Long-term effects of therapeutic education for patients with rheumatoid arthritis

IntroductionThe objective of this study was to assess the effects of an educational program on the course of rheumatoid arthritis (RA) after 3 years.MethodsFrom December 2002 to December 2003, 39 RA patients participated in a 3-day education program delivered to groups of four or five patients. Effects of the program were evaluated after 3 years in 33 patients, comparatively to baseline, based on the following variables: knowledge of RA (self-questionnaire), disease activity (DAS 28), functional impairment (health assessment questionnaire [HAQ]) and quality of life (arthritis impact measurement scale 2 [AIMS2], short-form). We also compared patient knowledge in the educational program participants and in 38 controls with RA. Direct questions were used to evaluate the program after 3 years.ResultsPatient knowledge 3 years after the education program was significantly improved compared to baseline (P < 0.0001) and was significantly better than in the controls (P < 0.0001). Disease activity was significantly lower in the education group after 3 years than at baseline (DAS28, 3.1 vs. 3.8, P < 0.005). Neither the HAQ nor the AIMS2 scores changed significantly after 3 years compared to baseline. The replies to the direct questions indicated a very high level of overall satisfaction with the educational program.ConclusionAn educational program tailored to patient needs can produce lasting improvements in knowledge of the disease and may help to control the activity of RA. These results warrant the development of education programs for patients with chronic inflammatory joint disease.     

儿童输注ABO主侧不合血小板的效果弱于输注血型相合的血小板

由于血小板只有5天的保存期,库存压力导致经常输注ABO血型不合的血小板.为了避免血小板过期,首先输注的是库存时间最长的血小板,包括输注ABO血型不合的血小板.AABB和英国血液学标准委员会建议,输注红细胞时必须要求ABO主侧相合,而输注血小板并没有要求ABO血型匹配.     

Effect of different application depths of mitomycin-C in deep sclerectomy with collagen implant: a randomized controlled trial

Purpose: To evaluate effects of mitomycin‐C (MMC) in deep sclerectomy with collagen implant applied under the superficial scleral flap or under the deep scleral flap. Methods: Twenty‐five patients with primary or secondary open‐angle glaucoma and at high risk for postoperative cicatrization underwent deep sclerectomy and were randomly distributed to the two treatment arms. In the superficial MMC group (S‐MMC), MMC was applied under the superficial scleral flap using a soaked sponge for 60 s; in the deep MMC group (D‐MMC), MMC was applied under the deep scleral flap for 60 s before entering the Schlemm's canal. In both groups, remaining MMC was irrigated with 40 mL balanced salt solution. Patients were followed up for up to 2 years. The volume of filtering blebs was studied with ultrasound biomicroscopy at the last follow‐up visit. Results: Mean preoperative intraocular pressure (IOP) was 20.5 ± 8.9 mmHg for D‐MMC and 21.6 ± 6.6 mmHg for S‐MMC eyes (P = 0.67). The mean postoperative IOP was 5.3 ± 3.3 mmHg (D‐MMC) and 6.9 ± 4.8 mmHg (S‐MMC) at day 1 (P = 0.22) and 11.4 ± 6.3 mmHg (D‐MMC) versus 11.3 ± 4.6 mmHg (S‐MMC) at last follow up (P = 0.54). The mean number of medications per patient was reduced from 2.5 ± 0.5 to 0.4 ± 0.5 (D‐MMC) (P < 0.001) and from 2.5 ± 0.9 to 0.3 ± 0.4 (S‐MMC) (P < 0.001). Ultrasound biomicroscopy at 24 months showed mean intrascleral space volume of 1.97 ± 0.35 mm3 (D‐MMC) and 5.68 ± 0.42 mm3 (S‐MMC) (P < 0.05). Conclusion: No significant difference in efficacy and safety was found between the two groups at a mean of 19.2 months of follow up. Deep scleral application of MMC, however, seems to produce significantly smaller intrascleral blebs.     

Pimecrolimus 1 percent cream in the treatment of psoriasis in a child

Psoriasis is a chronic inflammatory skin disorder of multifactorial etiology. Because of the potential side effects of repeated topical application of potent corticosteroids, equally-effective, safer therapeutic options are required, especially in the treatment of children. We report on the efficacy of twice daily application of pimecrolimus 1 percent cream in a girl who suffered from psoriasis involving the eyelids and anogenital region. After 20 days of application of pimecrolimus cream the plaques completely resolved. No significant side effects have been observed. Topical pimecrolimus appears to be an effective and safe treatment for children with psoriasis. Our case observations provide further evidence for the beneficial effects of topical pimecrolimus in the treatment of psoriasis. Vehicle-controlled studies on a larger number of patients are now needed to investigate long-term efficacy and safety of topical pimecrolimus in the treatments of a variety of types of psoriasis in children.     

Acquired oculomotor paralysis: a new therapeutic approach. Apropos of 10 cases

PURPOSE: The aim of this work is to report our rehabilitation scheme and outcome in patients with acquired oculomotor palsy. PATIENTS AND METHODS: We cared for 10 patients with oculomotor palsy between January 1996 and March 1998 at the Casablanca University Hospital. Our orthoptic rehabilitation scheme was based on reinforcing the patient's sensorial potential using a prism dioper and motor capacities by soliciting vergency and version movements. RESULTS: The 10 patients (7 males, 3 females, mean age 39.5 years) had unilateral IV palsy (n =3), bilateral IV palsy (n= 1), unilateral VI palsy (n= 2), bilateral VI palsy (n= 1), partial unilateral III palsy (n= 1) and dissociated bilateral III palsy (n= 2). Mean delay to initiation of rehabilitation was 49 days and mean duration for treatment was 3 months. We achieved total recovery in 50% of the cases and partial recovery in 40%. Intermittent diplopia persisted in 10 per thousand of the cases. These results differ slightly from those in the literature where total regression is reported in about 50% of the patients after therapeutic abstention. CONCLUSION: This small series is insufficient to validate our method. The results obtained do however show that rehabilitation is safe and should be applied more widely in patients with oculomotor palsy.     

Activity of antimicrobial-impregnated silicone tissue expanders

Because bacterial colonization of medical devices may result in clinical infection, it is conceivable that antimicrobial impregnation of tissue expanders may reduce the rate of infection. The objective of this in vitro study was to examine the spectrum, durability, and shelf-life antimicrobial activity of minocycline/rifampin-impregnated silicone tissue expander shells. The impregnated devices exhibited zones of inhibition at baseline against Staphylococcus epidermidis, Staphylococcus aureus, and Escherichia coli. The impregnated devices exhibited strong residual activity against S. epidermidis and S. aureus after suspension in serum at 37 degrees C for 4 weeks. There was no significant decrease in the size of zones of inhibition after storing the impregnated devices at room temperature for 1 year. These results indicate that minocycline/rifampin-impregnated tissue expander shells provide broad-spectrum and durable antimicrobial activity and that the shelf-life antimicrobial activity exceeds 1 year. These findings prompt future exploration of the anti-infective efficacy of these antimicrobial-impregnated devices.     

Vesico-uterine fistula of obstetrical origin. Report of 3 cases

Vesico-uterine fistulae (VUF) lead to an abnormal breech between the bladder and the womb. They are responsible for urinary incontinence and/or cyclic hematuria. They are rare and, in most cases, lead to complications following caesarean deliveries. We report observations of 3 vesico-uterine fistulae treated over a 5 years period at university maternity based at Casablanca, Morocco; they all occurred following caesarean deliveries. These patients were consulted for urinary leakage occurring few weeks up to many years following surgical traumatism. Diagnosis was evoked clinically in all cases and confirmed by intravenous urography and/or hysterography. These VUF were successfully treated by simple breech suture at laparotomy. Treatment is very simple and efficient when the diagnosis is made early and fistula simple. Surgery is recommended after medical treatment failure aiming at fistula drainage.     

Prevalence of urinary incontinence in Moroccan women. Report of 1,000 cases]

An inquiry concerning the prevalence of urinary incontinence for the moroccan women has been archived about 1000 women aged more than 18 years to study prevalence, epidemiology and risk factors of urinary incontinence. 271 women among the 1000 women said that they had suffered from the mictional disorder at least one time during the last month, let 27.1%; 48.7% of the incontinent women are from 30 to 60 years; 22.5% are less than 30 years old, and 8.85% are more than 75 years old. Among these 271 women, 49.44% suffered from leakage after making an effort; 42.80% an imperiosity, and 7.76% spontaneous leakage. Seventy per cent among these women had level of study at least medium; 85.97% among these women suffered the discomfort; but 8.48% of them had been consulted for this disorder, 78.96% are able to consult a medical and to have a clinical or paraclinical exams. The elements who are responsible of this disorder are: menopause, parity, the use of forceps, the weight of first child birth over 3.5 kg, the perineal tearing. Among the medical antecedents we find: chronic bronchitis, urinary infections, chronic constipation, diabetes, and in the other way among surgical antecedents are: hysterectomy and prolapsus cure.     

Ocular damage during HIV infection at the University Hospital Center of Casablanca. (Apropos of 400 cases)

The objective of this study was to report ocular manifestations in Moroccan patients infected with HIV/AIDS. 400 patients were surveyed retrospectively from 1993 to 1998 as part of a co-operative study undertaken by the departments of infectious diseases and ophtalmology of the Casablanca Teaching Hospital. Of the 400 patients, 127 had an infection of the posterior segment and 7 showed signs of a palpebral infection. We also found 44 cases of opportunist retinal infections, dominated by the Cytomegalovirus (CMV) (18 cases). Our sample study indicates an intermediary position between western countries where the widespread use of the tritherapy has increased the life expectancy of patients and sub-Saharan Africa where epidemiological data are still characterised by high mortality and increasing endemic disease.