On \u3ci\u3eDistoma felineum\u3c/i\u3e Riv. in the United States and on the Value of Measurements in Specific Determinations among the Distomes (1895)

The distomes of cats have received special attention of late in the two papers of Braun (94) and stiles and Hassall (94). The latter authors give a most admirable account of our present knowledge of a dozen allied forms, and record two, D. albidum and D. complexum n. sp., as found in cats in the United States. During the past year I have examined the cats killed at this laboratory, and have found neither of the forms recorded from the east. Distoma felineum, however, which Stiles and Hassall did not find, and which has not been reported hitherto for the United States, is not uncommon here. Among a dozen cats examined last spring, two contained specimens of this species, and one of the four killed this fall was likewise infected. The first cat contained over one hundred of the distomes, and the others approximately one dozen each. The exact correspondence of the forms with the figures and descriptions of Braun and Stiles and Hassall leave little doubt as to the identity of the two forms, and yet there are some points of disagreement which deserve mention, especially since the discovery of the European form in the liver of man in Siberia by Winogradoff adds this species to the list of human parasites

Entretien avec Alain Joubert

Claire Boustani : Alain Joubert, vous êtes connu pour avoir été un compagnon de route du « dernier » surréalisme. Dans votre livre Le Mouvement des surréalistes ou le fin mot de l’histoire : mort d’un groupe, naissance d’un mythe, vous décrivez votre entrée au sein du groupe surréaliste parisien et vous dites que vous avez rejoint un état d’esprit issu d’un profond sentiment de révolte. En quoi le mouvement surréaliste incarnait-il pour vous plus la révolte que d’autres groupes intellectuels ..

Groupe 4 : traitement substitutif de l’insuffisance surrénale

International audienceno abstract

Collaboration entre services support pour l'accompagnement des chercheurs dans la gestion des données de la recherche

International audienceUn groupe de travail réunissant tous les acteurs académiques impliqués dans la vie d'un projet de recherché a été créé à l'Université de Rouen Normandie en fin d'année 2020. Rassemblant des acteurs d'expertises diverses, il a permis d'aborder ensemble le cycle de vie d'un projet de recherche et des données associées dans le but de comparer puis concilier des cultures professionnelles diverses mais complémentaires

Reliability and Validity of SymTrak, a Multi-Domain Tool for Monitoring Symptoms of Older Adults with Multiple Chronic Conditions

BACKGROUND: A reliable and valid clinically practical multi-domain self-report and caregiver-report tool is needed for tracking actionable symptoms in primary care for elderly patients with multiple chronic conditions (MCCs). OBJECTIVE: Assess internal consistency reliability, test-retest reliability, construct validity, and sensitivity to change for SymTrak. DESIGN AND PARTICIPANTS: Among 600 (200 patient-caregiver dyads, 200 patients without an identified caregiver) participants, SymTrak was telephone interviewer-administered at baseline and 3-month follow-up, and at 24 h post-baseline for assessing test-retest reliability in a random subsample of 180 (60 dyads, 60 individual patients) participants. MAIN MEASURES: Demographic questions, SymTrak, Health Utility Index Mark 3 (HUI3). KEY RESULTS: Exploratory factor analysis indicated a single dominant dimension for SymTrak items for both patients and caregivers. Coefficient alpha and 24-h test-retest reliability, respectively, were high for the 23-item SymTrak total score for both patient-reported (0.85; 0.87) and caregiver-reported (0.86; 0.91) scores. Construct validity was supported by monotone decreasing relationships between the mean of SymTrak total scores across the poor-to-excellent categories of physical and emotional general health, and by high correlations with HUI3 overall utility score, even after adjusting for demographic covariates (standardized linear regression coefficient = -0.84 for patients; -0.70 for caregivers). Three-month change in the SymTrak total score was sensitive to detecting criterion standard 3-month reliable change categories (Improved, Stable, Declined) in HUI3-based health-related quality of life, especially for caregiver-reported scores. CONCLUSIONS: SymTrak demonstrates good internal consistency and test-retest reliability, construct validity, and sensitivity to change over a 3-month period, supporting its use for monitoring symptoms for older adults with MCCs

Development and Feasibility of SymTrak, aMulti-domain Tool for Monitoring Symptoms of Older Adults in Primary Care

BACKGROUND: A clinically practical, brief, user-friendly, multi-domain self-report and caregiver-report tool is needed for tracking actionable symptoms in primary care for elderly patients with multiple chronic conditions (MCCs). OBJECTIVE: Develop and assess usability, administration time, and internal reliability of SymTrak. DESIGN AND PARTICIPANTS: Phase I: legacy instruments, content validity, analyses of existing data, focus groups (physicians, nurses, patients, informal caregivers), and Think Aloud interviews (patients, caregivers) were used to develop SymTrak. Phase II (pilot feasibility study): 81 (27 patient-caregiver dyads, 27 patients without an identified caregiver) participants were self-administered SymTrak in clinic. MAIN MEASURES: SymTrak and demographic questions. KEY RESULTS: Consistent themes emerged from phase I focus groups. Ambiguous wording was corrected with Think Aloud feedback. In phase II, patients and caregivers preferred circling words instead of numbers for item response options. SymTrak self-administration completion time in clinic was brief; mean was 2.4, 3.0, and 3.3 min for the finalized circlingwords version, respectively, for caregivers, dyadic patients, and patients without a caregiver; and the maximum was 6.2 min for any participant. Usability questionnaire ratings were high. Cronbach's alpha for the SymTrak 23-item total score was 0.86, 0.79, and 0.81 for caregivers, dyadic patients, and patients without a caregiver, respectively. CONCLUSIONS: SymTrak demonstrates content validity, positive qualitative findings, high perceived usability, brief self-administered completion time, and good internal reliability

Psychosocial Factors That Shape Patient and Carer Experiences of Dementia Diagnosis and Treatment : A Systematic Review of Qualitative Studies

Funding: This article presents independent research commissioned by the UK National Institute for Health Research (NIHR) under Research for Patient Benefit (Grant Reference Number PB-PG-0808-16024). The views expressed in this paper are those of the authors and not necessarily those of the NHS, the NIHR, nor the Department of Health. The sponsor of the study had no role in study design, data analysis, data interpretation or writing of the reportEarly diagnosis and intervention for people with dementia is increasingly considered a priority, but practitioners are concerned with the effects of earlier diagnosis and interventions on patients and caregivers. This systematic review evaluates the qualitative evidence about how people accommodate and adapt to the diagnosis of dementia and its immediate consequences, to guide practice. Methods and Findings: We systematically reviewed qualitative studies exploring experiences of community-dwelling individuals with dementia, and their carers, around diagnosis and the transition to becoming a person with dementia. We searched PubMed, PsychINFO, Embase, CINAHL, and the British Nursing Index (all searched in May 2010 with no date restrictions; PubMed search updated in February 2012), checked reference lists, and undertook citation searches in PubMed and Google Scholar (ongoing to September 2011). We used thematic synthesis to identify key themes, commonalities, barriers to earlier diagnosis, and support identified as helpful. We identified 126 papers reporting 102 studies including a total of 3,095 participants. Three overarching themes emerged from our analysis: (1) pathways through diagnosis, including its impact on identity, roles, and relationships; (2) resolving conflicts to accommodate a diagnosis, including the acceptability of support, focusing on the present or the future, and the use or avoidance of knowledge; and (3) strategies and support to minimise the impact of dementia. Consistent barriers to diagnosis include stigma, normalisation of symptoms, and lack of knowledge. Studies report a lack of specialist support particularly post-diagnosis. Conclusions: There is an extensive body of qualitative literature on the experiences of community-dwelling individuals with dementia on receiving and adapting to a diagnosis of dementia. We present a thematic analysis that could be useful to professionals working with people with dementia. We suggest that research emphasis should shift towards the development and evaluation of interventions, particularly those providing support after diagnosis.Peer reviewedFinal Published versio

Consensus sur l'insuffisance surrénale de la SFE/SFEDP : introduction et guide

International audienceThe French endocrinology society (SFE) and the French pediatric endocrinology society (DFSDP) have drawn up recommendations for the management of primary and secondary adrenal insufficiency in the adult and child, based on an analysis of the literature by 19 experts in 6 work-groups. A diagnosis of adrenal insufficiency should be suspected in the presence of a number of non-specific symptoms except hyperpigmentation which is observed in primary adrenal insufficiency. Diagnosis rely on plasma cortisol and ACTH measurement at 8am and/or the cortisol increase after synacthen administration. When there is a persistant doubt of secondary adrenal insufficiency, insulin hypoglycemia test should be carried out in adults, adolescents and children older than 2 years. For determining the cause of primary adrenal insufficiency, measurement of anti-21-hydroxylase antibodies is the initial testing. An adrenal CT scan should be performed if auto-antibody tests are negative, then assay for very long (Y. Reznik). chain fatty acids is recommended in young males. In children, a genetic anomaly is generally found, most often congenital adrenal hyperplasia. In the case of isolated corticotropin (ACTH) insufficiency, it is recommended to first eliminate corticosteroid-induced adrenal insufficiency, then perform an hypothalamic-pituitary MRI. Acute adrenal insufficiency is a serious condition, a gastrointestinal infection being the most frequently reported initiating factor. After blood sampling for cortisol and ACTH assay, treatment should be commenced by parenteral hydrocortisone hemisuccinate together with the correction of hypoglycemia and hypovolemia. Prevention of acute adrenal crisis requires an education of the patient and/or parent in the case of pediatric patients and the development of educational programs. Treatment of adrenal insufficiency is based on the use of hydrocortisone given at the lowest possible dose, administered several times per day. Mineralocorticoid replacement is often necessary for primary adrenal insufficiency but not for corticotroph deficiency. Androgen replacement by DHEA may be offered in certain conditions. Monitoring is based on the detection of signs of under-and over-dosage and on the diagnosis of associated auto-immune disorders.La Société française d'endocrinologie (SFE) et la Société française d'endocrinologie pédiatrique (SFEDP) ont élaboré des recommandations sur la prise en charge de l'insuffisance surrénale primaire et secondaire de l'adulte et de l'enfant, à partir d'une analyse de la littérature réalisée par 19 experts répartis en 6 groupes de travail. Le diagnostic d'insuffisance surrénale doit être évoqué devant l'association de signes cliniques et biologiques non spé-cifiques, en dehors de la mélanodermie observée dans l'insuffisance surrénale primaire. Le diagnostic repose sur les dosages du cortisol et de l'ACTH le matin et/ou le dosage du cortisol après stimulation par l'ACTH synthétique (synacthène). En cas de doute, le test d'hypoglycémie insulinique est le test de référence chez l'adulte l'adolescent et l'enfant de plus de 2 ans. La recherche étiologique est basée sur le dosage en 1 re intention des anticorps anti 21-hydroxylase. En cas de négativité, un scanner surrénalien sera réalisé, puis le dosage des acides gras à chaînes longues sera effectué chez le garçon. Chez l'enfant, une cause génétique sera recherchée, principalement l'hyperplasie congénitale des surrénales. Devant un déficit corticotrope, après la recherche d'une prise prolongée de glucocorticoïdes sera effectuée une imagerie hypothalamo-hypophysaire. L'insuffisance surrénale aiguë est une complication grave souvent déclenchée par une infection gastro-intestinale. Elle nécessite après prélèvement pour dosage du cortisol et ACTH l'administration parentérale d'hémisuccinate d'hydrocortisone et la correction de l'hypovolémie et/ou de l'hypoglycémie. Sa prévention repose sur l'éducation thérapeutique du patient pour laquelle des programmes seront développés. Le traitement de l'insuffisance surrénale s'appuie sur la prise pluriquotidienne d'hydrocortisone à la dose la plus faible possible. La substitution minéralocorticoïde est réalisée en cas d'insuffisance surrénale primaire mais n'est pas nécessaire en cas d'insuffisance surrénale secondaire. La substitution androgénique par la DHEA peut être proposée dans cer-taines indications précises. La monitoring comportera la recherche de signes cliniques et biologiques de sous/surdosage et de maladies auto-immunes associées

SRY ‐negative 46,XX testicular/ovotesticular DSD: Long‐term outcomes and early blockade of gonadotropic axis

International audienceObjective: SRY-negative 46,XX testicular and ovotesticular disorders/differences of sex development (T/OTDSD) represent a very rare and unique DSD condition where testicular tissue develops in the absence of a Y chromosome. To date, very few studies have described the phenotype, clinical and surgical management and long-term outcomes of these patients. Particularly, early blockade of the gonadotropic axis in patients raised in the female gender to minimize postnatal androgenization has never been reported.Design: Retrospective description of sixteen 46,XX T/OTDSD patients.Results: Sixteen 46,XX SRY-negative T/OTDSD were included. Most (12/16) were diagnosed in the neonatal period. Sex of rearing was male for six patients and female for ten, while the clinical presentation varied, with an external masculinization score from 1 to 10. Five patients raised as girl were successfully treated with GnRH analog to avoid virilization during minipuberty. Ovotestes/testes were found bilaterally for 54% of the patients and unilaterally for the others (with a contralateral ovary). Gonadal surgery preserved appropriate tissue in the majority of cases. Spontaneous puberty occurred in two girls and one boy, while two boys required hormonal induction of puberty. One of the girls conceived spontaneously and had an uneventful pregnancy. DNA analyses (SNP-array, next-generation sequencing and whole-exome sequencing) were performed. A heterozygous frameshit mutation in the NR2F2 gene was identified in one patient.Conclusions: This study presents a population of patients with 46,XX SRY-negative T/OTDSD. Early blockade of gonadotropic axis appears efficient to reduce and avoid further androgenization in patients raised as girls