Isotretinoin and the risk of depression in patients with acne vulgaris

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal

Effect of conflicting advice on return to work in patients with low back pain

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal

CAMPAGNE DE MESURE POUR UNE ÉTUDE DE L'EXPOSITION DE LA POPULATION FRANÇAISE AU CHAMP MAGNÉTIQUE 50 HZ

Longtemps considérés comme inoffensifs, les champs magnétiques (CM) alternatifs de fréquence 50 Hz liés à l'électricité en particulier, sont suspectés depuis une trentaine d'années d'être responsables de pathologies, notamment de leucémies chez l'enfant. Les dernières expertises collectives [1] ont conclu que la dernière grande interrogation en ce qui concerne les CM basse fréquence est l'association statistique observée dans plusieurs analyses conjointes entre l'augmentation du risque de leucémie de l'enfant et une exposition aux CM supérieure à 0,4 μT en valeur moyenne sur 24 heures

Exposition de la population française aux champs magnétiques 50 Hz : résultats partiels

Les champs magnétiques (CM) alternatifs de fréquence 50 Hz, liés à l'électricité en particulier, sont suspectés depuis une trentaine d'années d'être responsables de pathologies, notamment de leucémies chez l'enfant [1]. Les dernières expertises collectives (OMS 2007, SCENHIR 2009) ont conclu que la dernière grande interrogation en ce qui concerne les CM basse fréquence est l'association statistique observée dans plusieurs analyses conjointes entre l'augmentation du risque de leucémie de l'enfant et une exposition aux CM supérieure à 0,4 μT en valeur moyenne sur 24 h [2]. Actuellement, l'exposition de la population française à ces champs n'est connue que de manière très approximative. Une étude effectuée dans le département de la Côte d'Or sur des logements situés à proximité de lignes à haute et très haute tension a permis d'évaluer les expositions à l'intérieur de ces logements [3]. Mais, d'une part il s'agit d'un faible échantillon compte tenu de la diversité du parc de logements en France, d'autre part, il s'agit d'une exposition du logement et non des personnes. En effet, tout un chacun est exposé à de nombreuses sources de champ magnétique du simple fait qu'on ne reste pas chez soi 24 heures sur 24. Les transports, en particulier, représentent des sources d'exposition significatives, mais d'autres lieux de vie peuvent constituer des sources d'exposition, que ce soit le lieu de travail, le terrain de sport, le centre commercial ou l'école. Dans le cas où le CM supérieur 0,4 μT en moyenne représenterait un risque pour la santé, comment estimer la proportion de la population française à risque et identifier les sources favorisant l'exposition ? Pour répondre à cette question, la Direction Générale de la Santé a initié une étude sur l'exposition aux CM 50 Hz d'un échantillon représentatif de la population française. Une des problématiques de cette étude a été de réaliser cet échantillon et de collecter toutes les informations nécessaires. Pour réaliser cette étude, le recrutement des volontaires et les mesures du CM ont été effectués en trois campagnes. Nous présentons les résultats des deux premières campagnes

French population exposure to 50 Hz magnetic fields : intermediate results

International audienceFor the last thirty years, the electricity related 50 Hz magnetic fields (MF) have been suspected of being responsible for several pathologies, in particular childhood leukemia [1]. The most recent collective expertise (WHO 2007 and SCENHIR 2009) concluded that the last major interrogation with regard to low frequency MF is the statistical association observed in several joint analyses between the increase of risk of the childhood leukemia and a higher than 0.4 μT exposure to MF on average in a 24-hour period [2]. Currently, the exposure of the French population to these magnetic fields is only approximately known. A study carried out in residences located near high voltage power lines in the "département1 de la Côte d'Or" made it possible to assess the MF background level inside these residences [3]. However, these residences are a limited sample compared to the diversity of the housing developments in France and the study characterized the exposure of the houses and not of the resident people. We are all exposed to many sources of magnetic fields due the fact that we do not remain at home 24 hours a day. Transportation in particular, significantly contributes to the individual exposure. Other places or activities can also constitute sources of exposure such as the workplace, sport activity areas, shopping centers or schools. Should the MF in excess to 0.4 μT on average carry health risk, would the authorities be able to manage it, i.e. estimate the proportion of the French population at risk and identify and mitigate the main sources causing the exposure? To answer this question the Ministry of Health and Solidarities initiated a study on the exposure of a representative sample of the French population to 50 Hz MF. The major issues of this study were to select randomly a representative sample and to collect all of necessary data. Measurements were performed in three campaigns at winter time (October to April). The present paper gives the results of the two first campaigns

Clinical features of H1N1 2009 infection in critically ill immunocompromised patients

Seasonal influenza virus has been described as an emerging and severe pathogen in immunocompromised hosts. Since the beginning of the 2009 influenza A novel H1N1 pandemic, several series have described the clinical course of the disease in various populations. We report the clinical course of H1N1 2009 infection in 10 immunocompromised patients. Half of the patients received long-term steroid therapy. Disease was characterized by a clinical picture similar to that of non-immunocompromised patients but with prolonged course and higher mortality

The use of pioglitazone and the risk of bladder cancer in people with type 2 diabetes: nested case-control study

Objective To determine if the use of pioglitazone is associated with an increased risk of incident bladder cancer in people with type 2 diabetes

Hepatic resection for hepatocellular carcinoma in patients with Child–Pugh's A cirrhosis: is clinical evidence of portal hypertension a contraindication?

AbstractBackgroundAccording to international guidelines [European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD)], portal hypertension (PHTN) is considered a contraindication for liver resection for hepatocellular carcinoma (HCC), and patients should be referred for other treatments. However, this statement remains controversial. The aim of this study was to elucidate surgical outcomes of minor hepatectomies in patients with PHTN (defined by the presence of esophageal varices or a platelet count of <100 000 in association with splenomegaly) and well‐compensated liver disease.MethodsBetween 1997 and 2012, a total of 223 cirrhotic patients [stage A according to the Barcelona Clinic Liver Cancer (BCLC) classification] were eligible for this analysis and were divided into two groups according to the presence (n = 63) or absence (n = 160) of PHTN. The demographic data were comparable in the two patient groups.ResultsOperative mortality was not different (only one patient died in the PHTN group). However, patients with PHTN had higher liver‐related morbidity (29% versus 14%; P = 0.009), without differences in hospital stay (8.8 versus 9.8 days, respectively). The PHTN group showed a worse survival rate only if biochemical signs of liver decompensation existed. Multivariate analysis identified albumin levels as an independent predictive factor for survival.ConclusionsPHTN should not be considered an absolute contraindication to a hepatectomy in cirrhotic patients. Patients with PHTN have short‐ and long‐term results similar to patients with normal portal pressure. A limited hepatic resection for early‐stage tumours is an option for Child–Pugh class A5 patients with PHTN

Effect of combination treatment with glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors on incidence of cardiovascular and serious renal events:population based cohort study

Objective: To determine whether the combined use of glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter-2 (SGLT-2) inhibitors is associated with a decreased risk of major adverse cardiovascular events and serious renal events compared with either drug class alone among patients with type 2 diabetes, and to assess the effect of the combination on the individual components of major adverse cardiovascular events, heart failure, and all cause mortality. Design: Population based cohort study using a prevalent new-user design, emulating a trial. Setting: UK Clinical Practice Research Datalink linked to Hospital Episode Statistics Admitted Patient Care and Office for National Statistics databases. Participants: Two prevalent new-user cohorts were assembled between January 2013 and December 2020, with follow-up until the end of March 2021. The first cohort included 6696 patients who started GLP-1 receptor agonists and added on SGLT-2 inhibitors, and the second included 8942 patients who started SGLT-2 inhibitors and added on GLP-1 receptor agonists. Combination users were matched, in a 1:1 ratio, to patients prescribed the same background drug, duration of background drug, and time conditional propensity score. Main outcome measures: Cox proportional hazards models were fitted to estimate the hazard ratios and 95% confidence intervals of major adverse cardiovascular events and serious renal events, separately, comparing the GLP-1 receptor agonist-SGLT-2 inhibitor combination with the background drug, either GLP-1 receptor agonists or SGLT-2 inhibitors, depending on the cohort. Secondary outcomes included associations with the individual components of major adverse cardiovascular events (myocardial infarction, ischaemic stroke, cardiovascular mortality), heart failure, and all cause mortality. Results: Compared with GLP-1 receptor agonists, the SGLT-2 inhibitor-GLP-1 receptor agonist combination was associated with a 30% lower risk of major adverse cardiovascular events (7.0 v 10.3 events per 1000 person years; hazard ratio 0.70, 95% confidence interval 0.49 to 0.99) and a 57% lower risk of serious renal events (2.0 v 4.6 events per 1000 person years; hazard ratio 0.43, 0.23 to 0.80). Compared with SGLT-2 inhibitors, the GLP-1 receptor agonist-SGLT-2 inhibitor combination was associated with a 29% lower risk of major adverse cardiovascular events (7.6 v 10.7 events per 1000 person years; hazard ratio 0.71, 0.52 to 0.98), whereas serious renal events generated a wide confidence interval (1.4 v 2.0 events per 1000 person years; hazard ratio 0.67, 0.32 to 1.41). Secondary outcomes generated similar results but with wider confidence intervals. Conclusions: In this cohort study, the GLP-1 receptor agonist-SGLT-2 inhibitor combination was associated with a lower risk of major adverse cardiovascular events and serious renal events compared with either drug class alone