BeatWalk: Personalized Music-Based Gait Rehabilitation in Parkinson’s Disease

Taking regular walks when living with Parkinson’s disease (PD) has beneficial effects on movement and quality of life. Yet, patients usually show reduced physical activity compared to healthy older adults. Using auditory stimulation such as music can facilitate walking but patients vary significantly in their response. An individualized approach adapting musical tempo to patients’ gait cadence, and capitalizing on these individual differences, is likely to provide a rewarding experience, increasing motivation for walk-in PD. We aim to evaluate the observance, safety, tolerance, usability, and enjoyment of a new smartphone application. It was coupled with wearable sensors (BeatWalk) and delivered individualized musical stimulation for gait auto-rehabilitation at home. Forty-five patients with PD underwent a 1-month, outdoor, uncontrolled gait rehabilitation program, using the BeatWalk application (30 min/day, 5 days/week). The music tempo was being aligned in real-time to patients’ gait cadence in a way that could foster an increase up to +10% of their spontaneous cadence. Open-label evaluation was based on BeatWalk use measures, questionnaires, and a six-minute walk test. Patients used the application 78.8% (±28.2) of the prescribed duration and enjoyed it throughout the program. The application was considered “easy to use” by 75% of the patients. Pain, fatigue, and falls did not increase. Fear of falling decreased and quality of life improved. After the program, patients improved their gait parameters in the six-minute walk test without musical stimulation. BeatWalk is an easy to use, safe, and enjoyable musical application for individualized gait rehabilitation in PD. It increases “walk for exercise” duration thanks to high observance.This research was supported by a European grant: BeatHealth: Health and Wellness on the Beat for VC, DD, CL, AGi, VD, RV, EH, ED, ML, BB, and SB (EU FP7-ICT contract #610633)

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Les fables de La Fontaine

Pour poursuivre l\u27opération « Un livre pour les vacances », l\u27Agence régionale du Livre Paca a développé un projet expérimental intitulé « Rendez-vous en bibliothèque - Les Fables de La Fontaine » qui s\u27appuie sur le partenariat bibliothèque/école. Ce projet a été soutenu par le ministère de la Culture et déployé dans l\u27Académie d\u27Aix-Marseille

Quelle est la prise en charge de l'ostéoporose post-ménopausique, chez les femmes âgées de 50 à 90 ans, par les médecins généralistes et les rhumatologues, à Paris et en Seine-Saint-Denis, par rapport aux recommandations de la Haute Autorité de Santé 2006?

Introduction : Caractérisée par une diminution de la densité osseuse et une détérioration de la qualité du tissu à l origine de plus de 130 000 fractures par an, l ostéoporose entraine d importantes répercussions sur la qualité de vie et la mortalité. L objectif principal était de comparer certains points de la prise en charge de l'ostéoporose post-ménopausique chez les femmes âgées de 50 à 90 ans entre les médecins généralistes et les rhumatologues à Paris et en Seine-Saint-Denis par rapport à la littérature et aux recommandations de la Haute Autorité de Santé 2006. Matériel et méthode : Nous avons mené une étude descriptive, comparative, prospective à type d enquête de février 2010 à mars 2011. L ordre des médecins nous a fourni une liste de contacts de 4544 médecins généralistes et 285 rhumatologues. 300 médecins généralistes et 150 rhumatologues ont été interrogés. Résultats: 60 médecins généralistes et 60 rhumatologues ont répondu. Les 2 groupes de médecins analysés étaient comparables. 52% de médecins généralistes et 78% de rhumatologues recherchent les facteurs de risque de l ostéoporose (p=0,0022). 20% des médecins généralistes et 13% des rhumatologues affirment que généralement, la première fois qu'une patiente consulte pour discuter du diagnostic de l'ostéoporose se fait suite à une fracture (p=0,3272). 18% de médecins généralistes et 13% de rhumatologues décident de prescrire un traitement de l ostéoporose chez une patiente seulement après une fracture (p=0,4531). 77% des médecins généralistes et 93% de rhumatologues prescrivent une densitométrie osseuse avant de prescrire un traitement (p=0,0106). 84% de médecins généralistes et 64% de rhumatologues pensent que l ostéodensitométrie osseuse a une bonne spécificité (p=0,0147), de même respectivement, 86% et 60% pensent qu elle a une bonne sensibilité (p=0,0023). 55% de médecins généralistes et 95% de rhumatologues prescrivent un dosage phosphocalcique (p<0,0001). 50% de médecins généralistes et 81% de rhumatologues dosent systématiquement la vitamine D avant de supplémenter (p=0,0003). 68% de rhumatologues et 55% de généralistes font une dose d attaque de vitamine D (p=0,1331). 35% de médecins généralistes 68% de rhumatologues font un questionnaire des apports calciques avant de supplémenter en calcium (p=0,0003). 87% de médecins généralistes et 47% de rhumatologues supplémentent systématiquement en calcium (p=0,0014). 73% de médecins généralistes et 38% de rhumatologues associent du calcium à la prescription de vitamine D (p=0,0001). Quasiment aucun médecin ne dose le CTX sérique et la phosphatase alcaline dans le bilan de l ostéoporose. 8% de médecins généralistes et 17% de rhumatologues prescrivent un panoramique dentaire ou des soins dentaires avant d administrer un biphosphonate (p=0,1675). La plupart des médecins prescrivent en première intention l alendronate. Conclusion :Les rhumatologues maitrisent un peu mieux l ostéoporose que les médecins généralistes. Des propositions peuvent être faites pour améliorer les pratiques.PARIS13-BU Serge Lebovici (930082101) / SudocSudocFranceF

Racemization mechanism of lithium tert ‐butylphenylphosphido‐borane: A kinetic insight

International audienc

Multicentric Carpotarsal Osteolysis Syndrome Associated Nephropathy: Novel Variants of <i>MAFB</i> Gene and Literature Review

Multicentric carpo-tarsal osteolysis (MCTO) is a rare osteolysis syndrome mainly involving carpal and tarsal bones usually presenting in early childhood. MCTO has autosomal dominant inheritance with heterozygous mutation in the MAFB gene. The skeletal disorder is often associated with chronic kidney disease. Data on clinical characterization and best treatment option of MCTO-associated nephropathy are scarce and mostly limited to case reports. With the aim to better define the phenotype and long-term outcomes of MCTO-associated nephropathy, we launched an online survey through the Workgroup for hereditary glomerulopathies of the European Rare Kidney Disease Network (ERKNet). Overall, we collected clinical and genetic data of 54 MCTO patients, of which 42 previously described and 12 new patients. We observed a high rate of kidney involvement (70%), early age of kidney disease onset, nephrotic-range proteinuria, and a kidney survival around of 40% at long-term follow-up. Our finding confirmed the heterogeneity of clinical manifestations and widen the spectrum of phenotypes resulting from MCTO-associated nephropathy. Furthermore, we report the first case of complete remission after treatment with cyclosporine A. We demonstrated that multidisciplinary care is essential for MCTO patients and early referral to nephrologists is therefore warranted to facilitate prompt treatment

Rhythm disturbances as a potential early marker of Parkinson’s disease in idiopathic REM sleep behavior disorder

International audienceObjective: We aimed to identify timing distortions in production and perception of rhythmic events in patients with idiopathic REM sleep behavior disorder (iRBD) as early markers of Parkinson's disease (PD).Methods: Rhythmic skills, clinical characteristics, dysautonomia, depression, and olfaction were compared in 97 participants, including 21 participants with iRBD, 38 patients with PD, and 38 controls, matched for age, gender, and education level. Rhythmic disturbances can be easily detected with dedicated motor tasks via a tablet application. Rhythm production was tested in two conditions: to examine the ability to generate a spontaneous endogenous rhythm, tapping rate and variability in a finger tapping task without external stimulation was measured, while the ability to synchronize to an external rhythm was tested with finger tapping to external auditory cues. Rhythm perception was measured with a task, in which the participants had to detect a deviation from a regular rhythm. Participants with iRBD had dopamine transporter imaging.Results: Participants with iRBD and PD revealed impaired spontaneous rhythm production and poor rhythm perception compared to controls. Impaired rhythm production was correlated with olfaction deficits, dysautonomia, impaired non-motor aspects of daily living, and dopamine uptake measures.Conclusions: Participants with iRBD show impaired rhythm production and perception; this impairment is correlated with other early markers for PD. Testing rhythmic skills with short and inexpensive tests may be promising for screening for potential future PD in iRBD patients

Stratégie d’espacement des doses de dupilumab dans la dermatite atopique de l’adulte en vie réelle : résultats d’une étude multicentrique française

International audienc

Association of diabetes and outcomes in patients with COVID-19: Propensity score-matched analyses from a French retrospective cohort

International audienceBackground: Our study aimed to compare the clinical outcomes of patients with and without diabetes admitted to hospital with COVID-19.Methods: This retrospective multicentre cohort study comprised 24 tertiary medical centres in France, and included 2851 patients (675 with diabetes) hospitalized for COVID-19 between 26 February and 20 April 2020. A propensity score-matching (PSM) method (1:1 matching including patients' characteristics, medical history, vital statistics and laboratory results) was used to compare patients with and without diabetes (n = 603 per group). The primary outcome was admission to an intensive care unit (ICU) and/or in-hospital death.Results: After PSM, all baseline characteristics were well balanced between those with and without diabetes: mean age was 71.2 years; 61.8% were male; and mean BMI was 29 kg/m2. A history of cardiovascular, chronic kidney and chronic obstructive pulmonary diseases were found in 32.8%, 22.1% and 6.4% of participants, respectively. The risk of experiencing the primary outcome was similar in patients with or without diabetes [hazard ratio (HR): 1.16, 95% confidence interval (CI): 0.95-1.41; P = 0.14], and was 1.29 (95% CI: 0.97-1.69) for in-hospital death, 1.26 (95% CI: 0.9-1.72) for death with no transfer to an ICU and 1.14 (95% CI: 0.88-1.47) with transfer to an ICU.Conclusion: In this retrospective study cohort of patients hospitalized for COVID-19, diabetes was not significantly associated with a higher risk of severe outcomes after PSM.Trial registration number: NCT04344327