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Résumé Propos Décrire les facteurs associés au rang de classement aux ECN 2012 des étudiants de DCEM4 de Nancy et mesurer l’impact de conférences de préparation aux épreuves classantes nationales (ECN) sur ce rang. Méthodes Entre octobre 2011 et mai 2012, les assistants de la faculté de médecine de Nancy ont organisé un cycle de 15 conférences associant la composition de dossiers cliniques et une correction en aveugle par des pairs. Des données recueillies par auto-questionnaire ont permis de décrire les facteurs associés au rang de classement aux ECN et d’ajuster l’effet du cycle de conférences sur ce rang. Résultats Parmi les 287 étudiants inscrits en DCEM4 durant l’année universitaire 2011–2012, 195 (67,9 %) se sont inscrits au cycle de conférences sur la base du volontariat. Parmi les facteurs pronostiques évalués, l’absence de redoublement en PCEM1 ( p = 0,013), le nombre d’UE validés à la première session en DCEM ( p = 0,002), l’absence de difficultés ressenties en DCEM3 et 4 ( p = 0,032) ainsi qu’un classement visé parmi les meilleurs ( p = 0,011), étaient significativement associés à un meilleur rang de classement aux ECN après ajustement. La participation assidue aux conférences était significativement et indépendamment associée à un gain de 873 places aux ECN en moyenne ce qui correspondait à 63 places gagnées par conférence suivie. Conclusion La participation aux conférences de préparation aux ECN dispensées par des assistants et basées sur des dossiers cliniques et une correction en aveugle par des pairs était significativement associée à un meilleur classement aux ECN pour les étudiants en DCEM4. Purpose To describe factors associated with a better rank, and to assess the impact of training conferences on medical student's performance for the French National Ranking Examination (FNRE) in Lorraine University, France in 2012. Methods Between October 2011 and May 2012, assistant professors of the faculty of medicine of Nancy, France, organized a cycle of 15 conferences combining clinical cases theoretical training and student peer assessment. Data were recorded with a self-administered questionnaire in January 2012 to collect potential confounders. Results Among 287 students enrolled in the last year of medical school in 2011–2012 in Lorraine University, 195 (67.9%) of them registered to the cycle of conferences. Among the potential prognostic factors assessed, not repeating the first year of medical curriculum ( P = 0.013), the number of courses validated at the first session during the second part of the medical curriculum ( P = 0.002), absence of difficulties experienced in the fifth and sixth year ( P = 0.032) and a desired ranking among the best ( P = 0.011) were independently associated with a better rank at the FNRE. Regular participation in conferences was significantly and independently associated with a higher ranking (mean gain for the participation in 13 or more conferences: 873; mean gain by conference: 63). Conclusion Regular participation in conferences provided by assistant professors and based on clinical cases theoretical training and student peer assessment was significantly associated with a higher ranking to the FNRE in Lorraine University in 2012. [ABSTRACT FROM AUTHOR]

L'objectif de cette étude était de décrire les caractéristiques des patients ayant un diagnostic de SAPL après 65 ans, et de les comparer à une cohorte de sujets SAPL jeunes. Nous avons mené une étude rétrospective multicentrique au CHU de Nantes et de Nancy. Nous avons inclus les patients chez qui le diagnostic de SAPL avait été fait après 65 ans entre 2005 et 2017. Nous les avons comparé à une cohorte de patient SAPL jeunes. Au total, nous avons comparé les caractéristiques de 58 patients SAPL de plus de 65 ans à 127 patients SAPL jeunes. Il y avait une prédominance masculine chez les sujets âgés (58,6 % vs 36,2 % p = 0,001). Concernant les manifestations thrombotiques au diagnostic, les d'infarctus du myocarde étaient plus fréquents chez les patients âgés (12,1 % vs 1,6 % p = 0,005), ainsi que les thromboses veineuses des membres inférieurs (44,8 % vs 29,9 % p = 0,048). Sur le plan immunologique, l'aCL IgM était plus fréquent chez les patients âgés que chez les patients jeunes (33,9 % vs 18,1 % p = 0,02), contrairement au LAC (52,8 % vs 66,9 % p = 0,02). Le LAC était toutefois l'anticorps le plus fréquent chez les sujets SAPL âgés (52,8 %). Après un suivi médian de 52 mois [Q1–Q3 : 27–101] chez les sujets âgés et de 60 mois [Q1–Q3 : 29–104] chez les sujets jeunes, la survie sans récidive thrombotique globale était significativement moindre chez les SAPL âgés (p = 0,044). Cette différence significative était liée aux événements artériels (p = 0,003). Le traitement anticoagulant était moins souvent instauré chez ces patients (65,5 % vs 91,3 % p < 0,001), qui présentaient un taux de complication hémorragique plus important (17 % vs 3 % p = 0,002). En conclusion, les patients SAPL âgés de plus de 65 ans avaient une présentation clinique et biologique différente des patients SAPL jeunes, avec une prédominance masculine, plus d'infarctus du myocarde, plus de thrombose veineuse profonde des membres inférieurs, plus de SAPL simple positif et une positivité plus fréquente de l'aCL IgM. Une anticoagulation curative était moins souvent introduite chez ces patients, qui présentaient une survie sans récidive thrombotique moindre que les patients jeunes. [ABSTRACT FROM AUTHOR]

Background: Fetal biometry quality directly influences obstetrical care relevance. However, obstetrician proficiencies are heterogeneous in particular during initial training., Objectives: To assess the predictive value of OSAUS scale to identify operators with enough command to perform a valid estimation of fetal weight (EFW) (I). This study also assesses OSAUS intra-operator inter-exams variability (II) and pass/fail score relevancy (III)., Methods: Lecturers in Nancy University Hospital assessed trainees' proficiency for EWF systematically and prospectively through OSAUS scale. The trainee assessment was performed right after the one of the senior operator (reference EFW) on three consecutive patients during standard care ultrasounds. To ensure variability in proficiency within the sample, previous practice was taken into account during enrollment ("novices" and "intermediates" for<20 and 20 past exams, respectively). Correlation between mean OSAUS and validity of EFW (a valid EFW was defined by a difference with the reference EWF<0.8 Z-score) and variability between consecutive assessments were assessed., Results: The study population was constituted of 8 "novice" and 8 "intermediate" trainees. Association between OSAUS and EFW validity was significant (P<0.03) (I). Intra-operator inter-exams variability was majored in the "novice" group (coefficients of variation were 25% vs. 10% in "novice" and "intermediate" group respectively) (II). Within the sample, specificity and positive predictive value of a pass/fail score OSAUS>3.5 to predict EFW validity were 77% and 71%, respectively (III)., Conclusion: A 3.5 OSAUS pass/fail score could provide a relevant threshold to estimate operator proficiency in assessing fetal biometry in an autonomous and secure way., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Introduction: The purpose of this study was to describe the epidemiologic characteristics of adult uveitis evaluated at the regional center of excellence specializing in systemic and autoimmune disease in the Nancy university medical center. The secondary objectives were to describe the progression over time of the various etiologies and to identify local specificities., Materials and Methods: We performed a retrospective epidemiological study of patients diagnosed with uveitis. All patients were referred to the regional center of excellence of the Nancy university medical center between January 1, 2005 and December 31, 2016. Patients under 18 years of age, patients with a first episode of acute anterior uveitis, as well as patients for whom the etiological diagnosis was made by the ophthalmologist with no need of internal medicine referral, were excluded. Age, gender, laterality, site of inflammation, clinical signs, etiology (infectious, non-infectious or idiopathic, as well as diagnosis), and date of first consultation were recorded., Results: Six hundred and ninetypatients were included, with 59 % women and a mean age of 49 years. The uveitis was unilateral in 53 % of cases. Panuveitis was the most common form (52 %, N=358), followed by recurrent anterior uveitis (30 %, N=205), posterior uveitis (16 %, N=107), and intermediate uveitis (3 %, N=20). Non-infectious etiologies accounted for 35 % of all uveitis (the most common being HLA-B27 uveitis, sarcoidosis, ankylosing spondylitis and Behçet's disease) and infectious etiologies for 13 % (tuberculosis, toxoplasmosis and Lyme disease were the most frequent). The uveitis was idiopathic in 52 %. A trend toward improvement in diagnostic yield was observed : 53 % of uveitides were considered idiopathic prior to 2011 compared to 50 % after 2011 (P<0,01)., Conclusion: We identified a majority of panuveitis, which is explained by our inclusion criteria. Fifty-two percent of our series remained idiopathic, with an improvement in the diagnostic yield over time. This could be related to both repeated etiological assessments and better diagnostic performance. The study of this large cohort of patients improved our knowledge of the characteristics of uveitis in our center., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Purpose: To describe factors associated with a better rank, and to assess the impact of training conferences on medical student's performance for the French National Ranking Examination (FNRE) in Lorraine University, France in 2012., Methods: Between October 2011 and May 2012, assistant professors of the faculty of medicine of Nancy, France, organized a cycle of 15 conferences combining clinical cases theoretical training and student peer assessment. Data were recorded with a self-administered questionnaire in January 2012 to collect potential confounders., Results: Among 287 students enrolled in the last year of medical school in 2011-2012 in Lorraine University, 195 (67.9%) of them registered to the cycle of conferences. Among the potential prognostic factors assessed, not repeating the first year of medical curriculum (P=0.013), the number of courses validated at the first session during the second part of the medical curriculum (P=0.002), absence of difficulties experienced in the fifth and sixth year (P=0.032) and a desired ranking among the best (P=0.011) were independently associated with a better rank at the FNRE. Regular participation in conferences was significantly and independently associated with a higher ranking (mean gain for the participation in 13 or more conferences: 873; mean gain by conference: 63)., Conclusion: Regular participation in conferences provided by assistant professors and based on clinical cases theoretical training and student peer assessment was significantly associated with a higher ranking to the FNRE in Lorraine University in 2012., (Copyright © 2014 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.)

The antiphospholipid syndrome is a thrombophilia characterized by the combination of arterial and/or venous thrombotic events or obstetric clinical events, associated with persistent presence of antiphospholipid antibodies. In this syndrome, thromboses may affect all of the vascular tree, renal damage is frequently associated with a specific antiphospholipid syndrome nephropathy. We propose in this review to provide updated recommendations on the management of antiphospholipid syndrome in nephrology. Treatment is based on long-term anticoagulant therapy with or without antiplatelet agents according to clinical events. The use of a conventional nephroprotection must not be forgotten (strict control of blood pressure with drugs blocking the renin-angiotensin-aldosterone system). Catastrophic antiphospholipid syndrome is an extremely severe complication which can threaten the vital prognosis of the patient. This justifies particular surveillance, as well as prevention in high-risk situations. We also illustrate the difficulties of long-term management in these patients, both in dialysis or kidney transplantation., (Copyright © 2013 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.)