Informatización de una biblioteca mediante una BD multimedia

El projecte té com objectiu desenvolupar una aplicació informàtica per a una biblioteca. El principal handicap que tindrà aquesta aplicació és que algunes de les dades que s'hi volen desar són de diversos formats: imatges, sons, dibuixos, pel·lícules de DVD, arxius doc, arxius application/pdf, etc.

Intérêt d'une Consultation spécialisée multidisciplinaire en neuro-urologie et urologie fonctionnelle [Benefit of a specialized multidisciplinary clinic in neuro-urology and functional urology].

Functional disorders encounter for a large amount of the medical activity, including in urology. The decreased quality of life due to lower urinary tract symptoms requires a prompt management, with primary assessment undergone in community. Referral to a specialist is required when simple management has failed, and whenever any of these coexists: hematuria, recurrent urinary infection, and neurological condition. The specialized clinic in neurourology and functional urology aim at further investigating the underlying disorder responsible for the urinary symptoms and preventing urinary tract complications. A multidisciplinary team is the key to accurately assess patients with regards to their bother and handicap, therefore offering the most appropriate conservative, medical or surgical management.

Pronostic du coma après lésion cérébrale aiguë chez l'homme

Contexte: L'ensemble des phénomènes aigus suivant un arrêt cardio-respiratoire (ACR) est décrit sous le nom de maladie de post-réanimation (MPR) (post-resuscitation disease). Celle- ci est la conséquence du syndrome de reperfusion et est caractérisée par une réponse inflammatoire systémique intense, d'allure septique. La procalcitonine (PCT) est un marqueur aigu de la réponse inflammatoire systémique, qui a été beaucoup étudiée aux soins intensifs (SI) dans le contexte du sepsis, et constitue un outil diagnostic et pronostique important. Toutefois la PCT n'est pas un marqueur spécifique pour le sepsis mais peut également augmenter lors de réponse inflammatoire systémique d'origine non infectieuse. Objectifs: 1) Evaluer s'il existe une corrélation entre la valeur plasmatique de PCT et la MPR ; 2) examiner la relation entre le taux au pic de PCT et le pronostic des patients avec coma post-ACR ; 3) comparer la valeur pronostique de la PCT à celle d'un marqueur pronostic connu du coma post-anoxique tel que la neuron specific enolase (NSE). Méthodologie: Analyse d'une base de données prospective comprenant des patients admis aux SI du centre hospitalier universitaire vaudoise (CHUV) entre décembre 2009 et juillet 2011 en raison d'un ACR et traités par hypothermie thérapeutique (33 - 34 °C pendant 24h), selon notre protocole standard de prise en charge. La concentration plasmatique de PCT est mesurée à 24-72h après ACR, la valeur maximale (PCTmax) étant incluse dans l'analyse. La durée de l'arrêt circulatoire et le score de SOFA (Sequential Organ Failure Assessment) sont utilisés pour quantifier la sévérité de la MPR. Le pronostic est composé de la mortalité hospitalière, ainsi que la mortalité et la récupération neurologique à trois mois, mesurée avec le score de « Cerebral Performance Categories » (CPC), dichotomisé en bonne récupération (CPC 1 = pas de handicap ; CPC 2 = handicap modéré) et mauvaise récupération (CPC 3 = handicap sévère ; CPC 4 = état végétatif ; CPC 5 = décès). Résultats: 68 patients consécutifs (âge médian 65 ans, durée médiane totale de l'arrêt circulatoire [time to ROSC] 20.5 min) ont été étudiés. La PCTmax corrélait avec la durée de l'arrêt circulatoire (p = 0.001) ainsi qu'avec les scores de SOFA à l'admission et aux jours 1 et 2 (p<0.001 pour les trois associations). Une association significative a été observée entre la PCTmax et la survie hospitalière (médiane 3.9 [écart interquartile (EI) 1.0 - 16.8] chez les non-survivants vs. 1.4 [EI 0.6 - 6.2] ng/ml chez les survivants, p=0.032) et à trois mois (médiane 3.8 ([EI 1.0 - 15.6] vs. 1.4 [EI 0.5 - 6.0] ng/ml, p=0.034). La PCTmax était aussi plus basse chez les patients avec bonne récupération neurologique à trois mois (p=0.064). En comparaison avec la NSEmax, la PCTmax avait une valeur prédictive supérieure pour la sévérité de la maladie de post-réanimation et inférieure pour le pronostic. Conclusions: La valeur plasmatique maximale de PCT corrèle avec la sévérité de la MPR et est associé à la mortalité et à l'état neurologique à trois mois après coma post-anoxique. Ces données suggèrent que la PCT peut être un marqueur utile dans la prise en charge des patients comateux après ACR et hypothermie thérapeutique. Des études à plus large échelle sont en cours pour confirmer ces résultats.

Appropriate drug treatment for status epilepticus does not influence its prognosis

Objective: Status epilepticus (SE) prognosis, is mostly related to non-modifiable factors (especially age, etiology), but the specific role of treatment appropriateness (TA) has not been investigated. Methods: In a prospective cohort with incident SE (excluding postanoxic), TA was defined, after recent European recommendations, in terms of drug dosage (630% deviation) and sequence. Outcome at hospital discharge was categorized into mortality, new handicap, or return to baseline. Results: Among 225 adults, treatment was inappropriate in 37%. In univariate analyses, age, etiology, SE severity and comorbidity, but not TA, were significantly related to outcome. Etiology (95% CI 4.3-82.8) and SE severity (95% CI 1.2-2.4) were independent predictors of mortality, and of lack of return to baseline conditions (etiology: 95% CI 3.9-14.0; SE severity: 95% CI 1.4-2.2). Moreover, TA did not improve outcome prediction in the corresponding ROC curves. Conclusions: This large analysis suggests that TA plays a negligible prognostic role in SE, probably reflecting the outstanding importance of the biological background. Awaiting treatment trials in SE, it appears questionable to apply further resources in refining treatment protocols involving existing compounds; rather, new therapeutic approaches should be identified and tested.

The BRAIN TRIAL: a randomised, placebo controlled trial of a Bradykinin B2 receptor antagonist (Anatibant) in patients with traumatic brain injury

BACKGROUND Cerebral oedema is associated with significant neurological damage in patients with traumatic brain injury. Bradykinin is an inflammatory mediator that may contribute to cerebral oedema by increasing the permeability of the blood-brain barrier. We evaluated the safety and effectiveness of the non-peptide bradykinin B2 receptor antagonist Anatibant in the treatment of patients with traumatic brain injury. During the course of the trial, funding was withdrawn by the sponsor. METHODS Adults with traumatic brain injury and a Glasgow Coma Scale score of 12 or less, who had a CT scan showing an intracranial abnormality consistent with trauma, and were within eight hours of their injury were randomly allocated to low, medium or high dose Anatibant or to placebo. Outcomes were Serious Adverse Events (SAE), mortality 15 days following injury and in-hospital morbidity assessed by the Glasgow Coma Scale (GCS), the Disability Rating Scale (DRS) and a modified version of the Oxford Handicap Scale (HIREOS). RESULTS 228 patients out of a planned sample size of 400 patients were randomised. The risk of experiencing one or more SAEs was 26.4% (43/163) in the combined Anatibant treated group, compared to 19.3% (11/57) in the placebo group (relative risk = 1.37; 95% CI 0.76 to 2.46). All cause mortality in the Anatibant treated group was 19% and in the placebo group 15.8% (relative risk 1.20, 95% CI 0.61 to 2.36). The mean GCS at discharge was 12.48 in the Anatibant treated group and 13.0 in the placebo group. Mean DRS was 11.18 Anatibant versus 9.73 placebo, and mean HIREOS was 3.94 Anatibant versus 3.54 placebo. The differences between the mean levels for GCS, DRS and HIREOS in the Anatibant and placebo groups, when adjusted for baseline GCS, showed a non-significant trend for worse outcomes in all three measures. CONCLUSION This trial did not reach the planned sample size of 400 patients and consequently, the study power to detect an increase in the risk of serious adverse events was reduced. This trial provides no reliable evidence of benefit or harm and a larger trial would be needed to establish safety and effectiveness. TRIAL REGISTRATION This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN23625128.

Addictions [Addiction].

Les nouveautés en médecine 2012 pour les dépendances sont présentées sur trois axes d'actualité : tout d'abord dans le champ des neurosciences avec les travaux sur les processus d'extinction de la mémoire addictive. Puis dans le champ clinique avec une réflexion sur le traitement des addictions à l'hôpital psychiatrique. Enfin, dans le domaine de l'enseignement, un développement d'e-learning avec un patient virtuel présente un grand intérêt en psychiatrie de l'addiction. This year, the actuality about addiction is on psychopharmacology, in the controversy about the prescription of baclofene to reduce the craving for alcohol. More results from controlled studies are expected. The development of smartphones to access toe-Health skills is questionable, especially in matterofevaluation of these programs. Despite of encouraging results, open questions are remaining for clinicians, to be compared with clinical practice. Finally, it is necessary to keep in touch with translational neurosciences; in fact, research is showing that populations of addicts present a deficit in matter of empathy. This is the cause of a handicap in the social relationships. At a lower level, a difficulty to take the other's place could be the cause of this deficit at a higher level. Rehabilitation perspectives could come out of this discovery.

Fitness evaluation of two Brazilian Aedes aegypti field populations with distinct levels of resistance to the organophosphate temephos

In Brazil, decades of dengue vector control using organophosphates and pyrethroids have led to dissemination of resistance. Although these insecticides have been employed for decades against Aedes aegypti in the country, knowledge of the impact of temephos resistance on vector viability is limited. We evaluated several fitness parameters in two Brazilian Ae. aegypti populations, both classified as deltamethrin resistant but with distinct resistant ratios (RR) for temephos. The insecticide-susceptible Rockefeller strain was used as an experimental control. The population presenting the higher temephos resistance level, Aparecida de Goiânia, state of Goiás (RR95 of 19.2), exhibited deficiency in the following four parameters: blood meal acceptance, amount of ingested blood, number of eggs and frequency of inseminated females. Mosquitoes from Boa Vista, state of Roraima, the population with lower temephos resistance level (RR95 of 7.4), presented impairment in only two parameters, blood meal acceptance and frequency of inseminated females. These results indicate that the overall fitness handicap was proportional to temephos resistance levels. However, it is unlikely that these disabilities can be attributed solely to temephos resistance, since both populations are also resistant to deltamethrin and harbour the kdr allele, which indicates resistance to pyrethroids. The effects of reduced fitness in resistant populations are discussed.

Progressive decline of decision-making performances during multiple sclerosis.

The purpose of this study was to evaluate longitudinally, using the Iowa Gambling Task (IGT), the dynamics of decision-making capacity at a two-year interval (median: 2.1 years) in a group of patients with multiple sclerosis (MS) (n = 70) and minor neurological disability [Expanded Disability Status Scale (EDSS) < or = 2.5 at baseline]. Cognition (memory, executive functions, attention), behavior, handicap, and perceived health status were also investigated. Standardized change scores [(score at retest-score at baseline)/standard deviation of baseline score] were computed. Results showed that IGT performances decreased from baseline to retest (from 0.3, SD = 0.4 to 0.1, SD = 0.3, p = .005). MS patients who worsened in the IGT were more likely to show a decreased perceived health status and emotional well-being (SEP-59; p = .05 for both). Relapsing rate, disability progression, cognitive, and behavioral changes were not associated with decreased IGT performances. In conclusion, decline in decision making can appear as an isolated deficit in MS.

Cross-coding from the Swiss Disability Insurance listing to the ICIDH.

It has been suggested that converting, via a process of cross-coding, the listing used by the Swiss Disability Insurance (SDI) for their statistics into codes of the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) would improve the quality and international comparability of disability statistics for Switzerland. Using two different methods we tested the feasibility of this cross-coding on a consecutive sample of 204 insured persons, examined at one of the medical observation centres of the SDI. Cross-coding is impossible, for all practical purposes, in a proportion varying between 30% and 100%, depending on the method of cross-coding, the level of disablement and the required quality of the resulting codes. Failure is due to lack of validity of the SDI codes: diseases are poorly described, consequences of diseases (disability and handicap, including loss of earning capacity), insufficiently described or not at all. Assessment of disability and handicap would provide necessary information for the SDI. It is concluded that the SDI should promote the use of the ICIDH in Switzerland, especially among medical practitioners whose assessment of work capacity is the key element in the decision to award benefits or propose rehabilitation.

Molecular genetics of charcot-marie-tooth disease: from genes to genomes.

Charcot-Marie-Tooth disease (CMT) is a heterogeneous group of disorders of the peripheral nervous system, mainly characterized by distal muscle weakness and atrophy leading to motor handicap. With an estimated prevalence of 1 in 2,500, this condition is one of the most commonly inherited neurological disorders. Mutations in more than 30 genes affecting glial and/or neuronal functions have been associated with different forms of CMT leading to a substantial improvement in diagnostics of the disease and in the understanding of implicated pathophysiological mechanisms. However, recent data from systematic genetic screening performed in large cohorts of CMT patients indicated that molecular diagnosis could be established only in ∼50-70% of them, suggesting that additional genes are involved in this disease. In addition to providing an overview of genetic and functional data concerning various CMT forms, this review focuses on recent data generated through the use of highly parallel genetic technologies (SNP chips, sequence capture and next-generation DNA sequencing) in CMT families, and the current and future impact of these technologies on gene discovery and diagnostics of CMTs.

Treatment of status epilepticus: a comparison of phenytoin, valproate, or levetiracetam

Objectives: Phenytoin (PHT), valproic acid (VPA), or levetiracetam (LEV) are commonly used as second-line treatment of status epilepticus (SE), but comparative studies are not available to date.Methods: In our tertiary care hospital, among 279 SE episodes prospectively collected over four years, and occurring in adults, we identified 187 episodes in which PHT, VPA or LEV were prescribed after benzodiazepines. Patients with post-anoxic SE were not included. Demographics, clinical SE features, failure of second-line treatment to control SE, new handicap and mortality at hospital discharge were assessed. Uni- and multivariable statistical analyses were applied to compare the three agents.Results: Each compound was used in about one third of episodes. VPA failed to control SE in 25.4%, PHT in 41.4% and LEV in 48.3% of episodes in which these were prescribed as second-line agents. After adjustment for known SE outcome predictors, LEV failed more often than VPA (OR 2.69; 95% CI 1.19-6.08); in others words, 16.8% (95% CI 6.0-31.4%) of second-line treatment failures could be attributed to prescription for LEV instead of VPA. PHT was statistically not different from the other two compounds. At discharge, second-line treatment did not influence new handicap and mortality, while etiology and severity of the SE episode were robust independent predictors.Conclusions: Even without significant differences on outcome at discharge, LEV seems less efficcacious than VPA to control SE after benzodiazepines. A prospective comparative trial is needed to address this potentially concerning finding. The second interesting finding is that the outcome seems more influenced by the SE characteristics than the treatment.

Programa d’educació intercultural als centres penitenciaris

Després de la Jornada de Bones Pràctiques dels educadors socials de l'àmbit penitenciari català (febrer de 2008) es va veure la necessitat de revisar el Programa marc d'educació per a la convivència en la diversitat als centres penitenciaris. El programa fou elaborat i implementat als centres a partir de mitjan 2002. I, tot i que la justificació del seu naixement continua essent vàlida, sí que hi ha matisacions teòriques que han canviat a l’hora d'entendre la convivència en la diversitat i, sobretot, a l’hora de treballar-la des d'un enfocament educatiu. Proposem una educació intercultural que s'articuli com una pedagogia de la ciutadania i del desenvolupament d'una societat democràtica. Cal promoure la reflexió sobre aquesta nova ciutadania, la igualtat d'oportunitats i la dimensió social de la identitat en la complexa societat en la qual es desenvolupa. Així, ni la cultura ni la identitat ni tampoc els continguts educatius poden ser pensats des d'una perspectiva estàtica i determinista de les societats. La cultura, com a principal objectiu de l'educació intercultural, s'ha d'entendre com el dret a allò que és comú, o que hauria de ser comú. I per què un plantejament d'aquest tipus en el marc del sistema penitenciari? Doncs perquè precisament a les presons es tendeixen a amplificar les diferències i les caracteritzacions tenint en compte que una sèrie d'individus socialitzats en diferents maneres de pensar, sentir i actuar han de conviure de manera obligada. I que atesa la complexitat de les societats actuals (procés de globalització; interdependència a escala mundial; transformació dels models de comunicació, consum i treball; canvis polítics i econòmics; les migracions...) la uniformitat que se suposava que atorgava una cultura s'ha trencat. Així doncs, us presentem un programa d'educació intercultural que es proposa transmetre continguts, amb un valor social, per a la comprensió del món, de tal manera que permeti als participants adquirir els elements importants per circular per allò social ampli. Tampoc no se'ns escapa que estem plantejant la idea d'una acció educativa fora de l'espai social i familiar de la persona interna. És per aquest motiu que plantegem una pràctica educativa que parteix d'un handicap metodològic d'actuació: la impossibilitat d'una acció comunitària. Entenem tota acció comunitària des del punt de vista de lligam amb el territori de vida de les persones en llibertat. Per tant, l'acció educativa, en el cas que ens ocupa, s'ha de centrar necessàriament en un marc d'educació per a la transferència de coneixements i d'alternatives de canvi en la realitat personal i social des d'un punt de vista grupal i individual. Una transferència que pot posar en pràctica la persona interna en el moment en què s'incorpori a la vida en llibertat.