Standards and guidelines for performing central dual X-ray densitometry from the Canadian panel of International Society for Clinical Densitometry.

The International Society for Clinical Densitometry (ISCD) is a multidisciplinary nonprofit global organization formed to ensure excellence in densitometry imaging, interpretation, and application. The Canadian panel of the ISCD represents ISCD in Canada and oversees Canadian bone densitometry certification programs. The standards of care from the Canadian panel of the ISCD have been developed in order to establish the minimum level of acceptable performance for the practice of bone densitometry in Canada. A variety of techniques are available for skeletal assessment of bone mineral density, which vary in accuracy, precision, and clinical utility as well as availability. This article focuses on central dual X-ray absorptiometry in adults and does not address densitometry in the pediatric population. Other technologies will be addressed in a subsequent article.     

Relation between pulse oximetry plethysmographic waveform amplitude induced by passive leg raising and cardiac index in spontaneously breathing subjects

Introduction

Previous studies suggested that variation of pulse oximetric plethysmographic (POP) waveform amplitude (ΔPOP) could predict fluid responsiveness in mechanically ventilated patients. Our objective was to correlate the variations of ΔPOP and the variations of cardiac index (CI) induced by passive leg raising (PLR) in spontaneously breathing volunteers.

Methods

We studied 26 spontaneously breathing volunteers using a pulse oximeter attached to the middle finger. We assessed hemodynamic variables, including ΔPOP (%) (POP_max − POP_min)/[(POP_max + POP_min)/2] and CI determined by transthoracic echocardiography at baseline (eg, semirecumbent position), during PLR at 60°, and back to baseline.

Results

Cardiac index significantly increased from 2.2 to 2.5 L/min·m² (P < .01) at 60° PLR. Conversely, ΔPOP significantly decreased from 22% to 15% (P < .01) at 60° PLR. There was a weak correlation between CI and ΔPOP variations at 60° PLR (r = 0.40; P < .01). The area under curve of the receiver operating characteristic curve for ΔPOP as a predictor of an increase of CI of 15% was not significant (0.67 ± 0.10; P = .16).

Conclusion

The variation of ΔPOP induced by PLR is not an accurate predictor of increase in CI.     

Analgesic efficacy and safety of nefopam vs. propacetamol following hepatic resection*

In order to compare the morphine-sparing effect, analgesic efficacy and tolerance of nefopam and propacetamol given at their highest recommended doses, 120 patients undergoing elective hepatic resection were randomly assigned to receive postoperative intravenous patient-controlled analgesia with morphine alone, or in combination with nefopam (20 mg.4 h-1) or propacetamol (2 g.6 h-1). Compared with the control group (43 [7-92] mg), median [range] cumulative morphine consumption for 24 h after the study started was halved in the nefopam group (21 [3-78] mg, p <0.001) and 20% lower in the propacetamol group (35 [6-84] mg, p = 0.15). Analgesia was superior in the nefopam group despite the lower morphine consumption. Adverse effects were comparable in the three groups, except for significantly more nausea in the control group (39% vs. 17 and 26% in the nefopam and propacetamol groups, respectively) and more sweating in the nefopam group (17% vs. 0 and 3% in the control and propacetamol groups, respectively). Overall patient satisfaction was better (p < 0.001) in patients given nefopam (97%) than those receiving morphine alone (82%) or propacetamol (74%).     

Outcomes of Acute Stroke Patients Requiring Mechanical Ventilation: Study Protocol for the SPICE Multicenter Prospective Observational Study

Neurocritical Care - Care pathways and long-term outcomes of acute stroke patients requiring mechanical ventilation have not been thoroughly studied. Stroke Prognosis in Intensive Care (SPICE) is a...     

Hepatitis B and delta infection in Gabon: a seriological survey in a representative sample of the province of Haut-Ogooue

Hepatitis B virus markers and antibodies to delta agent were studied in adult people (15-54 years) in the province of Haut-Ogooue (Gabon), randomly selected by cluster sampling technique. Of the 384 people, 37 (9.6%) were positive for HBsAg, of which 23 (62.2%) were positive for HBeAg; 246 (65.3%) had anti-HBs and 53 (13.8%) had anti-HBc as the only marker. Chronic carriage of HBV defined as presence of HBsAg or exclusive anti-HBc was observed in 90 people (32%). At least one of the HBV markers was found in 89% of the people. Women were more frequently positive than men. No difference in relation to age was observed. Anti-delta was found in 12 (3.5%) of the 341 people with HBV markers and 7/12 of these could be considered as chronic HBV carriers.     

The effect of fluoride on bone histology in postmenopausal osteoporosis depends on adequate fluoride absorption and retention

Forty-one women with idiopathic postmenopausal osteoporosis have been followed for 2 years after initiation of sodium fluoride at 40-50 mg/day, given together with a daily calcium supplement of 1 gram and vitamin D2, at 50,000 IU weekly. Histological and histomorphometric analyses were done on bone biopsies taken prior to and after 1 year of treatment (mean 1.25 +/- 0.35 years). Thirty patients (74%) developed the histological fluoride effect of hyperosteoidosis, while the remaining 11 patients (26%) had no change from pretreatment biopsies. Hyperosteoidosis was based on increased values for osteoid volume and/or thickened osteoid with greater than 3 lamellar bands. Based on previously reported findings, this histological evidence of hypersoteoidosis within 12-18 months of initiation of therapy provides a useful predictor of ultimate satisfactory fluoride response in terms of bone mineral accretion. No increases in bone mass (measured by neutron activation analysis) were observed at the time of the posttreatment biopsy but, according to this previous work, increases are anticipated over a further 2-3 years of treatment. Factors affecting the development of hyperosteoidosis were analyzed. Hyperosteoidosis was associated with a significantly higher dose of sodium fluoride and a significantly higher level of bone fluoride retention but without significant increase in fasting serum fluoride. Results suggest that fluoride retention depends not only on fluoride dose but also on body size, renal function, and intestinal absorptions of calcium and fluoride. There were no differences in the initial investigations between patients with and without hyperosteoidosis, with respect to age, years of postmenopause, estrogen use, initial biochemistry, or initial bone histology.(ABSTRACT TRUNCATED AT 250 WORDS)     

Seroprevalence of cysticercosis in Bénin.

We report the results of a seroepidemiological study on the prevalence of cysticercosis in Bénin. Cluster sampling at 3 levels was performed in the 6 départements (Atacora, Borgou, Zou, Mono, Atlantique and Oueme) and 2625 serum samples, from 1329 adult females and 1296 adult males, were collected. Antibodies against Taenia solium cysticerci were first searched for by enzyme-linked immunosorbent assay and the 41 seropositive samples were then examined by enzyme-linked electroimmunotransfer blot assay (EITB). Thirty-five samples gave positive results in the EITB. The overall seroprevalence of cysticercosis was therefore 1.3% (95% confidence interval [95% CI] 0.9-1.9). The seroprevalence was 1.9% in males (95% CI 1.2-2.7) and 0.8% (95% CI 0.4-1.5) in females (P < 0.05). A progressive increase in seroprevalence with increasing age was found. The highest seroprevalences were observed in Atacora and Atlantique, 2 non-Muslim départements (3.3% and 3.0%, respectively). This study demonstrated the public health importance of cysticercosis in Bénin.