Cardiovascular function and psychological distress in urbanised black South Africans: the SA BPA study

Objective

The increased prevalence of cardiovascular disease risk factors in sub-Saharan Africa has increased the incidence of cardiovascular disease in this region but whether psychological distress contributes to this observed increased risk remains largely unclear.The aim of this study was to investigate the association between cardiovascular function and psychological distress in urbanised black South African men (n = 101) and women (n = 99).

Methods

Resting cardiovascular variables were obtained by making use of the Finometer device and 24-hour ambulatory blood pressure (BP) measurements with the Cardiotens apparatus. Psychological questionnaires assessed the perception of health (General Health questionnaire) and depression status (DSM-IV criteria). The resting ECG (NORAV PC-1200) was used to determine left ventricular hypertrophy (LVH) by making use of the Cornell product. Confounders included age, obesity, alcohol intake, smoking and physical activity.

Results

The hypertensive groups were overweight, with lower vascular compliance and higher LVH (only men) compared to the normotensive groups. In hypertensive men, perception of health (somatic symptoms) was positively associated with blood pressure, while in hypertensive women it was associated with heart rate. Major depression was associated with LVH in hypertensive men and mean arterial pressure in hypertensive women. LVH and depression showed odds ratios of 1.02 (95% CI: 0.997–1.05) and 1.15 (95% CI: 1.01–1.32), respectively, in predicting hypertension in women.

Conclusions

Psychological distress was associated with higher blood pressure in hypertensive African men but also with the development of left ventricular hypertrophy in hypertensive African men and women.     

预测急性脑卒中缺血半暗带的最优Tmax阈值

背景:挽救缺血半暗带对减少梗死范围有重要意义,一般以PWI与DWI的不匹配区域来评估半暗带.但PWI评估的低灌注范围可能会包括良性缺血区,从而使评估所得的半暗带体积大于实际值.为减少这种弊端,近来引入一新的参数:PWI的达峰时间(Tmax)阈值.Tmax为PWI成像信号强度-时间曲线中从对比剂开始出现到对比剂浓度达到峰值的时间.以对侧相应部位正常脑组织的Tmax为参考,脑组织中Tmax延迟超过阈值的区域即为PWI病灶区.     

Validity and reliability of the Siconolfi Step Test for assessment of physical fitness in patients with systemic lupus erythematosus

OBJECTIVE: Patients with systemic lupus erythematosus (SLE) have poor physical fitness as measured by maximal oxygen uptake (VO(2max)), which is associated with disability and fatigue. The purpose of this study was to validate, in this population, the Siconolfi Step Test (SST) developed to predict VO(2max) in healthy individuals. METHODS: Thirty patients with well-controlled SLE were tested on a cycle ergometer until volitional exhaustion, and 25 women and 4 men (mean +/- SD age 48 +/- 14 years, weight 71.5 +/- 13.7 kg) fulfilled the criteria for maximal effort. VO(2max) measured during this incremental test was compared with VO(2max) predicted by the SST using Bland and Altman 95% limits of agreement (LOA) and intraclass correlation coefficient (ICC). The SST was repeated twice to assess its reliability. RESULTS: The ICC between predicted and measured VO(2max) (mean +/- SD 1.67 +/- 0.41 liters/minute versus 1.57 +/- 0.39 liters/minute) was moderately high (0.73, P < 0.001). Bland and Altman analysis revealed a trend for a positive bias (P = 0.083) and 95% LOA of +/-0.58 liters/minute. There was a very high ICC (0.97, P < 0.001) between VO(2max) predicted by the first and second SST (mean +/- SD 1.66 +/- 0.40 liters/minute versus 1.67 +/- 0.41 liters/minute), and no significant bias (P = 0.500). The 95% LOA were +/-0.20 liters/minute. CONCLUSION: The results demonstrate that the SST is well tolerated, reasonably valid, and highly reliable in patients with well-controlled SLE. Therefore, this simple, submaximal exercise test might be useful for assessing physical fitness in clinical practice and epidemiologic studies.     

Severe sepsis and septic shock

Sepsis and consequent multiorgan dysfunction syndrome are responsible for over 60% of deaths in patients receiving critical care in spite of improvements in patient management. We describe the pathophysiology, epidemiology, clinical picture, and biochemical markers that contribute to the diagnosis and assessment of infection severity and progression of infection to sepsis and from severe sepsis to septic shock. Our focus is on the guidelines of the Surviving Sepsis Campaign, complemented with additional information published since those guidelines appeared. The Ovid MEDLINE database was used for a search from 1997 through 2006.     

Macrodactylies of the hand and foot

Macrodactyly is a rare congenital anomaly defined by an enlargement of all the structures of fingers or toes. Two forms of macrodactyly have been described. One form is static with an enlargement present at birth and growing proportionately to the other digits. The other is progressive with an enlargement beginning in early childhood and growing faster than that of the normal digits. Macrodactyly is responsible of a functional handicap and an aesthetic prejudice. Treatment may be indicated for this reason. Treatment must be individualised and depends on the proportionate size of the enlarged finger, growth rate and the patient's age when first seen. The parents and the child should be advised that multiple procedures may be required and that the result will be somewhat unsatisfactory. Surgical approaches include either reconstructive surgery or amputation. Amputation is indicated at any age for a large, unsightly and stiff digit that interferes with function of the rest of the hand. In feet with involvement of the lesser toes, proximal amputation has the best cosmetic and functional outcome. Epiphyseal arrest, bulk reduction procedures, finger shortening, lateral closing-wedge osteotomies or stripping of the nerves can be performed in the other cases.     

Le thorax en entonnoir : quelle prise en charge en chirurgie plastique ? À propos de 10 cas

Subject

Several controversial issues concern pectus excavatum (funnel chest), the most common chest wall deformity. The pathogenesis of this deformity is uncertain, and there is no agreement as to its psychological, cardiac and pulmonary effects. An even more debatable point is the choice of surgical treatment among the more or less radical proposals made by different teams. No consensus exists concerning the indications for surgery, the technique to be used, or the suitable age of the patient.

Materials and methods

This retrospective study concerns 10 patients with funnel chest who underwent reconstruction surgery in our unit between 1989 and 2002. Nine patients received a silicone chest implant made to measure, and one a single breast implant. Each patient was interviewed and examined to obtain information and provide a basis for evaluation. The effects of possible associated abnormalities were evidenced by complementary cardiopulmonary examinations, and the severity of funnel chest was evaluated according to the Haller pectus index.

Results

The mean period after surgery was 5 years. The effects of funnel chest deformity were essentially psychological, relating to aesthetic disgrace. Although two-thirds of the deformities were considered severe, cardiopulmonary repercussions were minor. All 10 patients were satisfied with the repair performed, and this judgment was independent of surgical assessment. Acute complications concerned 5 seromas and one minimal scar separation.

Discussion

The indications for surgery and the means of surgical treatment for funnel chest are considered after comparison of our results with those in the literature and a survey of the different existing possibilities for treatment (implant, chondrosternoplasty, fat transplant).     

The epidemiology and virology of hepatitis C virus genotype 5 in central France

BACKGROUND: We previously reported high prevalence of hepatitis C virus genotype 5a (HCV 5) (14%) in Central France. AIM: To identify the risk factors associated with HCV5 infection and to characterize local HCV5 lineages. METHOD: A case-control study and phylogenetic analysis were conducted. RESULTS: In all, 131 HCV5 and 343 HCV non 5 infected patients were enrolled. No HCV5 patient was born in sub-Saharan Africa and only two were injection drug user. HCV5 contamination was associated with living in a rural area called Vic le Comte (VLC) in non-transfused patients (OR = 17.7), with transfusion in patients living outside VLC (OR = 3.8) and with receiving injections in patients from VLC (OR = 3.1). More than 80% of the patients from outside VLC were contaminated by transfusion and those from VLC mainly by an iatrogenic factor - injections performed before 1972 by the local physician. Phylogenetic analysis of HCV5 isolates evidenced no distinct genetic cluster, but close relationships between the isolates of spouse pairs and between blood donors and recipients. CONCLUSIONS: Our results suggest that HCV5 spread in our district by iatrogenic route before 1972 and then via transfusion to the whole district. Collaborative studies are underway to study viral sequences from different parts of Africa and Europe to estimate the origin of our HCV 5a strains.