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PubMed | CHU Avicennes, hopital Sud, Private Practice, Center Hospitalier Of La Region Dannecy and 8 more.
Type: Comparative Study | Journal: Annales de dermatologie et de venereologie | Year: 2016

Several studies have shown a high prevalence of cardiovascular and metabolic comorbidities in psoriasis. Our study aimed to evaluate the association of psoriasis with key comorbidities such as smoking, obesity, hypertension, dyslipidaemia and diabetes comparatively with French national data.This multicentre noninterventional observational study of adults with psoriasis was conducted in 29 dermatology centres in France. A total of 2210 patients were included. The prevalence of comorbidities in psoriatic patients was compared to data from the French national databanks ObEpi 2012 (obesity, hypertension, dyslipidaemia and diabetes) and Baromtre Sant 2010 (smoking).We reported a higher prevalence of all metabolic comorbidities and high blood pressure in psoriatic patients. Smoking: 32.5% were active smokers; the age of onset and the prevalence of familial psoriasis were significantly lower in the smoking group but the severity of psoriasis was significantly higher. The frequency of smoking was higher than in the general population, particularly among young female patients. Obesity: 24% of patients with psoriasis were obese. Multivariate analysis showed obesity to be significantly associated with other comorbidities, severity of psoriasis and psoriatic arthritis. The incidence of obesity was higher than in general population, occurring chiefly in subjects aged over 45 years.26% of patients with psoriasis had hypertension. The age of onset of psoriasis and the prevalence of psoriatic arthritis were significantly higher in the hypertension group, although there was less familial psoriasis. The incidence of hypertension was higher than in general population. Dyslipidaemia: 27.5% of patients with psoriasis had dyslipidaemia. The age of onset in the dyslipidaemia group was higher although there was less familial psoriasis. The incidence of dyslipidaemia was higher than in general population. Diabetes: 11.0% of patients with psoriasis had diabetes. The age of onset of psoriasis was significantly higher in the diabetes group although there was less familial psoriasis. The incidence of diabetes was higher than in general population particularly after the age of 35 years.These results confirmed that psoriasis is associated with significant metabolic comorbidities and hypertension compared to the general population in France, with certain epidemiological differences for each.

PubMed | Service de chirurgie thoracique et transplantation pulmonaire, Service de chirurgie thoracique and Center hospitalier Victor Dupouy
Type: Journal Article | Journal: Revue des maladies respiratoires | Year: 2016

The objectives of outpatient surgery are to reduce the risks connected to hospitalization, to improve postoperative recovery and to decrease the health costs. Few studies have been performed in the field of thoracic surgery and there remains great scope for progress in outpatient lung surgery. The purpose of this article is to present a revue of the current situation and the prospects for the development of out patient thoracic surgery.

The benefits of a rehabilitation program before surgical lung cancer resection remain to be defined. The purpose of this prospective observational study was to assess the effects of rehabilitation together with the use of noninvasive ventilation (NIV) in patients who were at a high operative risk. Between January 2010 and June 2011, 20 consecutive patients (16 males, four females, mean age: 66 years [44-79]) with a clinical N0 non-small cell lung cancer were included. Eligibility criteria were predicted post-operative respiratory function (FEV1, VO2 max) below the guideline thresholds for eligibility for surgical resection and/or associated with severe co-morbidities. The protocol included a cardiorespiratory rehabilitation program and 3 hours of NIV each day. Functional tests were repeated after 3 weeks of therapy. Participants displayed a significant increase in their FEV1 and VO2 max, which allowed surgical resection to go ahead in all patients (lobectomy, n=15; pneumonectomy, n=3; bilobectomy, n=2). The morbidity rate was 20% (acute renal failure, n=2; pneumonia, n=1; haemothorax, n=1). The mortality rate was 5% (myocardial infarction, n=1). Further postoperative rehabilitation allowed a return at home in 19 patients after a mean hospital stay of 11 days. Pulmonary rehabilitation associated with a period of preoperative NIV allows surgery to be performed in patients who are not initially eligible for resection. An evaluation of long-term outcomes survival in comparison to non-surgical therapies is necessary. Copyright © 2013. Published by Elsevier Masson SAS.

Scanvic A.,Center hospitalier Victor Dupouy | Courdavault L.,Center hospitalier Victor Dupouy | Sollet J.-P.,Center hospitalier Victor Dupouy | Le Turdu F.,Center hospitalier Victor Dupouy
Pathologie Biologie | Year: 2011

Aim of the study: Recently, a rapid, fully automated real-time PCR test has become available for detection of Staphylococcus aureus in positive blood cultures, Xpert MRSA/SA blood culture. This study was defined to evaluate the use of this product in our hospital setting to assist in optimizing antibiotic treatment. Materials and methods: Over a period of 18months (from February 2008 to July 2009), 51 positive blood cultures were examined for Staphylococcus using the Xpert MRSA/SA assay on the GeneXpert® System. The PCR results were transferred to the clinician as soon as available. The presence of empirical antibiotic therapy was noted and modified if necessary after discussions between the clinician and the infectious disease specialist. Results: Twenty-three blood bottles were positive for S. aureus, two were resistant to methicillin. Twenty-eight were coagulase negative staphylococci. No discrepancy between identification (S. aureus) and methicillin resistance was observed. Thirty-two samples had clinically significant bacteremia (23 S. aureus and nine coagulase negative staphylococci). Sixteen (50%) of these patients had received inappropriate antibiotic therapy (11 without antibiotic therapy, five with betalactam antibiotics). For these patients, an appropriate antibiotic therapy was prescribed according to these results. Sixteen patients had adequate empirical antibiotic therapy at the time of receiving the PCR result. Among these 16 patients, eight switches were performed from broad-spectrum treatment to a more restrictive antistaphylococcal treatment. Of the 19 patients with a nonclinically relevant coagulase negative staphylococci infection, four were already on antibiotics for other infections and these treatments were not modified. Empirical treatment could be avoided in 13 patients who had a clinical presentation consistent with staphylococcal bacteremia (multiple sores, history of carrying methicllin-resistant or susceptible S. aureus infection, presence of intravascular material or prosthesis). Conclusion: The real-time PCR Cepheid Xpert MRSA/SA on GeneXpert® DX System has become an essential tool in our laboratory enhancing the reports of positive blood cultures for staphylococci. This test is fast (50min) and reliable. It allows optimization of antibiotic therapy in hospital. © 2010 Elsevier Masson SAS.

Raynaud C.,Center Hospitalier Victor Dupouy | Roche N.,University of Paris Descartes | Chouaid C.,University Pierre and Marie Curie
Respiratory Research | Year: 2011

An association between HIV infection and chronic obstructive pulmonary disease (COPD) has been observed in several studies.Objective and methods: we conducted a review of the literature linking HIV infection to COPD, focusing on clinical and epidemiological data published before and during widespread highly active antiretroviral therapy (HAART).Results: Interactions between HIV infection and COPD appear to be influenced by multiple factors. In particular, the bronchopulmonary tract can be damaged by HIV infection, the immunodeficiency it induces, and the resulting increase in the risk of pulmonary infections. In addition, the prevalence of smoking and intravenous drug use is higher in HIV-infected populations, also increasing the risk of COPD. Before the advent of HAART, respiratory tract infections probably played a major role. Since the late 1990s and the widespread use of HAART, the frequency of opportunistic infections has fallen but new complications have emerged as life expectancy has increased.Conclusion: given the high prevalence of smoking among HIV-infected patients, COPD may contribute significantly to morbidity and mortality in this setting. © 2011 Raynaud et al; licensee BioMed Central Ltd.

Ehrmann S.,Service de Reanimation Medicale Polyvalente | Badin J.,Service de Reanimation Medicale Polyvalente | Savath L.,Montpellier University | Pajot O.,Center Hospitalier Victor Dupouy | And 5 more authors.
Critical Care Medicine | Year: 2013

Objectives: To assess whether the use of iodinated contrast medium increases the incidence of acute kidney injury in ICU patients, compared with patients not receiving iodinated contrast medium. Design: Prospective observational matched cohort study. Setting: Two ICUs in two tertiary teaching hospitals. Patients: A total of 380 adults were included (20% more than once), before an iodinated contrast medium infusion (contrast inclusions, n = 307) or before an intrahospital transfer without iodinated contrast medium infusion (control inclusions, n = 170). Interventions: None. Measurements and Main Results: Among contrast inclusions, iodinated contrast medium-associated acute kidney injury occurred after 23 administrations (7.5%) according to the Acute Kidney Injury Network definition (stage ≥ 1, over 48 hr). As expected, a broader definition (≥ 25% increase in serum creatinine over 72 hr) yielded a greater incidence (16%). In 146 pairs of contrast and control inclusions, matched on propensity for iodinated contrast medium infusion, the incidence of acute kidney injury was similar (absolute difference in incidence, 0%; 95% confidence interval,-5.2; 5.2%), Acute Kidney Injury Network definition). Hospital mortality was also similar in 71 contrast and 71 control patients included only once and matched the same way. Contrary to iodinated contrast medium infusion (odds ratio, 1.57; 95% confidence interval, 0.69-3.53), the Sequential Organ Failure Assessment score at inclusion (odds ratio, 1.18; 95% confidence interval, 1.07-1.31) and the number of other nephrotoxic agents (odds ratio, 1.38; 95% confidence interval, 1.03-1.85) were independent risk factors for acute kidney injury. Conclusions: The specific toxic effect of monomeric nonionic low-osmolar iodinated contrast medium in ICU patients with multiple renal aggressions seemed minimal. Severity of disease and the global nephrotoxic burden were risk factors for acute kidney injury, regardless of iodinated contrast medium infusion. © 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.

PubMed | CHU Ambroise Pare, French Institute of Health and Medical Research, University of Versailles and Center hospitalier Victor Dupouy
Type: Journal Article | Journal: Annales de dermatologie et de venereologie | Year: 2016

To better understand the potential risk associated with sun exposure during the school year, we decided to evaluate behaviour, risk [UV index (UVI), minimal erythema dose (MED)] and benefits (vitamin-D synthesis) of sun exposure in primary schoolchildren in France, as well as the various sun protection methods used for children.We performed the study on a sunny day (July 24) in a school in Antony (France). Evaluation of UVI (with calculation of MED) and the amount of vitamin D synthesized according to exposed body surface area and phototype were performed every 15minutes from 9 a.m. to 5 p.m. The effects of albedo and shade on UVI were assessed in 8different locations at the school. The sun-protection measures used by the children were systematically evaluated.Fifty-seven children were evaluated; the maximum UVI was 7.2 and the maximum temperature was 30.7C. Irrespective of phototype and clothing, 1MED was reached and an adequate level of vitamin D was synthesized in the skin before midday. Albedo had little impact on irradiation. The amount of protection afforded by shadow varied greatly, with the highest level occurring in the covered courtyard (99.5% reduction of UVI) and the lowest in the shadow of buildings (53.7% reduction of UVI). With strict sun protection measures concerning dress, children reached 1MED before synthesizing 1000IU of vitamin D, but with clothing suited to high temperatures, 1000IU of vitamin D were synthetized before 1MED was reached. Compliance with photoprotection measures was poor. Regardless of duration of exposure during the day (minimal model: two play breaks+lunchtime break) and of skin phototype, at least 1.5MED was reached during the day.This was an experimental study ignoring childrens actual behaviour (movement, sweating, application of sun protection products, etc.). Moreover, due to weather conditions, the study was performed at a recreation centre in July and not during the standard school year.Sun protection campaigns should naturally be directed chiefly towards children for several reasons relating to solar risk and learning. This study shows the complex link between UV, MED, vitamin D as well as the difficulties of implementing solar protection measures in schools in France.

PubMed | Center Hospitalier Victor Dupouy and University Paris Diderot
Type: Journal Article | Journal: Transplant infectious disease : an official journal of the Transplantation Society | Year: 2016

Multidrug-resistant (MDR) bacteria are a growing concern worldwide. The aim of this study was to describe the epidemiology and risk factors of MDR bacteria detected in respiratory invasive samples during hospitalization in the intensive care unit (ICU) after lung transplantation (LT).This study was based on a retrospective analysis of 176 patients hospitalized in the ICU after LT in 2006-2012. Respiratory invasive samples were performed according to a routine protocol. MDR pathogens were defined according to in vitro susceptibility tests.A total of 1176 bacteria were cultured. Susceptibility testing was performed on 1046 strains and 404 (39%) MDR were detected in 90 (51%) patients. Pseudomonas aeruginosa, coagulase-negative staphylococci, and Enterobacteriaceae (mainly Enterobacter species) were the most common MDR pathogens. On multivariate analysis, an ICU stay >14 days, presence of a tracheostomy, and previous exposure to broad-spectrum antibiotics were associated with MDR acquisition (odds ratio [OR] 3.7; 95% confidence interval [1.69-8.12]; OR 3.28 [1.05-10.28]; and OR 2.25 [1.17-4.34], respectively). We consistently observed an increasing emergence of resistance to several antibiotics, from week 1 to week 4 of ICU hospitalization: for ticarcillin, piperacillin-tazobactam, ceftazidime, imipenem/cilastatin, amikacin, and ciprofloxacin in P. aeruginosa; and for piperacillin-tazobactam, cefepime, and amikacin in Enterobacteriaceae.A large proportion of MDR bacteria are detected on respiratory invasive samples in LT patients, and the risk of their emergence is mainly determined by the previous exposure to broad-spectrum antibiotics and the length of ICU stay. Adequate treatment requires broad-spectrum empiric antibiotic therapy.

PubMed | Center hospitalier Rene Dubos, Institute Of Puericulture Et Of Perinatalogie, Center hospitalier Victor Dupouy, PICU and 7 more.
Type: | Journal: International journal of nursing studies | Year: 2016

Heelstick is the most frequently performed skin-breaking procedure in the neonatal intensive care units (NICUs). There are no large multicenter studies describing the frequency and analgesic approaches used for heelsticks performed in NICUs.To describe the frequency of heelsticks and their analgesic management in newborns in the NICU. To determine the factors associated with the lack of specific preprocedural analgesia for this procedure.EPIPPAIN 2 (Epidemiology of Procedural PAin In Neonates) is a descriptive prospective epidemiologic study.All 16 NICUs in the Paris region in France.All newborns in the NICU with a maximum corrected age of 44 weeks +6 days of gestation on admission who had at least one heelstick during the study period were eligible for the study. The study included 562 newborns.Data on all heelsticks and their corresponding analgesic therapies were prospectively collected. The inclusion period lasted six weeks, from June 2, 2011 to July 12, 2011. Newborns were followed from their admission to the 14th day of their NICU stay or discharge, whichever occurred first.The mean (SD) gestational age was 33.3 (4.4) weeks and duration of participation was 7.5 (4.4) days. The mean (SD; range) of heelsticks per neonate was 16.0 (14.4; 1-86) during the study period. Of the 8995 heelsticks studied, 2379 (26.4%) were performed with continuous analgesia, 5236 (58.2%) with specific preprocedural analgesia. Overall, 6764 (75.2%) heelsticks were performed with analgesia (continuous and/or specific). In a multivariate model, the increased lack of preprocedural analgesia was associated with female sex, term birth, high illness severity, tracheal or noninvasive ventilation, parental absence and use of continuous sedation/analgesia.Heelstick was very frequently performed in NICUs. Although, most heelsticks were performed with analgesia, this was not systematic. The high frequency of this procedure and the known adverse effects of repetitive pain in neonates should encourage the search of safe and effective strategies to reduce their number.

PubMed | Center Hospitalier Rene Dubos, Center Hospitalier Victor Dupouy, Center Hospitalier Delafontaine, PICU and 7 more.
Type: | Journal: International journal of nursing studies | Year: 2016

Newborns in intensive care units (ICUs) undergo numerous painful procedures including venipunctures. Skin-breaking procedures have been associated with adverse neurodevelopment long-term effects in very preterm neonates. The venipuncture frequency and its real bedside pain management treatment are not well known in this setting.To describe venipuncture frequency, its pain intensity, and the analgesic approach in ICU newborns; to determine the factors associated with the lack of preprocedural analgesia and with a high pain score during venipuncture.Further analysis of EPIPPAIN 2 (Epidemiology of Procedural Pain In Neonates), which is a descriptive prospective epidemiologic study.All 16 neonatal and pediatric ICUs in the Paris region in France.All newborns in the ICU with a maximum corrected age under 45 weeks of gestation on admission who had at least one venipuncture during the study period.Data on all venipunctures, their pain score assessed with the DAN scale and their corresponding analgesic therapies were prospectively collected. The inclusion period lasted six weeks, from June 2, 2011, to July 12, 2011. Newborns were followed from their admission to the 14th day of their ICU stay or discharge, whichever occurred first.495 newborns who underwent venipunctures were included. The mean (SD) gestational age was 33.0 (4.4) weeks and duration of participation was 8.0 (4.5) days. A total of 257 (51.9%) neonates were very preterm (<33 weeks). The mean (SD; range) number of venipunctures per neonate during the study period was 3.8 (2.8; 1-19) for all neonates and 4.1 (2.9; 1-17) for neonates <33 weeks. Of the 1887 venipunctures, 1164 (61.7%) were performed successfully in one attempt, 437 (23.2%) with continuous analgesia, 1434 (76.0%) with specific preprocedural analgesia. In multivariate models, lack of preprocedural analgesia was associated with higher disease-severity score, intrauterine growth retardation, invasive or noninvasive ventilation, venipuncture performed on the first day of hospitalization or at nighttime, and the use of continuous sedation/analgesia. High pain scores were significantly associated with absence of parents during procedures, surgery during the study period, and higher number of attempts.Venipuncture is very frequent in preterm and term neonates in the ICUs. 76% were performed with preprocedural analgesia. Strategies to reduce the number of attempts and to promote parental presence seem necessary.

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