Introduction
Rheumatoid arthritis (RA) is a chronic inflammatory degenerative disease whose symptoms are mainly joint with significant functional impact, resulting in a restriction of the activities ...of the patient and increasing the impact on mental well-being.
Objectives
This study aimed to screen for mental functioning in RA patients, detect anxiety and depression, evaluate self-esteem and study its relation to clinical parameters, as well as disease activity.
Methods
Single-centre cross-sectional study, involving patients with RA using the hospital anxiety and depression scale (HADs). Rosenberg scale was used to evaluate self-esteem. We evaluated the RA severity Disease Activity Severity (DAS 28).
Results
Fifty patients were included. The average age was 54 years 24-72. The mean duration of the disease was 10 years. Thirty-nine patients had immunopositive RA with a mean Rheumatoid Factor level of 189.1 ± 291.3 U/ml and a mean anti-CCP antibody level of 165 ± 225.3 U/ml. At diagnosis, the mean DAS 28 of the patients was 5.1 ± 1.4. Moderately active and highly active RA were predominant with percentages of 40% and 50% respectively. All patients were treated, and 36% received biological treatment.
Depression was noted in 42% of the patients with a mean score of 10.1 ± 3.7. Anxiety was noted in 50% of the patients with a mean score of 10.3 ± 4.
In this study, we did not find a statistically significant association between disease activity and depression or anxiety scores (p=0.6 and p=0.1 respectively).
The mean Rosenberg scale score was 27± 3. Sixty-eight per cent of patients had low self-esteem, twenty-one per cent had moderate self-esteem and eleven per cent very low self-esteem. Disease activity was associated with low self-esteem.
Conclusions
RA is a chronic inflammatory disease that has a significant impact on the mental health and quality of life of patients. The detection and treatment of psychiatric disorders such as anxiety, depression and low self-esteem; improve the care of patients with RA.
Disclosure of Interest
None Declared
Our study aimed to determine the efficacy and safety of colistin in the treatment of ventilator-associated pneumonia (VAP) caused by pan-drug-resistant Pseudomonas aeruginosa or Acinetobacter ...baumanii. Pairwise, retrospective exposed-unexposed study. Combined medical and surgical intensive care unit of Habib Bourguiba University Hospital (Sfax, Tunisia). Sixty patients with VAP caused by pan-drug-resistant A. baumanii or P. aeruginosa matched to 60 controls with VAP caused by A. baumanii or P. aeruginosa susceptible to imipenem. All patients had normal renal function at the onset of antibiotic therapy. Case patients were treated by colistin intravenously and control patients were treated by imipenem intravenously. Baseline characteristics were similar between the colistin and imipenem groups. The mean duration of antibiotic therapy for VAP was 9.5+/-3.8 days (range 5-22 days) with colistin and 8.9+/-2.8 days (range 5-20 days) with imipenem (p=0.32). A favorable clinical response to antibiotic therapy for VAP occurred in 45 patients (75%) in the colistin group and in 43 patients (71.7%) in the imipenem group (p=0.68). The time to resolution of infectious parameters after the initiation of antibiotic therapy was not statistically different between the two groups. During the antibiotic course, none of the patients in either group developed renal failure. We conclude that colistin can be a safe and effective option in the treatments of VAP caused by pan-drug-resistant P. aeruginosa or A. baumanii.
Introduction
Ankylosing spondylitis (AS) is an inflammatory rheumatic disease characterized by spinal and/or peripheral involvement, enthesitis, dactylitis, and several extra-articular ...manifestations. Chronic inflammation often leads to reduced spinal mobility and functional disability. The frequency of psychological problems has increased in AS patients.
Objectives
The objective of this study was to determine the prevalence of symptoms of anxiety and depression among AS patients and explore the underlying associated factors.
Methods
The Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and other clinical measures were collected during the clinical trial. We evaluated also the hospital anxiety and depression scale (HADs). P values < 0.05 were considered statistically significant.
Results
Sixty-two patients with AS were included in the study. The average age was 41 years 18-65. The diagnostic delay varied from one year to 26 years with an average of 4 years. Twenty-nine years is the average age of onset of symptoms with a standard deviation of 10 years. The mean duration of the disease was 10 ± 8 years. At baseline, the mean BASFI score was 53.9 ± 2 and BASDAI was 4.5± 2.
Clinically significant symptoms of anxiety and depression were present in 48.4% and 54.8% of patients, respectively. Depression was noted with a mean HADS depression of 10,5 ± 5,2. Anxiety was noted with a mean HADS anxiety of 11,3 ± 4,6.
In univariate analysis, anxiety was associated with the low educational level of patients (p = 0.038) and with CRP level (p= 0.041). There was a significant association between depression and anxiety (p=0.000). There was no relationship between these psychiatric disorders and disease activity, treatment modalities or functional status (p>0.05)
Conclusions
In patients with Ankylosing spondylitis, the prevalence of risk of mental disorders is high.
Anxiety and depression are common in AS and even alter the quality of life.
Patients should be regularly screened for these disorders.
Disclosure of Interest
None Declared
IntroductionAnkylosing spondylitis (AS) is a chronic inflammatory disease that primarily affects the axial skeleton and may alter the quality of life of patients. Fatigue, one of the major clinical ...features of rheumatic diseases is a major clinical feature of AS, yet it has often been ignored in clinical practice.ObjectivesThis study aims to evaluate the quality of life in AS and to address the prevalence of fatigue in this disease and its associated factors.MethodsWe conducted a cross-sectional study among AS patients. The Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), The Ankylosing Spondylitis Disease Activity Score (ASDAS) and other clinical measures were collected during the study.We evaluated the psychometric characteristics of the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue subscale) and the AS Quality of Life questionnaire (ASQoL). P values < 0.05 were considered statistically significant.ResultsSixty-two patients with AS were included in the study. The average age was 41 years 18-65. The diagnostic delay was between 1 year and 26 years with an average of 4 years. The mean duration of the disease was 10 ± 8 years. The erythrocyte sedimentation rate (ESR) was between 2 and 50 mm/hour and the C reactive protein (CRP) level was between 1 and 45 mg/l. At baseline, the mean BASFI score was 53.9 ± 2, the mean BASDAI score was 4.5± 2 and the mean ASDAS score was 3.9 ± 2.The mean FACIT-Fatigue score observed in these patients with AS was 20± 10,8 and the mean ASQoL score was 12,8 ± 4,8. Severe fatigue was observed in 43.5 % of patients and poor quality of life was detected in 62.9% of patients.In univariate analysis, fatigue was associated with the low educational level of patients (p = 0.011), with sacroiliitis stage (p= 0.018) and with ASQoL score (p=0.000). ASQol was also associated with a high level of ESR (p=0.01). There was no relationship between FACIT or ASQoL and disease activity or functional status (p>0.05)ConclusionsThis study confirms that poor QoL and fatigue were frequent in patients with AS which can expose them to the risk of psychiatric disorders like anxiety and depression. Therefore, patients suffering from AS should be regularly evaluated for these disorders.Disclosure of InterestNone Declared
In the American continent, larval forms (caterpillars) of the Lonomia genus can cause systemic reactions in human beings. In this Paper, we report the third case of Lonomia envenoming recorded in ...French Guiana in 25 years, and the first in which specific antivenom was administered. Severe symptoms of the envenoming were observed in our patient including pain; coagulopathy and systemic hemorrhage. They are caused by skin contact with caterpillars. Recovery, however, was quite satisfactory thanks to the international cooperation of the health authorities in both France and Brazil.
•Clinical symptoms of envenoming by caterpillars include pain, coagulopathy and systemic hemorrhage.•We report a case of hemorrhagic syndrome due to Lonomia envenoming in French Guiana.•Bleeding and coagulation disturbances were reversed with Brazilian Lonomia antivenom.•Cooperation between Brazilian and French government institutions was essential to use Lonomia antivenom.
Introduction
: Les urgences vitales sont fréquentes dans les centres de santé isolés guyanais. La population médicale est composée de médecins généralistes avec peu de formation en médecine ...d’urgence.
Méthodes
: Nous avons réalisé une étude descriptive au moyen d’un questionnaire diffusé à l’aide d’une mailing liste de 310 contacts de médecins ayant travaillé dans les centres délocalisés de prévention et de soins (CDPS) depuis les années 2010 à 2019.
Résultats
: Nous avons obtenu 90 réponses sur 310 (29 %) et analysé 87 (28 %). La majorité des médecins était des généralistes (72 %) de moins de 40 ans (69 %) sans formation de médecine d’urgence (76 %). Les urgences majoritairement rencontrées étaient les comas et les polytraumatisés ainsi que les urgences gynéco-obstétricales. La majorité des médecins ont rapporté avoir été inconfortables durant ces prises en charge (67 %). La relation avec le service d’aide médicale urgente (Samu) a été jugée majoritairement adaptée (93 %). L’aide apportée par l’équipe paramédicale des CDPS était jugée correcte dans 49 % et excellente dans 48 % des cas. Plus d’un médecin sur cinq (21 %) a déclaré ne pas vouloir renouveler son contrat en CDPS du fait du vécu des urgences vitales. Afin d’améliorer la prise en charge des patients graves, les médecins sont favorables à la présence de fiches réflexes (87 %), à la formation en préaffectation sur mannequin (75 %), à de courtes formations aux déchoquages par des médecins urgentistes (67 %), à des alternatives à l’intubation orotrachéale telles que des dispositifs supraglottiques (68 %) et à l’aide guidée par la télémédecine (30 %).
Conclusion
: Ce travail révèle une importante souffrance des médecins face aux difficultés vécues dans la prise en charge des urgences vitales. Afin de répondre aux problématiques soulevées par cette étude, la majorité des mesures d’amélioration évoquées dans ce travail sont en cours de mise en place depuis la fin de l’année 2019.
Introduction
: Life-threatening emergencies are common in remote Guyanese health centers. The medical population is composed of general practitioners with lack of training in emergency medicine.
Methods
: We conducted a descriptive study using a questionnaire distributed through a mailing list of 310 contacts of physicians who have worked in the remote health centers (RHC) from 2010 to 2019.
Results
: We obtained 90 responses out of 310 (29%) and analyzed 87 (28%). The majority of physicians were general practitioners (72%) under 40 years of age (69%) without emergency medicine training (76%). The most common emergencies were comas and polytrauma as well as gynecological and obstetrical emergencies. The majority of the physicians reported being uncomfortable during these treatments (67%). The relationship with the emergency medical service (EMS) was judged to be mostly appropriate (93%). The assistance provided by the RHC paramedical team was judged correct in 49% and excellent in 48% of cases. More than one physician out of five (21%) stated that they did not want to renew their RHC contract because of the experience of life-threatening emergencies. In order to improve the management of serious patients, the physicians are in favor of the presence of reflex cards (87%), pre-assignment training on mannequins (75%), short training courses in resuscitation by emergency physicians (67%), alternatives to orotracheal intubation such as supraglottic devices (68%), and telemedicine-guided assistance (30%).
Conclusion
: This work reveals a significant suffering of physicians facing the difficulties in the management of vital emergencies. In order to respond to the issues raised by this study, the majority of the improvement measures mentioned in this work are being implemented since the end of 2019.
Our study aimed to determine the efficacy and safety of colistin in the treatment of ventilator-associated pneumonia (VAP) caused by pan-drug-resistant Pseudomonas aeruginosa or Acinetobacter ...baumanii.
Pairwise, retrospective exposed-unexposed study.
Combined medical and surgical intensive care unit of Habib Bourguiba University Hospital (Sfax, Tunisia).
Sixty patients with VAP caused by pan-drug-resistant A. baumanii or P. aeruginosa matched to 60 controls with VAP caused by A. baumanii or P. aeruginosa susceptible to imipenem. All patients had normal renal function at the onset of antibiotic therapy.
Case patients were treated by colistin intravenously and control patients were treated by imipenem intravenously.
Baseline characteristics were similar between the colistin and imipenem groups. The mean duration of antibiotic therapy for VAP was 9.5+/-3.8 days (range 5-22 days) with colistin and 8.9+/-2.8 days (range 5-20 days) with imipenem (p=0.32). A favorable clinical response to antibiotic therapy for VAP occurred in 45 patients (75%) in the colistin group and in 43 patients (71.7%) in the imipenem group (p=0.68). The time to resolution of infectious parameters after the initiation of antibiotic therapy was not statistically different between the two groups. During the antibiotic course, none of the patients in either group developed renal failure.
We conclude that colistin can be a safe and effective option in the treatments of VAP caused by pan-drug-resistant P. aeruginosa or A. baumanii.
Objectifs
: La traumatologie routière représente 13,1 décès pour 10
5
habitants en Guadeloupe. Marie-Galante (MG), île de l’archipel guadeloupéen, située dans les Antilles françaises, est fortement ...impactée par l’accidentologie routière. La prise en charge de ces victimes implique des spécificités organisationnelles liées à la géographie et au système de soins. Les objectifs de ce travail sont la description épidémiologique des victimes d’accident de la voie publique (AVP) et l’évaluation de la prise en charge (PEC) médicale initiale des victimes les plus graves.
Méthodes
: Étude observationnelle rétrospective de 2016 à 2018 incluant les victimes prises en charge par le service médical d’urgence et de réanimation (Smur) et/ou par le centre hospitalier de Sainte-Marie (CHSM) à Marie-Galante. Les patients ont été répartis par critère de gravité : instables, critiques, potentiellement graves ou stables.
Résultats
: Sur la période, 499 victimes ont nécessité une PEC : 164 (33 %) impliquant des véhicules légers, 217 (43 %) des deux-roues motorisés et 60 (12 %) des vélos. La population est jeune (29 21–49 ans), et masculine (sex-ratio H/F : 3,3). Le CHSM a pris en charge 467 (95 %) victimes, 6 (1 %) étaient instables, 11 (2 %) critiques, 142 (28 %) potentiellement graves et 264 (53 %) stables ; 7 (1 %) ont bénéficié d’un transfert héliporté (TH) direct vers le centre hospitalier universitaire de Guadeloupe (CHUG), 52 (10 %) d’un TH secondaire après une PEC au CHSM. Tous les patients instables et 10 (91 %) des 11 critiques ont été admis au CHUG.
Conclusion
: Cette étude souligne la forte incidence de la traumatologie routière à Marie-Galante. Ce travail doit permettre d’élaborer des axes d’amélioration de PEC, notamment par la filiarisation du patient traumatisé.
Aim
: Road trauma represents 13.1 deaths per 10
5
inhabitants in Guadeloupe. Marie-Galante (MG), an island of the Guadeloupe archipelago, located in the French West Indies, is strongly impacted by road accidents. The care of these victims involves organizational specificities linked to the geography and the care system. The aims of this work are the epidemiological description of road accident victims in MG and the evaluation of initial medical management of the most severe victims
Methods
: Retrospective observational study, from 2016 to 2018, included victims managed by the emergency medical service and resuscitation (Smur) and the Sainte-Marie Hospital (SMH) in MG. Patients were categorized by severity: unstable, critical, potentially severe, or stable.
Results
: During the 3 years, 499 victims required a rescue: 164 (33%) involving light vehicles, 217 (43%) motorized two-wheelers, and 60 (12%) bicycles. The population was young (29 21–49 years) and predominantly male (sexratio H/F 1.3). The SMH managed 467 (95%) victims, 6 (1%) unstable, 11 (2%) critical, 142 (28%) potentially severe, and 264 (53%) stable; 7 (1%) were directly transferred to the Guadeloupe University Hospital (GUH) by helicopter, 52 (10%) secondarily after a SMH first support. All unstable patients and 10 of 11 (91%) critical patients were admitted to the GUH.
Conclusion
: This study highlights the high incidence of road traumas in MG. Therefore, the creation of a trauma management protocol should make possible the improvement of medical management.
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