Introduction La neuropathie diabétique (ND) est une complication fréquente après 20 ans de diabète mal contrôlé. Elle entraîne une perte de sensibilité thermo-algique. Lorsqu’elle atteint la ...mi-cuisse, il y a une perte de sensibilité des mains qui débute au bout des doigts. Ce travail illustre les lésions observées au niveau des mains chez 3 patients avec ND sévère. Patients et méthodes Photographie 1 : Patient âgé de 80 ans, diabétique de type 2 mal contrôlé depuis 32 ans avec rétinopathie diabétique sévère, présentant une ND qui a occasionnée des maux perforants chroniques et une amputation d’orteil. Il consulte en urgence pour une plaie étendue de la main : il s’est brûlé en posant la main sur une plaque de cuisson brûlante dont il n’a pas perçu la chaleur. Cas clinique Photographie 2 : Patient âgé de 56 ans, diabétique depuis 16 ans, présentant un pied de Charcot et un mal perforant d’origine mixte : neuropathie alcoolique et diabétique. Il présente des lésions de brûlure au troisième degré des mains : il s’est brûlé avec son gobelet de café dont il n’a pas perçu la chaleur. Photographie 3 : Patient âgé de 49 ans diabétique de type 1 lent diagnostiqué il y a 3 ans avec rétinopathie diabétique sévère, ND et mal perforant. Il se blesse la main en bricolant et développe rapidement un phlegmon extensif des tendons nécessitant une chirurgie invasive, il garde des séquelles tendineuses invalidantes. Conclusion Ces observations témoignent du risque augmenté de brûlures et d’infections graves des mains chez les patients souffrant de ND étendue. Ces patients doivent bénéficier de programmes éducatifs ciblés pour prévenir ces accidents.
Under anesthesia, systemic variables and CBF are modified. How does this alter the connectivity measures obtained with rs-fMRI? To tackle this question, we explored the effect of four different ...anesthetics on Long Evans and Wistar rats with multimodal recordings of rs-fMRI, systemic variables and CBF. After multimodal signal processing, we show that the blood-oxygen-level-dependent (BOLD) variations and functional connectivity (FC) evaluated at low frequencies (0.031–0.25 Hz) do not depend on systemic variables and are preserved across a large interval of baseline CBF values. Based on these findings, we found that most brain areas remain functionally active under any anesthetics, i.e. connected to at least one other brain area, as shown by the connectivity graphs. In addition, we quantified the influence of nodes by a measure of functional connectivity strength to show the specific areas targeted by anesthetics and compare correlation values of edges at different levels. These measures enable us to highlight the specific network alterations induced by anesthetics. Altogether, this suggests that changes in connectivity could be evaluated under anesthesia, routinely used in the control of neurological injury.
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•Different anesthetics lead to different systemic and brain alterations.•BOLD variations and functional connectivity are affected by anesthesia.•Systemic variables have little influence on functional connectivity.•Baseline cerebral blood flow has no influence on functional connectivity.•Anesthetics reshape distributions of connections.
Patient education constitutes a relevant strategy to improve pain management. In the field of therapeutic patient education (TPE), we aimed 1) to assess pain impact in cancer patients, 2) to identify ...patients' educative needs in pain management, and 3) to refine research criteria for its future evaluation.
Pain intensity, relief and interference were assessed in 75 cancer patients with unbalanced background pain. Self-assessment questionnaire evaluated i) patients' pain management and ii) their knowledge and needs in TPE.
Most patients experienced pain for more than 6 months and 41.6% reported adequate pain relief. Understanding pain and pain management were major patients' preferences (>58%). Most patients declared they knew their pain treatments, but fewer than half of them were able to name them. However, education concerning pain treatment was considered as essential in <30% of patients. Almost all patients (97.1%) stated pain education as beneficial, with a preference for individualized sessions (41.2%). In addition, the assessment criteria for its future evaluation were refined.
Targeted population mainly concerned patients with persistent pain. Only half of patients reported pain relief despite antalgics. Patient education was declared as beneficial for almost all participants.
Tailoring a pain TPE on patients' needs has the potential to help them to optimally manage their pain daily.
Objectives
The submucous cleft palate (SMCP) is considered to be the most subtle type of cleft palate. Early detection is important to allow on time intervention by speech therapy and/or surgical ...repair before the children already develop compensatory speech mechanisms. The purpose of this study was to investigate at what time children with a SMCP present, to determine when children are operated, and to analyze the postoperative outcomes for in SMCP children.
Patient and methods
Medical records from 766 individuals registered in the cleft registry in the Wilhelmina’s Children’s’ Hospital, Utrecht, were retrospectively reviewed. Inclusion criteria were children diagnosed with SMCP. The following data were collected: age at diagnosis, physical examination, age at surgery, surgical technique, speech therapy pre- and post-surgery, otitis media, secondary cleft surgery, family history, syndromes, and other anomalies.
Results
In total, 56 SMCP children were identified. The mean age of diagnosis was 44.0 months (range 0–150, SD = 37.0). In 48 children (85.7%), surgical intervention was performed (Furlow plasty, intravelar veloplasty, pharyngoplasty, or Furlow combined with buccal flap).
Conclusion
This retrospective study reconfirms that SMCP often presents late, even in a country with a modern healthcare system and adequate follow-up of all newborns by the so-called youth doctors in “children’s healthcare centers” up to the age of 4 years old. Almost 86% of patients ultimately needed palate surgery when SMCP was suspected.
Clinical relevance
Any child presenting with repeated episodes of otitis media, nasal regurgitation, or speech difficulties should have prompt consideration for SMCP as diagnosis.
The severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic has become a major public health issue worldwide. Developing and evaluating rapid and easy‐to‐perform diagnostic tests is a ...high priority. The current study was designed to assess the diagnostic performance of an antigen‐based rapid detection test (COVID‐VIRO®) in a real‐life setting. Two nasopharyngeal specimens of symptomatic or asymptomatic adult patients hospitalized in the Infectious Diseases Department or voluntarily accessing the COVID‐19 Screening Department of the Regional Hospital of Orléans, France, were concurrently collected. The diagnostic specificity and sensitivity of COVID VIRO® results were compared to those of real‐time reverse‐transcriptase quantitative polymerase chain reaction (RT‐qPCR) results. A subset of patients underwent an additional oropharyngeal and/or saliva swab for rapid testing. A total of 121 patients confirmed to be infected and 127 patients having no evidence of recent or ongoing infection were enrolled for a total of 248 nasopharyngeal swab specimens. Overall, the COVID‐VIRO® sensitivity was 96.7% (CI, 93.5%–99.9%). In asymptomatic patients, symptomatic patients having symptoms for more than 4 days and those with an RT‐qPCR cycle threshold value ≥ 32, the sensitivities were 100%, 95.8%, and 91.9%, respectively. The concordance between RT‐qPCR and COVID VIRO® rapid test results was 100% for the 127 patients with no SARS‐CoV‐2 infection. The COVID‐VIRO® test had 100% specificity and sensitivity greater than 95%, which are better than the recommendations set forth by the WHO (specificity ≥ 97%–100%, sensitivity ≥ 80%). These rapid tests may be particularly useful for large‐scale screening in emergency departments, low‐resource settings, and airports.
The separation of methane and nitrogen from binary mixtures using a commercial activated carbon, Norit RB3, was investigated. The adsorption of pure fluids and CH4 + N2 mixtures were measured at ...temperatures of 242, 273, and 303 K, at pressures ranging from 53 to 5000 kPa using a high pressure volumetric apparatus and at pressures from 104 to 902 kPa using a dynamic column breakthrough apparatus (DCB). The pure gas equilibrium adsorption capacities were regressed to Toth, Langmuir, Langmuir–Freundlich, and Sips isotherm models; the Toth model gave the best prediction of measured capacities at pressures from 800 to 5000 kPa. The uptake of components from gas mixtures calculated using the Ideal Adsorbed Solution Theory (IAST), Extended Langmuir and Multi-Sips models were all within the uncertainties of the measured adsorption capacities, suggesting that for this adsorbent there is no significant advantage in using the more computationally intensive IAST method. A linear driving force (LDF)-based model of adsorption in a fixed bed was developed to extract the lumped mass transfer coefficients for CH4 and N2 from the pure gas DCB experimental data. This model was used with results from the pure gas experiments to predict the component breakthroughs from equimolar CH4 + N2 mixtures in the DCB apparatus. The Norit RB3 exhibited equilibrium selectivities for CH4 over N2 in the range 3 to 7 (measured selectivites have an average uncertainty of 37%), while the lumped mass transfer coefficients of CH4 and N2 were similar for this activated carbon, ranging from 0.004 to 0.052 s–1. The results presented can serve as a reference data set upon which industrial PSA processes for separating CH4 + N2 mixtures using generic activated carbons can be developed and optimized over a wide range of pressures and temperatures.
Introduction Notre centre de cicatrisation ambulatoire accueille 200 nouveaux patients diabétiques par an pour plaie de pied (1220 pansements/an). Pour une cicatrisation optimum, ces plaies ...nécessitent une détersion mécanique quasi quotidienne. Les infirmières de ville ne sont pas toutes formées à ces pratiques ce qui peut freiner l’évolution de ces plaies. Nous avons donc décidé de réaliser un film éducatif et de l’insérer dans une formation spécifique ciblée sur la prise en charge du pied diabétique. Patients et méthodes Un film a été réalisé concernant les soins des plaies de pied diabétique. Une IDE du service a été filmé pendant la réalisation de soins de pied. Les séquences privilégiées sont: la préparation du matériel, les procédures d’asepsie, mais surtout la détersion mécanique à la curette et ou au bistouri, la pose des pansements (découpage). Les séquences concernant les différents types de plaies à différents stades évolutifs sont en cours de tournage. Ce film à visée éducative et formative a été réalisé par l’équipe audiovisuelle de l’APHP en collaboration avec le service de diabétologie. Il s’adresse aux IDE à domicile et de l’HAD, mais peut aussi être utilisé pour la formation des étudiants en soins et des nouveaux soignant du service. Résultats Depuis septembre 2010, ce film inséré dans une formation théorique et pratique sous forme d’ateliers, est utilisé pour la formation des IDE d’HAD de l’APHP, soit 20 personnes formées en 2010. Pour l’année 2011, 2 formations sont déjà programmées pour former 40 IDE du réseau Paris Diabète. Conclusion La diffusion de ce film couplé à une formation ciblée sur le pied diabétique doit permettre une meilleure collaboration et synchronisation des soignants pour la prise en charge des soins de pieds diabétiques à domicile et limiter le nombre des complications type ostéites et amputations.
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