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La mort subite de l'adulte, mode de décès correspondant le plus souvent à un trouble du rythme cardiaque ventriculaire, est un problème majeur de santé publique. Bien que la maladie coronaire soit la principale cause de mort subite cardiaque, d'autres étiologies doivent être systématiquement envisagées et recherchées. Un bilan étiologique exhaustif et standardisé est nécessaire pour optimiser la prise en charge du patient et de sa famille dans le cas d'une maladie cardiaque héréditaire. L'identification d'une anomalie cardiaque et la question de son imputabilité pouvant être délicates, la prise en charge par une équipe pluridisciplinaire expérimentée se justifie pleinement. Sudden cardiac death, mostly related to ventricular arrhythmia, is a major public health issue, with still very poor survival at hospital discharge. Although coronary artery disease remains the leading cause, other etiologies should be systematically investigated. Exhaustive and standardized exploration is required to eventually offer specific therapeutics and management to the patient as well as his/her family members in case of inherited cardiac disease. Identification and establishing direct causality of the detected cardiac anomaly may remain challenging, underlying the need for a multidisciplinary and experimented team. [ABSTRACT FROM AUTHOR]

Introduction/Background The use of myoelectric prosthetics in upper limb amputees introduced compensations on the residual shoulder and trunk which could be the cause of musculoskeletal disorders. Task/work involving movements in abduction of shoulder (> 60°) more than two hours per day in cumulative have been identified to be responsible of musculoskeletal disorders. The aim of the study is to evaluate the shoulder compensations in upper limb amputees with the use of the new myoelectric multi-articulated prosthetic hands compared to tri-digital hands during different functional tasks. Material and method Five unilateral trans-radial upper limb amputees (4 male, 1 female; age 45.6 ± 13.8 years old) participated in this prospective crossover study. Evaluations were realized by each participant with their own tri-digital myoelectric prosthesis and 2 multigrip prosthesis: I Limb Ultra ® (IL) without a wrist mobility and Michelangelo ® (MA) with a wrist mobility, after specific rehabilitation and one month of home use. Mean of internal rotation, mean of abduction shoulder, percent time in abduction higher than 60° and its extrapolation in hours were calculated by an optoelectronic system (VICON) for the both sides (amputated - non-amputated) during the Box and Block Test (BBT) and 2 common daily life tasks (cut meat, make a knot). Results Whatever the tasks, there is any significant difference in internal rotation with the different prosthetic devices. Conclusion New types of grip of innovative prosthetic hands and wrist mobility seems to decrease shoulder abduction, considered as pathogenic compensations. However, the compensation strategy is different across patients, which involve a personalized analysis for his rehabilitation program and for the prosthetic device choice. Further studies are necessary to evaluate the impact of trunk compensations. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The authors had for aim to make an inventory of antibiotic treatment for severe community-acquired Streptococcus pneumoniae pneumonia and compare local practices to the local and national guidelines. Patients and method: An audit was conducted retrospectively in the Versailles hospital ICU between January 2006 and April 2009. Forty patients were included. Results: Ninety-three percent had major risk factors for pneumonia. Ninety-eight percent were treated, with the usual empirical treatment (69%) or treatment active against Pseudomonas aeruginosa (31%). Eighty-five percent of empirical treatment complied with the French national guidelines issued by the SPILF and 49% with the local ICU protocol, more restrictive for the choice of the agent and dose. Early de-escalation to amoxicillin was applied to 41% of patients after obtaining results for pneumococcal and Legionella antigen and results of respiratory sample direct examination. For all patients, empirical treatment was reassessed according to culture results: 81% were prescribed amoxicillin. Evaluation showed that 92% of treatment complied with SPILF guidelines and 65% with the local ICU protocol that required adaptation of amoxicillin doses according to MICs; adaptation to severity and BMI was necessary for ten patients. Mortality remained high, at 37%, despite using antibiotics still effective against S. pneumoniae. Conclusions: This survey revealed a satisfactory adhesion to recommendations and prompt responsiveness of the team for adjustment of antibiotic therapy. The audit allowed updating the local ICU protocol. [Copyright &y& Elsevier]

Au CHIV, la demande institutionnelle de consultation diététique dans les services se fait par fax, préalablement remplie par le médecin. Le Clan a réalisé une évaluation des pratiques professionnelles(EPP) en UGA de février à mai 2018 afin de renseigner les pourcentages de prescription de régimes, de CNO ainsi que leur dispensation et consommation. Puis nous avons apporté des axes d'amélioration et nous avons fait un 2e tour d'audit. Il s'agit d'une étude prospective avant-après moncentrique. Nous avons étudié 38 dossiers de patients en UGA sur les items précédents. Puis devant les résultats obtenus, nous avons choisi des axes d'amélioration : – arrêt du fax au profit d'un item informatique créé sur le logiciel Pharma. Les médecins vont renseigner les antécédents du patient et demander un régime diététique particulier ainsi que des CNO. La diététicienne peut visualiser la prescription de son bureau, sur son ordinateur, cibler alors le patient, venir le voir et conseiller le type de CNO, – création pour les paramédicaux, d'items sur Pharma renseignant la date et l'heure de délivrance ainsi que la quantité consommée, – nous avons dispensé un cours à tous les personnels sur les conséquences de la dénutrition, son intérêt de la dépister, et avons expliqué l'utilisation des nouveaux outils informatiques. Nous avons refait un 2e tour d'audit 2 mois plus tard sur 20 patients dénutris. Nous constatons que le taux de dénutrition est de 55 % en UGA. La prescription de régime par fax est de 55 % et passe à 95 % quand il y a un support informatique. La délivrance des CNO ainsi que leurs horaires et leurs consommations sont respectivement de 0 %, 0 %, 0 % ! Avec la création d'items sur Pharma, la délivrance est notée à 60 %, les horaires à 55 % et la consommation à 15 %. 100 % des médecins prescripteurs sont satisfaits de ce mode de prescription. Nous avons donc abandonné le fax. Le nouvel outil de prescription se déploie dans tous les services, appuyés par un cours sur les conséquences de la dénutrition, une intervention par la diététicienne du service, et la démonstration informatique par la référente paramédicale du logiciel. Les équipes sont satisfaites car la traçabilité est manifeste et la surveillance plus aisée. Mais il faut être vigilant et revenir dans les services afin de sensibiliser encore et toujours sur les méfaits de la dénutrition. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Invasive aspergillosis is a serious disease, the lethality of which is important among hematology patients. Early diagnosis is crucial for treatment options and the prognosis. Detection of the antigen galactomannan is the most frequently used microbiological tools. But galactomannan detection may be falsely positive, and this false positivity has been associated with piperacillin-tazobactam treatment, the main antibiotic combination used in clinical hematology. Objective: The purpose of our study, carried out from January 2009 to December 2010 at the Versailles hospital on in-patients with hematological disorders, was to evaluate the association between false galactomannan positivity and administration of piperacillin-tazobactam, and to study a possible variability of products issued by three manufacturers. Patients and method: We noted that 207 patients were included (n =207), accounting for 69 false positive and 138 true negative results. The intrinsic galactomannan values in the study were sensitivity 100%, specificity 68%, positive and negative predictive values respectively 16%, 100%, and a likelihood positive and negative test at respectively 3.12, and 0. Results: The statistical analysis did not determine any association between false positivity in galactomannan and piperacillin-tazobactam issued by two manufacturers (P =0.87 and P =0.94). But, there was a significant association between false galactomannan positivity and piperacillin-tazobactam issued by the third manufacturer (P =0.02). Four of the 25 batches issued by this manufacturer were tested and negative “in vitro” for galactomannan. Discussion: This study results suggest that the association between false galactomannan positivity and piperacillin-tazobactam is not longer systematic, but can still prevail depending on the manufacturers. It also confirmed the positive contribution of testing piperacillin-tazobactam batches “in vitro” before using the antibiotic. [Copyright &y& Elsevier]