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Biomedical subjects

M Druet-Cabanac

Publications and source records attributed to M Druet-Cabanac.

At least 19 recordsLinked to original sources
PubMed2006

[Dépistage de l'épilepsie en zones tropicales: validation d'un questionnaire en Mauritanie].

Prevalence of epilepsy in developing countries is considered to be 2 to 5 times superior to the industrialized countries. In tropical areas, the diagnosis of epilepsy is still reliant on the clinic and requires a precise semiological description. A good epidemiological and clinical research requires standardized and validated screening tools. The objective of this work was to evaluate the validity of the screening module of the investigation questionnaire on epilepsy in tropical areas, in Nouakchott, Mauritania. All the patients included in the study were examined at first by a neurologist, then directed towards an investigator who asked the 5 screening items of the investigation questionnaire. Any person answering "yes" at least one question was regarded as "suspected of epilepsy" by the investigator. Secondly the neurologist re-examined the subjects and confirmed the diagnosis. The sensitivity and the specificity of the module of screening were calculated. On the whole, 236 patients were included in the study 131 had answered "yes" at least one of the questions of the module of screening and was regarded as "suspected" of epilepsy (55.5%) by the questionnaire. The diagnosis of epilepsy was made for 82 subjects by the neurologist. The sensitivity of the module of screening of the epilepsy was 95.1% (CI 95%: 87.3-98.4) and specificity was 65.6% (CI 95%: 57.5-72.9). The screening module of the investigation questionnaire of epilepsy in tropical zones, made up only by 5 questions, has diagnosis qualities acceptable and comparable with those reported in the literature. The use of this tool integrated in a more general questionnaire of investigation of the. epilepsy proves to be an essential instrument in conducting epidemiologic studies in epileptology' in tropical zones.

Adolescent↗
PubMed2005

[Electroencephalograms (EEG) in 250 patients with epilepsy in a cysticercosis endemic area in Burundi].

OBJECTIVES: This work aimed at describing EEG abnormalities in epileptic patients living in areas endemic for cysticercosis, underlining the electroclinical correlations and discussing the interest of EEG examination in this context. METHODS: During a case-control study, 250 EEGs from patients with epilepsy were recorded with a portable system. Types of seizures were assessed clinically and from information obtained through a standardised questionnaire, and along with EEG were related to the results of cysticercosis serological tests. RESULTS: Among the 249 EEGs, 48% were normal, 5.2% had epileptic abnormalities, 6.8% showed an association between epileptic abnormalities and slow alterations. Slow theta and delta abnormalities were found in 21.8% of cases, and isolated deterioration of basic rhythms was observed in 17.3% of cases. Most seizures were generalized, and 61% of the patients had positive serology. One EEG was uninterpretable and another showed isolated spikes. Electroclinical agreement was considered to be satisfactory in 33 patients, and was better with the epileptic than with slow abnormalities. The existence of epileptiform EEG abnormalities confirmed clinically diagnosed epilepsy, but did not allow etiological diagnosis. Electroserological agreement was good in 24 patients. A significant association (Chi2, p = 0.03) existed between slow focal abnormalities and positive cysticercosis serology. Conversely, no significant association was detected between epileptic patterns and serology results. CONCLUSION: While the EEG alone clearly does not allow aetiological diagnosis, its joint use with clinical and biological results was a key element of the etiological and therapeutic discussion. When it shows focal abnormalities in a patient with epilepsy living in a high prevalence cysticercosis area, it confirms the clinical suspicion of neurocysticercosis. Morphological imagery alone can provide etiological information on the seizures by showing the nature and localization of the parenchymal lesions.

Adult↗
PubMed2004

[Cysticercosis and epilepsy: a case-control study in Mbam Valley, Cameroon].

The impact of neurocysticercosis in Africa is not well known, and its role in the occurrence of epilepsy is not well defined. The concomitant high prevalence of both diseases in this region suggests a causal association of cysticercosis and epilepsy. The few attempts to find such a link in Africa have yielded discordant data. In order to answer this question, we conducted a case-control study between June and August 1998 in the Bilomo village in Central Cameroon, where a recent study had demonstrated very high epilepsy prevalence of 58/1000. Ninety-three epilepsy patients and eighty-one age matched controls were included. All subjects were examined by a neurologist and serology for cysticercosis was performed using an ELISA method. Serologies for cysticercosis were positive in twenty-nine out of one hundred and seventy four patients (16.7%; 95% CI: 11.6-23.2). Seventeen cases (18.3%) and twelve controls (14.8%) had a positive serology The odd ratio was 1.3 (95% CI: 0.6-3.0). This study was not in favour of an epidemiological relationship between cysticercosis infection and epileptic disorders.

Adolescent↗
PubMed2003

[Neurological manifestations of fish, mollusk and shellfish poisoning].

Sea-food poisoning is observed in several areas of the world. Intoxication results from ingestion of fresh fish, mollusks, or shellfish contaminated by toxins produced by microorganisms (dinoflagellates). Neurological manifestations are sometimes associated with signs and may be life-threatening. We describe here the principle toxins, their geographic distribution, clinical manifestations, therapeutic management, and possible prevention measures.

Adult↗
PubMed2002

[Contribution of computerized tomography in the diagnosis of cerebrovascular accidents in Nouakchott, Mauritania].

This prospective study was focused on the radiological features of stroke and the recent contribution of computerized tomographic scan (CT scan) to diagnosis of hospitalized stroke patients. All patients admitted for stroke to the Neurology Department of the Nouakchott Hospital between January 1, 1996 and June 30, 1997 were enrolled in this study. Patients were divided into two groups, i.e. CT group including patients that underwent CT scan during hospitalization and control group including patients that did not undergo CT scan for financial reasons. The etiology of stroke (35.1% of hospitalizations) was ischemic in 52% of cases and hemorrhagic in 48%. There were more men than women and mean age was 60 years for ischemic stroke versus 56 years for hemorrhagic stroke. Only 8% of patients presented documented diabetes. Deep infarction accounted for 52% of ischemic stroke including large-artery infarction in 61.2% and lacunar infarction in 38.8%. Superficial infarction usually involved the territory supplied by the superficial sylvian artery. Intraparenchymal hematomas accounted for 78% of hemorrhagic strokes in relation with the high incidence of arterial hypertension (65.2%). The most common locations were capsulo-lenticular (55%) and capsulo-thalamic (39%). Stroke-related mortality was high (20.3%) especially in patients presenting prolonged disturbances of consciousness and renal insufficiency. By allowing more accurate assessment of lesions, CT-scan improved patient management and therapeutic outcome.

Adult↗
PubMed2002

[Quality of medical records in the "Medical Information System Program": application of the lot quality assurance sampling method].

BACKGROUND: The aim of this study was to validate a new method of quality control of medical records of the "Medicalisation of Information System Program" (P.M.S.I.) in Limoges university hospital. METHODS: Lot quality assurance sampling (L.Q.A.S.), developed to meet industrial quality control needs, has been applied. This method allows to give an opinion on the quality of a lot from a sample randomised in this lot. Ten hospital units have been randomised. During three months, these medical units have recoded ten medical units abstracts (R.U.M.) which were randomised each month within their stays. If five or more R.U.M. had been modified on Principal Diagnosis (D.P.), Associated Significant Diagnosis (D.A.S.) or Diagnosis Related Group (D.R.G.), the lot was rejected. The hospital unit had then less 70% R.U.M. of good quality (alpha=5%). The global errors rates were compared to the results of usually performed quality control (1998). RESULTS: Nine hospital units were included. Hospital units which already had a low quality rate during the 1998 quality control had also an insufficient quality by L.Q.A.S. method. Among these, 33.7 [CI(95%): 21.6-45.8] R.U.M. have been modified. Medical units had a poorer data quality than surgical ones. No statistically significant difference was shown between 1998 errors rates and L.Q.A.S. rates, except for D.P. (p=0.002). CONCLUSION: L.Q.A.S. is easy to apply, could be repeated more frequently than usual controls, and allows to detect hospital units which require a faster action. This process could be applied to P.M.S.I., in which the search of quality is necessary because of the new cost model which includes secondary D.R.G.

Abstracting and Indexing↗
PubMed2002

[Sociocultural aspects of epilepsy in secondary school students in Bobo-Dioulasso (Burkina Faso)].

In Black Africa, epilepsy is usually affected by sociocultural attitudes. A school survey concerning epilepsy was conducted in February 1999 in Bobo-Dioulasso, an Islamic region. Knowledge and attitudes towards epilepsy in secondary school students was evaluated through focus group discussions done in secondary schools. Epilepsy was supposed to be a chronic disease attributed to brain damage, or spiritual. The students usually described the "Grand Mal" generalized tonic-clonic form of epilepsy. Epilepsy is believed to have hereditary causes and the students believed it to be contagious through saliva and physical contact. For students, epilepsy cannot be cured. When a treatment was proposed, only traditional medicine was supposed to be competent. If burns occur in the course of the disease, the prognosis is supposed to be bad. Generally fear and mistrust are dominant feelings among students despite the fact they are literate urban population. Their belief in the contagiousness of epilepsy could be a major reason for discriminating against an epileptic person. Our data suggest that there is a need to make additional efforts in order to increase the knowledge of the general population and the level of formal education. Poor knowledge and lack of information explained secondary school students attitudes towards epilepsy in Bobo-Dioulasso.

Adolescent↗
PubMed2001

Expression of p53 protein in T- and natural killer-cell lymphomas is associated with some clinicopathologic entities but rarely related to p53 mutations.

To determine if p53 abnormalities could be involved in the pathogenesis of T- or natural killer (NK)-cell lymphomas, we investigated 51 cases of these lymphomas for the expression of p53 and its relationship with p53 gene mutations, the expression of the p21 protein as well as the proliferative and apoptotic indices. Overexpression of p53 was found in 19 cases (37%), whereas mutations of the p53 gene were observed in only 5 of 28 tested cases. The analysis of immunohistochemical data showed some entity-related phenotypic profiles. Anaplastic large cell lymphomas showed a frequent overexpression of p53 (7/8 cases) and p21 (6/8 cases) proteins and rare p53 mutations (1/7 cases), suggesting accumulation of a functional wild type p53 protein able to induce p21 expression. Nodal peripheral T-cell lymphomas unspecified showed relatively frequent overexpression of p53 protein (5/7 cases), infrequent p21 expression (2/7 cases), and rare p53 gene mutations (1/6 cases). In angioimmunoblastic lymphomas, the common phenotype was p53-/p21- (15/17 cases), with only a few scattered p53-positive cells, which, on the basis of double staining results, were mostly Epstein-Barr virus-infected B cells. A p53 gene mutation was only found in 1 case (1/8 cases) of angioimmunoblastic lymphoma, which showed cytologic tumor progression. Mycosis fungoides showed p53 overexpression in 2 of 4 cases, including 1 case with p53 gene mutation and features of cytologic tumor progression. Nasal NK/T lymphomas showed p53 overexpression in 2 of 5 cases, 1 of which had a p53 gene mutation. Finally, all lymphoblastic T-cell lymphomas (5 cases) and gammadelta hepatosplenic T-cell lymphomas (3 cases) were negative for expression of p53 and p21 proteins. We conclude that p53 protein overexpression is a common finding in some entities of T- and T/NK-cell lymphomas, whereas a p53 gene mutation is a rare, sporadic, and rather late event associated with tumor progression in some instances. The p53/p21 expression pattern appears to be variable in T- and T/NK-cell lymphoma entities, reinforcing the concept of distinct, entity-related mechanisms of pathogenesis in these tumors.

Adolescent↗
PubMed2000

Estimation of the amyotrophic lateral sclerosis incidence by capture-recapture method in the Limousin region of France.

Amyotrophic lateral sclerosis (ALS) is a rapidly fatal degenerative neurological disease categorized among motor neuron diseases. In the literature, the incidence of ALS varies between 0.7 and 2.4 per 100, 000 inhabitants. A study using the capture-recapture method (multiple records system analysis) was undertaken in Limousin (France) ascertaining all patients having onset of definite or probable ALS during the period 1994-1995. Three information sources able to identify these new ALS cases were selected: the first source was a computerized database of the Neurology Department of the University Hospital of Limoges; the second source consisted of the neurologists of the Limousin region and neighboring provinces (county-sized regions); the third source grouped the hospitals of the Limousin region and neighboring provinces (county-sized regions). During this period, 46 new cases of ALS were seen, corresponding to an observed mean annual incidence of 3.2 (+/-0.6) per 100,000 inhabitants. After standardization for age, the annual incidence was 2.5 per 100,000 inhabitants. The number of new cases estimated by the capture-recapture method was 70, corresponding to an estimated mean annual incidence of 4.9 (+/-1.0) for 100,000 inhabitants. Hence, statistical modeling utilizing partially overlapping information sources permitted a more exhaustive compendium of the new cases of ALS and may be a truer reflection of actual disease incidence than has been previously reported.

Amyotrophic Lateral Sclerosis↗
PubMed2000

Estimation of the prevalence of epilepsy in the Benin region of Zinvié using the capture-recapture method.

BACKGROUND: The prevalence of epilepsy was estimated in two villages of 3134 inhabitants, in Benin, in April and May 1997 using the capture-recapture method. METHODS: Information was obtained from (i) a door-to-door cross-sectional study, (ii) a non-medical source consisting of key informants (traditional practitioners, teachers, village leaders, and religious representatives) and (iii) a medical source through evaluation of medical records in health centres. In all the three situations, the diagnosis of epilepsy was confirmed by a neurologist. RESULTS: The door-to-door survey found 50 epileptics, i.e. a prevalence of 15.9 per 1000. The non-medical source found 26 patients. The medical source found only four patients. In total, 66 epileptics were found by combining the three sources, giving a prevalence of 21.1 per 1000. After application of the capture-recapture method, the estimated number of cases from the door-to-door survey and non-medical source was 105, and 110 cases when the medical source was considered as well. The respective prevalences were 33.5 per 1000, and 35.1 per 1000. CONCLUSIONS: The door-to-door survey has been usefully improved by using key informants. The epilepsy prevalence estimate found by capture-recapture is clearly higher than that found by traditional cross-sectional methods, and could better depict the frequency of epilepsy in Africa.

Adolescent↗
PubMed2000

[Interest of a computerized ALS database in the diagnosis and follow-up of patients with ALS].

The aim of the study is to present a computerized database of the Neurology department of Limoges University Hospital and the main results obtained from data of 340 patients suffering from amyotrophic lateral sclerosis (ALS), diagnosed between 1984 and 1997. It is a user friendly and can be accessed by all neurologists at any level of computer knowledge. This database is modular (6 modules) and flexible according to need. The software used, Access 7, is an open relation database, which allows export of data to statistical or other compatible software. One of the reasons, which led to the elaboration of this database was to develop a means of collecting data in an analyzable manner for therapeutic trials. During these trials, a great number of data can be collected during each clinic visit for the evaluation of the degree of impairment, disability, and handicap. We present part of the data from the patients followed, some of whom were treated with riluzole, the current reference molecule for ALS.

Aged↗
PubMed1999

Onchocerciasis and epilepsy: a matched case-control study in the Central African Republic.

The occurrence of epileptic seizures during onchocercal infestation has been suspected. Epidemiologic studies are necessary to confirm the relation between onchocerciasis and epilepsy. A matched case-control study was conducted in dispensaries of three northwestern towns of the Central African Republic. Each epileptic case was matched against two nonepileptic controls on the six criteria of sex, age (+/-5 years), residence, treatment with ivermectin, date of last ivermectin dose, and the number of ivermectin doses. Onchocerciasis was defined as at least one microfilaria observed in iliac crest skin snip biopsy. A total of 561 subjects (187 cases and 374 controls) were included in the study. Of the epileptics, 39.6% had onchocerciasis, as did 35.8% of the controls. The mean dermal microfilarial load was 26 microfilariae per mg of skin (standard deviation, 42) in the epileptics and 24 microfilariae per mg of skin (standard deviation, 48) in the controls. This matched case-control study found some relation (odds ratio = 1.21, 95% confidence interval 0.81-1.80), although it was nonstatistically significant.

Adolescent↗
PubMed1999

Long-term cyclosporin continuation rates in rheumatoid arthritis patients.

OBJECTIVE: To evaluate the continuation rate of cyclosporin therapy in rheumatoid arthritis patients followed for at least three years. METHODS: Retrospective medical chart review of rheumatoid arthritis patients on cyclosporin. Treatment efficacy was assessed based on a visual analog scale pain score, Ritchie's articular index, and Lee's functional index. Nonparametric Kaplan-Meier survival curves were used to evaluate continuation rates. RESULTS: 24 cyclosporin-treated patients with a mean age of 58 years and a mean disease duration of ten years were included in the study; 87% had received three second-line drugs prior to cyclosporin. Mean cyclosporin treatment duration was 28 months (range, 1-103 months). Overall cyclosporin continuation rates were 75% after four months and 50% after 36 months. Toxicity and inefficacy caused 33% and 13% of cyclosporin discontinuations, respectively. CONCLUSION: The continuation rate of cyclosporin was satisfactory and similar to that reported for other second-line drugs.

Adult↗
PubMed1999

[Interventional radiology and the medical applications of information systems: what consequences for the radiology department?].

The French health care system reform has introduced some changes in the distribution of hospital budgets according to the distribution of admitted patients in diagnosis related groups (DRGs). This new model of budget allocation does not take into account the more technical nature of some medical procedures and services and does not promote the implementation of new technologies. Using four simulated clinical cases, we studied the length of stay in different DRGs and the number of associated points (points d'indice synthétique d'activité, ISA). The addition of the interventional radiologic procedures did not modify the DRG (which remained unchanged from the initial DRG). In order to achieve recognition of the specific nature of interventional radiology procedures, a database should be created and an economical evaluation conducted.

Age Factors↗
PubMed1997

[Epilepsy and its impact in northwest region of the Central African Republic].

In African countries, epilepsy is an important public health problem with major medical, socio-cultural, and economic implications. This study was carried out to evaluate attitudes towards epilepsy in the Central African Republic. A total of 187 epileptic patients were included. Only 20.9% of the study population were married. School attendance never exceeded the elementary level. Epilepsy was active in 98.4% of patients who continued to present attacks despite extensive treatment which was either poorly complied with or inadequate. Attitudes towards epilepsy remain rooted in belief in supernatural phenomenon and evil spirits with use of traditional therapies involving abstinence from certain foods and use of laxative agents to drive out evil forces. Epileptics are excluded from their families and not allowed to attend school but, in our study, they were not prevented from the work place since 70% held jobs. In this study, 54% of epileptics believed that the disease was contagious, 55.6% that it was incurable, and 20.9% that it was due occult or supernatural causes. While precise quantification is impossible, our experience based on interviews with patients and frequent observation of burn wounds suggests that moral and physical suffering is immense among epileptics in the Central African Republic. Epilepsy in Black Africa is a major public health problem requiring serious attention from government officials, health care specialists, and the families of patients. Better information to promote awareness of the non-contagious nature of the disease, greater support for families of patients, and improvement in treatment compliance are essential.

Adolescent↗