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Search Results: 1 - 10 of 10886 matches for " Pierre Hausfater "
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Dantrolene and heatstroke: a good molecule applied in an unsuitable situation
Pierre Hausfater
Critical Care , 2004, DOI: 10.1186/cc2939
Abstract: The magnitude of heat-related deaths during the August 2003 heatwave in France and conflicting discussions about Earth's global warming consequences have forced physicians to revisit an up to now rare disease: classic or environmental heatstroke (CHS) [1,2]. Indeed, most reported cases of CHS are sporadic except for a few previously published epidemics linked to unusual heatwaves [3,4]. The CHS therapeutic approach to date has therefore been limited to human case reports or experimental data on animal models.CHS is often compared with other extreme hyperthermia syndromes such as malignant hyperthermia and neuroleptic malignant syndrome, two situations where dantrolene administration has proved to reduce mortality. It therefore seemed superficially attractive to study the usefulness of dantrolene in CHS. The review by Hadad and colleagues aims to summarize previously published data on dantrolene use in CHS [5]. Overall, although there are conflicting results, analysis does not support the use of dantrolene in this situation. Notably, the few case reports that exhibited a beneficial effect were not confirmed in controlled studies. Moreover, heterogeneous study designs make data interpretation difficult, as dantrolene was used either as a preventive or curative therapeutic, either on humans or animals, and either in CHS or exertional heatstroke.The temptation to use dantrolene in CHS is the result of a misjudgement about pathophysiology. Dantrolene effectiveness in malignant hyperthermia does not result from direct action on the hypothalamic setpoint, but from reducing muscular heat production. Indeed, as discussed by Hadad and colleagues, malignant hyperthermia/neuroleptic malignant syndrome and CHS represent two clinical hyperthermia entities with quite different heat-generating pathophysiology: although muscular rigidity is the cornerstone of heat production in the former, massive thermoregulatory failure related to prolonged environmental heat exposure seems to be
Procalcitonina: ?marcador de elección de infección bacteriana en 2007?
Acta bioqu?-mica cl?-nica latinoamericana , 2009,
Abstract: la procalcitonina (pct) es un marcador precoz, sensible pero sobre todo específico de las infecciones bacterianas. después de haber sido estudiada, principalmente en reanimación, sus indicaciones se ampliaron a los servicios médicos y de urgencias. los campos de aplicación de la determinación de pct en medicina son variados: enfermedad inflamatoria versus complicación infecciosa, infección bacteriana versus infección viral, diagnóstico etiológico de meningitis con examen directo negativo o estado de shock, seguimiento de la eficacia de una terapia con antibióticos. la pct tiene igualmente un valor pronóstico en el sentido de que su aumento en el curso de una sepsis parece directamente proporcional a la intensidad de la reacción inflamatoria del huésped frente a la agresión microbiana.
Procalcitonina: marcador de elección de infección bacteriana en 2007?
P. Hausfater
Acta bioqu?-mica cl?-nica latinoamericana , 2009,
Abstract: La procalcitonina (PCT) es un marcador precoz, sensible pero sobre todo específico de las infecciones bacterianas. Después de haber sido estudiada, principalmente en reanimación, sus indicaciones se ampliaron a los servicios médicos y de urgencias. Los campos de aplicación de la determinación de PCT en Medicina son variados: enfermedad inflamatoria versus complicación infecciosa, infección bacteriana versus infección viral, diagnóstico etiológico de meningitis con examen directo negativo o estado de shock, seguimiento de la eficacia de una terapia con antibióticos. La PCT tiene igualmente un valor pronóstico en el sentido de que su aumento en el curso de una sepsis parece directamente proporcional a la intensidad de la reacción inflamatoria del huésped frente a la agresión microbiana.
Serum procalcitonin measurement as diagnostic and prognostic marker in febrile adult patients presenting to the emergency department
Pierre Hausfater, Ga?lle Juillien, Beatrice Madonna-Py, Julien Haroche, Maguy Bernard, Bruno Riou
Critical Care , 2007, DOI: 10.1186/cc5926
Abstract: This was a prospective, single centre, non-interventional study, conducted in the adult emergency department of an academic tertiary care hospital. We included patients with body temperature of 38.5°C or greater. A serum sample for measurement of PCT was collected in the emergency room. Patients were followed up until day 30. After reviewing the medical files, two independent experts, who were blind to the PCT results, classified each of the patients as having a bacterial/parasitic infection, viral infection, or another diagnosis.Among 243 patients included in the study, 167 had bacterial/parasitic infections, 35 had viral infections and 41 had other diagnoses. The PCT assay, with a 0.2 μg/l cutoff value, had a sensitivity of 0.77 and a specificity of 0.59 in diagnosing bacterial/parasitic infection. Of the patients with PCT 5 μg/l or greater, 51% had critical illness (death or intensive care unit admission) as compared with 13% of patients with lower PCT values.Bearing in mind the limitations of an observational study design, the judgements of the emergency department physicians were reasonably accurate in determining the pretest probability of bacterial/parasitic infection. PCT may provide additional, valuable information on the aetiology and prognosis of infection in the emergency department.Accurate identification of bacterial aetiology of fever in patients attending the emergency department (ED) is a desirable objective but it is often unattainable, largely because signs and symptoms of bacterial and viral infections overlap considerably. Delay in identifying pathogens from specimen cultures adds to the difficulty in establishing an aetiological diagnosis in the ED and leads to inappropriate use of antibiotics. In addition, estimation of the severity of bacterial infection is mostly based on the presence of characteristics suggestive of systemic inflammatory response syndrome, which may not be apparent when the patient is seen early in the course of the infecti
Cytokine Profiles in Sepsis Have Limited Relevance for Stratifying Patients in the Emergency Department: A Prospective Observational Study
Virginie Lvovschi, Laurent Arnaud, Christophe Parizot, Yonathan Freund, Ga?lle Juillien, Pascale Ghillani-Dalbin, Mohammed Bouberima, Martin Larsen, Bruno Riou, Guy Gorochov, Pierre Hausfater
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0028870
Abstract: Introduction Morbidity, mortality and social cost of sepsis are high. Previous studies have suggested that individual cytokines levels could be used as sepsis markers. Therefore, we assessed whether the multiplex technology could identify useful cytokine profiles in Emergency Department (ED) patients. Methods ED patients were included in a single tertiary-care center prospective study. Eligible patients were >18 years and met at least one of the following criteria: fever, suspected systemic infection, ≥2 systemic inflammatory response syndrome (SIRS) criteria, hypotension or shock. Multiplex cytokine measurements were performed on serum samples collected at inclusion. Associations between cytokine levels and sepsis were assessed using univariate and multivariate logistic regressions, principal component analysis (PCA) and agglomerative hierarchical clustering (AHC). Results Among the 126 patients (71 men, 55 women; median age: 54 years [19–96 years]) included, 102 had SIRS (81%), 55 (44%) had severe sepsis and 10 (8%) had septic shock. Univariate analysis revealed weak associations between cytokine levels and sepsis. Multivariate analysis revealed independent association between sIL-2R (p = 0.01) and severe sepsis, as well as between sIL-2R (p = 0.04), IL-1β (p = 0.046), IL-8 (p = 0.02) and septic shock. However, neither PCA nor AHC distinguished profiles characteristic of sepsis. Conclusions Previous non-multiparametric studies might have reached inappropriate conclusions. Indeed, well-defined clinical conditions do not translate into particular cytokine profiles. Additional and larger trials are now required to validate the limited interest of expensive multiplex cytokine profiling for staging septic patients.
Elevation of cardiac troponin I during non-exertional heat-related illnesses in the context of a heatwave
Pierre Hausfater, Beno?t Doumenc, Sébastien Chopin, Yannick Le Manach, Aline Santin, Sandrine Dautheville, Anabela Patzak, Philippe Hericord, Bruno Mégarbane, Marc Andronikof, Nabila Terbaoui, Bruno Riou
Critical Care , 2010, DOI: 10.1186/cc9034
Abstract: In a post hoc analysis, we evaluated 514 patients admitted to emergency departments during the August 2003 heat wave in Paris, having a core temperature >38.5°C and who had analysis of cTnI levels. cTnI was considered as normal, moderately elevated (abnormality threshold to 1.5 ng.mL-1), or severely elevated (>1.5 ng.mL-1). Patients were classified according to our previously described risk score (high, intermediate, and low-risk of death).Mean age was 84 ± 12 years, mean body temperature 40.3 ± 1.2°C. cTnI was moderately elevated in 165 (32%) and severely elevated in 97 (19%) patients. One-year survival was significantly decreased in patients with moderate or severe increase in cTnI (24 and 46% vs 58%, all P < 0.05). Using logistic regression, four independent variables were associated with an elevated cTnI: previous coronary artery disease, Glasgow coma scale <12, serum creatinine >120 μmol.L-1, and heart rate >110 bpm. Using Cox regression, only severely elevated cTnI was an independent prognostic factor (hazard ratio 1.93, 95% confidence interval 1.35 to 2.77) when risk score was taken into account. One-year survival was decreased in patients with elevated cTnI only in high risk patients (17 vs 31%, P = 0.04).cTnI is frequently elevated in patients with non-exertional heat-related illnesses during a heat wave and is an independent risk factor only in high risk patients where severe increase (>1.5 ng.mL-1) indicates severe myocardial damage.In contrast to exertional heatstroke related to a high production of heat during strenuous exercise, non-exertional or classic heatstroke results from prolonged exposure to high temperature [1]. Classic heatstroke is encountered in tropical areas, but exceptional heat waves have been increasingly reported in temperate countries [2-4], and are possibly related to climate change [5]. The health consequences of these heat waves can be catastrophic leading to overcrowding of health facilities [6], excess mortality [7] and poor lon
Twelve Months of Routine HIV Screening in 6 Emergency Departments in the Paris Area: Results from the ANRS URDEP Study
Enrique Casalino, Bruno Bernot, Olivier Bouchaud, Chakib Alloui, Christophe Choquet, Elisabeth Bouvet, Florence Damond, Sandra Firmin, Aurore Delobelle, Beatrice Ename Nkoumazok, Guillaume Der Sahakian, Jean-Paul Viard, Olivier Zak Dit Zbar, Elisabeth Aslangul, Anne Krivine, Julie Zundel, Jade Ghosn, Patrice Nordmann, Yann-Erick Claessens, Tassadit Tahi, Bruno Riou, Agnès Gautheret-Dejean, Christine Katlama, Pierre Hausfater, Fran?oise Brun-Vézinet, Dominique Costagliola
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0046437
Abstract: Objective In October 2009 the French National Authority for Health recommended that HIV testing be proposed at least once to all persons aged 15 to 70 years in all healthcare settings. We examined whether routine HIV screening with a rapid test in emergency departments (EDs) was feasible without dedicated staff, and whether newly diagnosed persons could be linked to care. Methods This one-year study started in December 2009 in 6 EDs in the Paris area, using the INSTI? test. Eligible individuals were persons 18 to 70 years old who did not present for a vital emergency, for blood or sexual HIV exposure, or for HIV screening. Written informed consent was required. Results Among 183 957 eligible persons, 11 401 were offered HIV testing (6.2%), of whom 7936 accepted (69.6%) and 7215 (90.9%) were tested (overall screening rate 3.9%); 1857 non eligible persons were also tested. Fifty-five new diagnoses of HIV infection were confirmed by Western blot (0.61% (95% CI 0.46–0.79). There was one false-positive rapid test result. Among the newly diagnosed persons, 48 (87%) were linked to care, of whom 36 were not lost to follow-up at month 6 (75%); median CD4 cell count was 241/mm3 (IQR: 52–423/mm3). Conclusions Screening rates were similar to those reported in opt-in studies with no dedicated staff. The rate of new diagnoses was similar to that observed in free anonymous test centres in the Paris area, and well above the prevalence (0.1%) at which testing has been shown to be cost-effective.
Bending Fuchsian representations of fundamental groups of cusped surfaces in PU(2,1)
Pierre Will
Mathematics , 2011,
Abstract: We describe a family of representations of $\pi_1(\Sigma)$ in PU(2,1), where $\Sigma$ is a hyperbolic Riemann surface with at least one deleted point. This family is obtained by a bending process associated to an ideal triangulation of $\Sigma$. We give an explicit description of this family by describing a coordinates system in the spirit of shear coordinates on the Teichm\"uller space. We identify within this family new examples of discrete, faithful and type-preserving representations of $\pi_1(\Sigma)$. In turn, we obtain a 1-parameter family of embeddings of the Teichm\"uller space of $\Sigma$ in the PU(2,1)-representation variety of $\pi_1(\Sigma)$. These results generalise to arbitrary $\Sigma$ the results obtained in a previous paper for the 1-punctured torus.
Two Generator groups acting on the complex hyperbolic plane
Pierre Will
Mathematics , 2015,
Abstract: This is an expository article about groups generated by two isometries of the complex hyperbolic plane.
How to Introduce the Cyclic Group and Its Properties Representation with Matlab ? Thanks to Magic Using the Perfect Faro Shuffle  [PDF]
Pierre Schott
Creative Education (CE) , 2011, DOI: 10.4236/ce.2011.21005
Abstract: Why use Magic for teaching arithmetic and geometric suit, additive groups, and algorithmic notions through Matlab? Magicians know that, once the surprise has worn off, the audience will seek to understand how the trick works. The aim of every teacher is to interest their students, and a magic trick will lead them to ask how? And why? And how can I create one myself? In this article we consider a project I presented in 2009. I summarize the project scope, the students' theoretical studies, their approach to this problem and their computer realizations. I conclude using the mathematical complement as well as weak and strong points of this approach. Whatever the student's professional ambitions, they will be able to see the impact that originality and creativity have when combined with an interest in one's work. The students know how to “perform” a magic trick for their family and friends, a trick that they will be able to explain and so enjoy a certain amount of success. Sharing a mathematical / informatics demonstration is not easy and that they do so means that they will have worked on understood and are capable of explaining this knowledge. Isn't this the aim of all teaching?
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