PART 2: Practice and research recommendations for quality developmental care in the NICU

Developmental care interventions, which may promote preterm infant's neurodevelopment during the hospitalization in the Neonatal Intensive Care Unit, should be implemented and integrated to care delivered by nurses, other healthcare professionals, and parents. These interventions may have an impact on the preterm infants' developing brain and optimize their short and long-term health outcomes. Based on a previous narrative overview, more high-quality research is still needed in this field. Nevertheless, best practice of developmental care can still be recommended to improve today's neonatal clinical practice. The aim of this article is to provide both practice and research recommendations according to the seven categories of developmental care interventions in the neonatal intensive care unit: family-centered care, sleep protection, assessment and management of pain, infant positioning, optimized infant-driven feeding, administration of human milk, and control of the environmental light and noise.     

Sophrology versus resistance training for treatment of women with fibromyalgia: A randomized controlled trial

IntroductionPhysical training has been recommended to improve overall well-being in patients with fibromyalgia. Body relaxation exercises also seem to have some beneficial effect, however there is no consensus regarding this modality.ObjectiveComparing the effectiveness of sophrology and resistance training in improving the pain of women with fibromyalgia.MethodA randomized controlled clinical trial with a blind evaluator. Sixty (60) women with a medical diagnosis of fibromyalgia were randomized and included in two groups: sophrology group (SG) who participated in a relaxation program based on sophrology (n = 30), and resistance group (RG) (n = 30) who participated in a resistance training program for biceps, pectoral, triceps, knee extensors, trapezius, knee flexors, hip abductors. Both groups were treated twice a week for 12 weeks and reevaluated every 4 weeks. The assessment instruments used were the Visual Analog Scale for Pain (VAS), the one-repetition maximum test (1 RM), the overall quality of life (SF-36), the 6-min walk test (6MWT), the Timed Up and Go test (TUG) and the Fibromyalgia Impact Questionnaire (FIQ).ResultsWe found that the RG presented statistically significant decreases in pain (VAS) during the evaluations (p < 0.05) and increased strength of the evaluated muscles (p < 0.05). A statistically significant decrease in pain (p < 0.05) was observed in the SG compared to T0, with no significant differences in muscle strength. Differences between groups were observed, with better indices only for 6MWT and functional capacity domain of the SF36 for the RG (p < 0.05).ConclusionNo differences in pain were found between the groups. Resistance training was more effective than sophrology in improving strength and functional capacity of women with fibromyalgia.     

Influence of nicotinic acid on the rates of turnover and oxidation of plasma glucose in man

The effects of antilipolysis induced by nicotinic acid on the rates of turnover and oxidation of plasma glucose were studied in normal overnight fasted, obese overnight fasted, and obese starved subjects, using a ¹⁴C-glucose infusion technique. Changes induced by nicotinic acid were similar whatever the nutritional state of the subjects. Plasma FFA levels and blood concentrations of glycerol and ketones decreased by about 60%; glycemia remained essentially unchanged but both the removal rate of plasma glucose and the hepatic glucose output increased by about 25%. Moreover, the fraction of glucose taken up by tissues and promptly oxidized and the fraction of expired CO₂ derived from plasma glucose increased, respectively, by 18% and 33%. This enhancement of glucose utilization occurred despite a small but significant decrease in plasma IRI concentration, indicating that nicotinic acid increased sensitivity to insulin. The above-mentioned results were obtained in 8 of the 10 patients studied. The remaining two subjects did not respond to the administration of nicotinic acid by any significant decrease in FFA nor in glycerol concentrations and showed no change in the rates of glucose turnover and oxidation. These data indicate that the effects of nicotinic acid on glucose metabolism may be partly mediated through changes in plasma FFA concentration and are consistent with the idea that the “glucose-fatty acid cycle” plays a significant role in the control of glucose metabolism in man.     

Association of HTR2A-1438G/A Genetic Polymorphism With Smoking and Chronic Obstructive Pulmonary Disease

Introduction

Cigarette smoking is a major risk factor in the development of chronic obstructive pulmonary disease (COPD). Serotonin levels have been associated with COPD and smoking has been as a significant modulator. Elevated levels of serotonin are responsible for bronchoconstriction and pulmonary vasoconstriction and also nicotine dependence, thus serotonin response could be affected by genetic polymorphisms in transporters and receptors of serotonin.

Exploration des conjonctivites allergiques : comment explorer ?

The management of allergic conjunctivitis requires a specific approach, which can be divided into three particular schemes: (1) faced with a benign acute seasonal or chronic conjunctivitis, the workup should include skin prick-tests and assays for specific IgE antibodies. The allergens to use and the criteria for a positive reaction should be adapted to the condition of the ocular surface. When not clinically evident, the pertinence of the tests to be used will depend on the results of conjunctival provocation tests; they can be done on an ambulatory basis ; (2) contact allergy should be suspected in another context, that is, when the patient is older and the lesion looks more like blepharitis than conjunctivitis. Patch tests or open testing can detect many allergies, such as eye drop additives, various cosmetics and occupational allergens ; (3) when confronted with vernal or atopic kerato-conjunctivitis, arguments in favour of an allergy of the ocular surface may be obtained by comparing results of lachrymal and blood assays (eosinophils, ECP, total IgE). When sensitization is obvious, conjunctival allergen challenge is indicated with the suspected allergen in a specialized clinic. Then specific allergic treatment can be evaluated.     

Aneurysms of the sinus of Valsalva. Report of seven cases and review of the literature

The aneurysms of the sinuses of valsalva are relatively rare. The first case was described by Thurnam in 1840. Since then, more than 200 cases have been reported; in most surgery was performed. The lesions of the aortic sinuses are either congenital or the result of the syphilis or of the bacterial endocarditis.Between 1967 and 1976, seven patients (four men and three women) with this pathology were admitted to the Hospital Cantonal of Geneva (HCG). Their ages ranged from 13 to 51 years. Clinical symptoms consisted of chest pain, palpitations, dyspnea, cardiac insufficiency and fever. In one patient, a sudden cardiovascular shock was present. Physical examination had revealed a systolic and/or diastolic thrill in four patients, and a systolic and diastolic murmur on the left sternal edge in all. An increase in the differential arterial pressure was found in all patients and hepatomegaly in two. The electrocardiograms showed signs of left ventricular hypertrophy in five patients, right ventricular hypertrophy in four, incomplete right bundle branch block in one and signs of a subendocardial ischemic lesion in another. The chest films indicated a severe or moderate heart dilatation in all seven patients and an enlarged hilar area in six.All patients had been subject to cardiac catheterization. Rightsided pressures were increased in the majority of patients. Arterial and pulmonary capillary pressures were increased in all. A correct preoperative diagnosis had been made only twice.Cardiac surgery had been performed with cardiopulmonary bypass in all patients. The aneurysm was ruptured into the right ventricle in four patients and unruptured in the others. The lesion originated from the right coronary sinus in six patients and from both right and left coronary sinuses in one. Ventricular septal defects (three) and aortic lesions (five) were also found. The postoperative course was uneventful and all patients are still alive.