Underlying disease for percutaneous endoscopic gastrostomy tube placement predicts short- and long-term mortality.

Background: PEG (percutaneous endoscopic gastrostomy) is a well established endoscopic procedure for enteral feeding. However, patients with a shorter life expectancy will not benefit from PEG tube placement. Furthermore, some specific evolving diseases will never benefit from PEG. The aim of the study focuses on short and long term mortality rates after PEG tube placement in a referral gastroenterology centre (Geneva University Hospital). 219 patients were enrolled in this study. Patients and methods: All patients scheduled for a PEG procedure between January 2011 and December 2014 were included. Nine patient parameters were collected for further analysis as well as the main underlying disease requiring PEG tube placement. Patients were subsequently divided into 4 groups according to underlying disease: Group 1) swallowing disorders of neurologic origin; Group 2) swallowing disorders associated with upper digestive tract neoplasia ; Group 3) nutritional support for a non GI reason ; Group 4) Other. Results: 219 patients had undergone a PEG tube placement. 33 patients died within 60 days after the procedure. After one year, 71 patients died. Global survival was 870 days. The nutritional support group had the better survival rate with 1276 days compared to the swallowing groups and others. The multivariate analysis has highlighted the underlying disease as the only associated parameter with short and long term mortality. Conclusions: PEG tube placement is associated with high short and long term mortality depending on the underlying disease. We outlined the potential role of PEG tube insertion as a supportive transient approach for nutritional support.

[Appropriateness of the prescriptions of conventional versus new oral anticoagulants at discharge from a department of internal medicine]. / Pertinence des prescriptions d'anticoagulants oraux à la sortie d'un service de médecine interne d'un hôpital régional suisse.

BACKGROUND: The recently introduced oral direct anticoagulants (ODAs), presumably safer, and with comparable efficacy to the vitamin K antagonists (VKAs), may reshape the world of anticoagulation medicine. This study aimed to assess the prescription appropriateness of ODAs and VKAs at discharge from hospital. METHODS: We performed a one year retrospective study between August 2012 and July 2013 in the department of internal medicine of a regional hospital (HVs Sion) using Electronic Medical Records. All patients receiving an ODA were included and matched to a patient treated with a VKA. The appropriateness of prescription at discharge was defined by an adequate indication and dosing, the absence of contraindication, a minimal risk of drug-drug interactions and no major bleeding or venous thromboembolism during the hospitalization. The bleeding risk was evaluated with the HAS-BLED score when the indication was atrial fibrillation (AF). RESULTS: Out of the 44patients included (22 with an ODA and 22 with a VKA), 38 received an appropriate prescription according to all criteria. Two patients had an inadequate dosing. A potential drug-drug interaction was detected in 3patients receiving a VKA and in 1patient receiving an ODA. No major contraindication was found, but a relative contraindication was discussed in 3cases. The majority of patients receiving an ODA for an AF had a minor bleeding risk. CONCLUSION: No significant difference was ascertained between the two groups regarding the appropriateness of prescription. Our results suggest that ODAs were cautiously used in our setting.

[When should we give albumin in patients with cirrhosis?]. / Quand administrer de l'albumine aux malades atteints de cirrhose?

The beneficial effects of the use of albumin, either alone or combines with other treat- ments, have been demonstrated in patients with various complications of cirrhosis. Therefore, albumin should be administred in patients with spontaneous bacterial peritonitis in association with antibiotics, and in association with terlipressin in patients with type 1 hepatorenal syndrome. Albumin use reduces the occurrence of paracentesis-related circulatory dysfunction, in patients with large ascites undergoing paracentesis. So far, the beneficial effect of albumin has not been demonstrated, neither for infections other than spontaneous bacterial peritonitis nor for hepatic encephalopathy. This article provides an overview of the data evaluating the effects of albumin in patients with cirrhosis.

[Imported malaria in Geneva: 1998-2004]. / Paludisme d'importation à Genève: 1998-2004.

Epidemiological surveillance of malaria cases reported in Geneva between 1998 and 2004 is analysed and compared to a similar retrospective study conducted in 1988-1994. A total of 426 cases have been reported, with a mean of 61 cases per year and an increase of 29,4% compared to the initial study. Most of the increase was seen in patients of African origin, from 115 to 170 cases, of whom 56% visited friends and relatives. Malaria was acquired predominantly in sub-Saharan Africa (88,5%), mainly West and Central Africa. P. falciparum was the predominant species (75,3%), with significant seasonality during the summer and in January. This was not the case for other species. Two third of cases did not take any chemoprophylaxis. These results stress the importance of the disease and the need for adequate protection of travellers.

Metal Ion Coordination at the Water-Manganite (gamma-MnOOH) Interface.

The local structure of Cd(II) surface complexes adsorbed onto manganite (gamma-MnOOH) has been investigated by extended X-ray absorption fine structure (EXAFS) spectroscopy. Adsorption experiments were carried out within the pH range 7.4-9.8 and with surface coverage from 2.2 to 8.9 µmol/m(2). Quantitative analysis of the EXAFS spectra shows little difference in the local coordination environment of Cd regardless of the coverage. Analysis of the first shell required a third cumulant in an asymmetric distribution model (i.e., non-Gaussian distribution), indicating distorted CdO(6) octahedra with an average Cd-O distance of 2.31 Å. A single second shell of Mn neighbors at a constant distance of 3.33 Å was detected. This comparatively short distance shows that inner-sphere complexes are formed. No Cd neighbor was found which means that cadmium hydroxide precipitation or cluster formation does not occur at the surface at the experimental conditions probed in this study. We assign the Cd-Mn distance to edge sharing between CdO(6) and MnO(6) octahedra, with a geometry similar to that in the mixed solid Cd(2)Mn(3)O(8). This adsorption mode is possible on the {110} and {010} cleavage planes of manganite. Copyright 2000 Academic Press.

Metal Ion Coordination at the Water-Manganite (gamma-MnOOH) Interface.

The local structure of Zn(II) adsorbed at the water-manganite (gamma-MnOOH) interface has been investigated by extended X-ray absorption fine structure (EXAFS) spectroscopy. Adsorption experiments were carried out within the pH range 6.17-9.87 and surface coverages of 0.9 to 9.7 µmol/m(2)cZn(II) coordination was observed to change from six to four as pH was increased. This was indicated by a change in Zn-O distance from 2.04 to 1.96 Å and by a decrease in the obtained coordination numbers. Two higher shells were detected at about 3.08 and 3.33 Å, at all pH values and surface coverage investigated. As the backscattering phase and amplitude functions of Mn and Zn are similar, we used structural and chemical considerations to assign the backscattering at 3.08 Å to Mn neighbors, and the one at 3.33 Å to Zn atoms. Indeed the size of the Zn polyhedra, especially of ZnO(4), does not quite match the structure of the manganite surface. We conclude that Zn(II) forms multinuclear hydroxo-complexes or a zinc hydroxide phase at the surface, as it might be easier for an additional Zn(II) to bond to an already sorbed Zn. These results were compared to our previous EXAFS study of Cd(II) adsorption onto manganite, where mononuclear inner-sphere complexes bound to the surface via edges were found. Copyright 2000 Academic Press.