L'aménagement transsexuel comme solution à l'adolescence

peer reviewedL’aménagement transsexuel comme solution à l’adolescence La transsexualité est souvent banalisée par les médias, séduits par l’idée facile à vendre d’une âme sexuée, donc du drame de la possible inadéquation entre le sexe psychique et le sexe corporel. L’observation clinique rigoureuse de son élaboration plaide cependant pour une architecture complexe, résultant d’une dynamique subtile entre le psychisme, l’histoire et l’environnement. En effet, dans l’analyse d’un cas clinique, nous constatons que, face au risque de l’effondrement identitaire d’une structure fragile le Moi tente de se renforcer par l’organisation de mécanismes de défense qui élabore une nouvelle identité étayée sur un physique transité vers l’autre sexe. Si l’on analyse les interactions précoces sous l’angle de la formation de l’identité sexuelle, le noyau « genré » du Moi peut subir une double attaque, par manque d’identification au même et par attaque mortifère du différent. Le Moi se trouve ainsi délié et persécuté par des objets partiels ou peu introjectés. A l’adolescence, moment potentiellement traumatique de la sexuation, le jeune se trouve confronté à l’interrogation sur son identité sexuelle, et lorsque le noyau « genré » s’est précisément trouvé fragilisé, l’angoisse surgit, avec le risque d’une bascule psychotique. Dans ces cas extrêmes, la recherche d’une nouvelle enveloppe, remodelage de la peau, permet de contenir l’éclosion du courant psychotique grâce à la disponibilité permanente de l’incorporation du différent, identification certes coûteuse en ressources mais peut-être, à même d’éviter l’effondrement narcissique complet

Bayesian analysis of the ICAT·COVID randomized clinical trial

This communication provides new effect measures in the multiplicative scale from the ICAT·COVID randomized clinical trial, obtained through Bayesian statistics. These could not be calculated using the traditional frequentist statistics included in the original publication because the benefits of icatibant (a competitive antagonist of the bradykinin B2 receptors) on top of standard care in patients with COVID-19 pneumonia were such that there were no events in the active group.1 Additive effect measures (eg, risk differences) are the most appropriate measures for identifying the population groups that will benefit most from interventions in presence of interactions acting as effect modifiers.2 However, an aspect that multiplicative measures provide where additive effect measures cannot, is an indication of how many times interventions or exposures increase or decrease disease risk (eg, risk ratio, hazard ratio). Furthermore, multiplicative measures are more commonly used in epidemiology, and are more appropriate for outcome measures with strictly positive values, such as counts and the numerators of incidence rates

Validation of organ dose calculations with PyMCGPU-IR in realistic interventional set-ups

Introduction: Interventional radiology procedures are associated with high skin dose exposure. The 2013/59/ EURATOM Directive establishes that the equipment used for interventional radiology must have a device or a feature informing the practitioner of relevant parameters for assessing patient dose at the end of the procedure. This work presents and validates PyMCGPU-IR, a patient dose monitoring tool for interventional cardiology and radiology procedures based on MC-GPU. MC-GPU is a freely available Monte Carlo (MC) code of photon transport in a voxelized geometry which uses the computational power of commodity Graphics Processing Unit cards (GPU) to accelerate calculations. Methodologies: PyMCGPU-IR was validated against two different experimental set-ups. The first one consisted of skin dose measurements for different beam angulations on an adult Rando Alderson anthropomorphic phantom. The second consisted of organ dose measurements in three clinical procedures using the Rando Alderson phantom. Results: The results obtained for the skin dose measurements show differences below 6%. For the clinical procedures the differences are within 20% for most cases. Conclusions: PyMCGPU-IR offers both, high performance and accuracy for dose assessment when compared with skin and organ dose measurements. It also allows the calculation of dose values at specific positions and organs, the dose distribution and the location of the maximum doses per organ. In addition, PyMCGPU-IR overcomes the time limitations of CPU-based MC codePeer ReviewedPostprint (updated version

Hydroxychloroquine Myocardial Toxicity in a Patient with Systemic Lupus Erythematosus

Hydroxychloroquine is an antimalarial drug used in many rheumatologic and systemic diseases. Although considered by clinicians to be relatively safe, serious side effects have been documented (retinotoxicity, neuromyotoxicity and cardiotoxicity). We present the case of a 41-year-old woman with systemic lupus erythematosus (SLE) who presented at our institution with acute heart failure after taking hydroxychloroquine for a period of 3 months. An endomyocardial biopsy ruled out myocarditis related to systemic lupus erythematosus but demonstrated pathological changes related to hydroxychloroquine toxicity. It is exceptional to observe such cardiac toxicity after such a low cumulative dose (16 grams). The potential severity and reversibility of this complication underscores the importance of a high level of suspicion and timely diagnosis

Review of skin dose calculation software in interventional cardiology

PurposeIn interventional cardiology, patients may be exposed to high doses to the skin resulting in skin burns following single or multiple procedures. Reviewing and analysing available software (online or offline) may help medical physicists assessing the maximum skin dose to the patient together with the dose distribution during (or after) these procedures.Method and resultsCapabilities and accuracy of available software were analysed through an extensive bibliography search and contacts with both vendor and authors. Their markedly differed among developers. In total, 22 software were identified and reviewed according to their algorithms and their capabilities. Special attention was dedicated to their main features and limitations of interest for the intended clinical use. While the accuracy of the 12 software products validated with measurements on phantoms was acceptable (within ± 25%), the agreement was poor for the two products validated on patients (within ± 43% and ± 76%, respectively). In addition, no software has been validated on angiographic units from all manufacturers, though several software developers claimed vendor-independent transportability. Only one software allows for multiple procedures dose calculation.ConclusionLarge differences among vendors made it clear that work remains to be done before an accurate and reliable skin dose mapping is available for all patients

A multicenter, open-label, randomized, proof-of-concept phase II clinical trial to assess the efficacy and safety of icatibant in patients infected with SARS-CoV-2 (COVID-19) and admitted to hospital units without invasive mechanical ventilation: study protocol (ICAT-COVID)

Background: COVID-19 has quickly become a global pandemic with a substantial number of deaths and is a considerable burden for healthcare systems worldwide. Although most cases are paucisymptomatic and limited to the viral infection-related symptoms, some patients evolve to a second phase, with an impaired inflammatory response (cytokine storm) that may lead to acute respiratory distress syndrome and death. This is thought to be caused by increased bradykinin synthesis. Methods: ICAT-COVID is a multicenter, randomized, open-label, proof-of-concept phase II clinical trial assessing the clinical efficacy and safety of adding icatibant to the standard of care in patients hospitalized with COVID-19 without invasive mechanical ventilation. Patients hospitalized with a confirmed COVID-19 pneumonia diagnosis (RTPCR or antigen test <= 10 days prior to randomization, and radiographic evidence of pulmonary infiltrates), rated 4 or 5' on the WHO's clinical status scale, are eligible. Patients will be randomized on a 1:1 ratio to either standard of care-plus-icatibant (experimental group) or to standard of care alone (control group). The experimental group will receive 30 mg of icatibant subcutaneously 3 times a day for 3 days (for a total of 9 doses). The expected sample size is 120 patients (60 per group) from 2 sites in Spain. Primary outcomes are the efficacy and safety of Icatibant. The main efficacy outcome is the number of patients reaching grades 2 or 1 on the WHO scale within 10 days of starting treatment. Secondary outcomes include long-term efficacy: number of patients discharged who do not present COVID-19-related relapse or comorbidity up until 28 days after discharge, and mortality. Discussion: Icatibant, a bradykinin type 2 receptor antagonist with proven effectiveness and safety against hereditary angioedema attacks, may be beneficial for COVID-19 patients by inhibiting bradykinin's action on endothelial cells and by inhibiting the SARS-CoV-2 M protease. Our working hypothesis is that treatment with standard of care-plus-icatibant is effective and safe to treat patients infected with SARS-CoV-2 admitted to hospital for pneumonia without invasive mechanical ventilation

VERIDIC: validation and estimation of radiation skin dose in interventional cardiology

Interventne procedure u radiologiji i kardiologiji povezani su sa visokim dozama za kožu pacijenta i potencijalnim radijacionim povredama kože. Različita metodologije i rešenja razvijene us za procenu maksimalne doze za kožu, čija se svojsvta, uključujuši i tačnost značajno razlikuju. U radu su prokazani ciljevi, metode i preminiran a rešenja projekta VERIDIC usmerenoj na validaciju zaličitih ofline i online softvera za procenu doze za kožu pacijenta u intervenatnoj kardiologiji.In interventional cardiology (IC), patients may be exposed to high doses to the skin resulting in tissue reactions (skin burns) following single or multiple procedures. To address this issue, online and offline software has been developed to estimate the maximum skin dose (MSD) to the patient from IC procedures. However, the capabilities and accuracy of such skin dose calculation (SDC) software to estimate MSD and 2D dose distributions markedly differ among vendors. Hence, this project focuses onthe harmonisation of RDSR (radiation dose structured report) and on the validation of SDC software products in IC, which will optimise radiation protection of patients. The outcome of the project will include the standards for digital dose reporting, development of protocols for acceptance testing and Quality Control (QC)of SDC software and setting of diagnostic reference levels per clinical complexity, assessing thefrequency of high-dose procedures as well as dose reduction strategies based on the multi-centric data collection. This paper focuses on the work performed to investigate performance of solid state dosimeters used in clinical environment.Proceedings: [http://vinar.vin.bg.ac.rs/handle/123456789/8681]XXX симпозијум ДЗЗСЦГ (Друштва за заштиту од зрачења Србије и Црне Горе), 2- 4. октобар 2019. године, Дивчибаре, Србиј