrial fibrillation. Conclusion: In this study, symptomatic atrial fibrillation or AF with fast ventricular rate has not been demonstrated by the implantable loop recorder in patients under 75 years with unexplained cerebral ischemia. The use of this device should not be generalized in the systematic evaluation of these patients. In addition, this study attests that the assessment of atrial vulnerability is poor at predicting spontaneous arrhythmia in such patients. © The Author(s) 2010. Source

Depla M.,University of Tours | d'Alteroche L.,University of Tours | Gouge A.,University of Tours | Moreau A.,University of Tours | And 12 more authors.

Most clinical studies suggest that the prevalence and severity of liver steatosis are higher in patients infected with hepatitis C virus (HCV) genotype 3 than in patients infected with other genotypes. This may reflect the diversity and specific intrinsic properties of genotype 3 virus proteins. We analyzed the possible association of particular residues of the HCV core and NS5A proteins known to dysregulate lipid metabolism with steatosis severity in the livers of patients chronically infected with HCV. We used transmission electron microscopy to quantify liver steatosis precisely in a group of 27 patients, 12 of whom were infected with a genotype 3 virus, the other 15 being infected with viruses of other genotypes. We determined the area covered by lipid droplets in liver tissues and analyzed the diversity of the core and NS5A regions encoded by the viral variants circulating in these patients. The area covered by lipid droplets did not differ significantly between patients infected with genotype 3 viruses and those infected with other genotypes. The core and NS5A protein sequences of the viral variants circulating in patients with mild or severe steatosis were evenly distributed throughout the phylogenic trees established from all the collected sequences. Thus, individual host factors seem to play a much greater role than viral factors in the development of severe steatosis in patients chronically infected with HCV, including those infected with genotype 3 viruses. © 2012 Depla et al. Source

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