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J-F Bergmann

Publications and source records attributed to J-F Bergmann.

8 recordsLinked to original sources
PubMed2006

A prospective observational study of a cohort of outpatients with an acute medical event and reduced mobility: incidence of symptomatic thromboembolism and description of thromboprophylaxis practices.

OBJECTIVES: The study was performed to determine the incidence of symptomatic venous thromboembolism in outpatients with an acute medical event causing temporary reduced mobility. Risk factors for venous thromboembolism and thromboprophylaxis practices were also studied. DESIGN: This was a prospective, observational, multicentre, cohort study. SETTING: General practitioners randomly selected from a registry of 25,000 active representative doctors in France including eligible outpatients. SUBJECTS: Outpatients aged at least 40 years anticipated to have reduced mobility for at least 48 h due to an acute medical event were eligible. INTERVENTIONS: None required. MAIN OUTCOME MEASURES: Symptomatic deep-vein thrombosis and pulmonary embolism at 3 weeks were the main study end-points. RESULTS: Overall, 16,532 evaluable patients of mean age 71 years were recruited between October 2002 and June 2003 by 2895 doctors. The main acute medical events leading to reduced mobility were infection, acute rheumatism and falls without fracture. The incidence rates (95% confidence interval) of symptomatic deep-vein thrombosis and pulmonary embolism were 1% (0.84-1.14) and 0.20% (0.13-0.27) respectively. Venous insufficiency in legs, cancer, and a personal or family history of venous thromboembolism were independent risk factors for venous thromboembolism. Pharmacological thromboprophylaxis was initiated in 35.0% (n=5782) of the patients. The principal driver of prescription was a personal history of venous thromboembolism. CONCLUSIONS: The risk of symptomatic venous thromboembolism in outpatients with reduced mobility for medical reasons is close to that reported in medical and surgical inpatients. This risk and the potential need for thromboprophylaxis should be taken into account by primary care doctors.

Acute Disease↗
PubMed2005

[Troponin and other markers of myocardial ischemia injury, what is the relevance in internal medicine?].

PURPOSE: Troponin is now the gold standard for the diagnosis of myocardial infarction. Aiming at improving the management of a patient suspect of an acute coronary syndrome, this article will point the interpretation of troponin dosages according to the clinical presentation and concomitant diseases. ACTUALITIES: First, the interest of troponin dosage as compared with other markers of myocardial ischemia will be underlined. Then, the literature available about troponin in cardiovascular diseases but also in extracardiac diseases will be analysed. Finally, the difficulties of assay will be discussed. PERSPECTIVES: The availability of a sensitive and specific marker such as troponin is definitively a progress in the management of patients with an acute coronary syndromes. But it remains a biological contribution to the global management of the patient. It is important to know the causes susceptible to increase the levels of troponin to avoid a wrong interpretation of the dosage, leading to diagnostic but also therapeutic mistakes.

Biomarkers↗
PubMed2005

Venous thromboembolism in the medically ill patient: a call to action.

The risk of venous thromboembolism (VTE) in medical patients is generally underestimated. However, recent studies including two large double-blind placebo-controlled trials, the Prospective Evaluation of Dalteparin Efficacy for Prevention of VTE in Immobilised Patients trial (PREVENT) and prophylaxis in MEDical patients with ENOXaparin, study show that low-molecular-weight heparins (LMWHs) provide effective thromboprophylaxis for medical patients at risk from VTE without increasing the risk of bleeding. In PREVENT the significant 45%, reduction in VTE among patients receiving dalteparin 5000 IU once daily for 14 days was attributed entirely to a reduction in clinically relevant VTE. The recently published guidelines for the prevention and treatment of VTE, issued by the American College of Chest Physicians, recommend prophylaxis with LMWHs (or low-dose unfractionated heparin) in acutely ill medical patients with risk factors for VTE (grade 1A). Current evidence should encourage the more widespread adoption of thromboprophylaxis in at-risk medical patients, and thus reduce the number of preventable deaths and complications due to VTE.

Anticoagulants↗
PubMed2005

Factors associated with virological response in HIV-infected patients failing antiretroviral therapy: a prospective cohort study.

OBJECTIVES: To assess the antiviral response to optimized therapy following genotypic resistance testing and to identify factors associated with virological response in HIV-1-infected patients failing antiretroviral therapy. METHODS: A prospective cohort study was conducted in 344 HIV-1-infected patients who underwent genotypic resistance testing because of virological failure. Virological response was defined as a plasma HIV RNA level below 200 HIV-1 RNA copies/mL or a drop of plasma viral load from baseline of more than 1 log10. A multivariate logistic regression analysis was performed to identify factors associated with virological response. RESULTS: The median age of the patients was 40 years, with a male to female ratio of 4:1. Fifty-one per cent of patients had received the three major classes of antiretrovirals and the median duration of previous antiretroviral therapy was 4.6 years. At baseline, the median plasma HIV RNA level was 4.4 log10 copies/mL and the median CD4 cell count was 274 cells/microL. At 3 months, 55% of patients (188 of 344) had a virological response, which was sustained at 6 months (53%). Predictors of virological response were exposure to two or fewer protease inhibitors [odds ratio (OR) 1.8; P=0.046], and use in optimized therapy of a new class of antiretrovirals (OR 2.9; P=0.006), of more than two new drugs (OR 3.0; P<0.0001), of abacavir (OR 1.9; P=0.03), or of lopinavir/ritonavir (OR 3.7; P=0.0002). CONCLUSIONS: A high proportion of patients achieved a short-term virological response in this cohort study. Patients with the least experience of protease inhibitor treatment and in whom a new class of antiretroviral, more than two new drugs, abacavir or lopinavir/ritonavir was used in optimized therapy had the best virological outcome.

Adult↗
PubMed2003

[An aetiological survey of venous thromboembolic disease. What examinations for which patients? 104 observations].

OBJECTIVE: The objective of the study was to determine, depending on the risk profile of the patients and characteristics of the venous thromboembolic disease (VTED), the interest of an aetiological control in the search for a neoplasia or abnormality in haemostasis among a cohort of patients hospitalised for deep-vein thrombosis (DVT) and/or pulmonary embolism (PE). METHOD: This was a single centre, retrospective study of 104 files of patients hospitalised over a period of 3 years for DVT and/or PE in a department of internal medicine, in an intensive care unit. The patients included must have been diagnosed with DVT and/or PE, confirmed by respectively venous Doppler, pulmonary scintigraphy and pulmonary angiography or spiralled tomodensitometry. The thromboembolic risk factors and the supplementary examinations conducted for etiological research were analysed. RESULTS: In our population, with a mean age of 71.4 years, 98 patients exhibited at least one thromboembolic risk factor. The thromboembolic episode was considered as idiopathic in 33 patients, i.e. in 31.7%. An abnormality in haemostasis was discovered in 10 patients, with a mean age of 57.5 years and 7 exhibited personal or familial past history of venous thromboembolic disease. Nine neoplasia were discovered, 4 of which were at metastatic stage. There was no significant difference in discovery of a neoplasia with regard to age, but it was more frequent in cases of seemingly idiopathic thrombosis. Anamnesis and the clinical examination suggested its existence in 6 patients. Abdominal-pelvic sonography was sufficient to orient the etiological research in 7 cases. The other examinations without clinical orientation (endoscopy, tumour markers) provided no further contribution. CONCLUSION: We feel that systemic exhaustive survey in search of the etiology of a DVT/PE in all patients is not warranted. Simple explorations--including interrogation, complete clinical examination, current biological examinations (blood count, sedimentation rate), pulmonary x-ray and abdominal-pelvic sonography--were evocative in our series. Haemostasis tests should be reserved for young patients or for those in whom thromboembolic events occur repeatedly. The more specific examinations should be set-aside for patients in whom this first assessment has not suggested an underlying carcinoma.

Adult↗