Difference scores between single-task and dual-task gait measures are better than clinical measures for detection of fall-risk in community-dwelling older adults.

BACKGROUND: As the proportion of older adults in the population increases, so does the associated prevalence of falls, making falls the leading cause of fatal and nonfatal injuries among adults aged ≥65 years. In response, researchers and clinicians seek to develop a clinical tool that accurately predicts fall risk. These Investigations have included measures of clinical mobility and balance tests, strength, physiologically based tests, postural sway, and mean and variability of gait measures. To date, no study has concurrently explored all these measures to determine which measures, alone or in combination, emerge as the most predictive of fall risk. While there is evidence that dual-task gait conditions are sensitive indicators of fall risk, difference scores between dual-task and single-task gait conditions (DS) have not been explored. RESEARCH QUESTION: This study included outcome measures representing diverse domains (clinical mobility and balance, strength, physiological, postural sway, and mean and variability of difference scores between dual- and single-task gait conditions) to determine the combination of measures that were the most sensitive for retrospectively classifying fallers from non-fallers. METHODS: Forty-two (mean: 75.8 yrs ± 3.3) community-dwelling older adults completed a comprehensive battery of 76 measures and classified into two groups based on self-report of having one or more falls in the previous year. RESULTS: Results suggest that 11 measures captured the salient characteristics of the total cohort (fallers (N = 27) and non-fallers (N = 15) and that five gait measures were sufficient for correctly classifying fallers and non-fallers with 92.3% sensitivity and 66.7% specificity with a total model classification of 82.9%. SIGNIFICANCE: The five variables comprise mean DS of stride timing, stride width, and stride length and DS in variability for stride width and stride velocity demonstrating that difference in performance between dual-task and single-task gait trials was essential for discriminating fallers and superior to other measures.

Clinical-radiological correlation after functional endoscopic sinus surgery in patients with chronic rhinosinusitis: interest of a sinonasal aerial volumetry.

BACKGROUND: Although a CT scan is often performed after functional endoscopic sinonasal surgery (FESS) in patients with chronic rhinosinusitis, its role hasn`t been firmly established. The goal of this study is to investigate the correlation between symptoms and CT findings before and after FESS for chronic rhinosinusitis. In addition, the interobserver agreement for both sinonasal aerial volumetry and CT score is assessed. METHODS: Thirty-three patients surgically treated for chronic rhinosinusitis were included in this prospective study. Conventional and modified Lund-Mackay scores and sinonasal volumetry were determined by two radiologists before (M0), at 3 months (M3) and 1 year (M12) after surgery. The symptoms were evaluated by the 22-item SinoNasal Outcome Test (SNOT-22). RESULTS: Change of SNOT-22 and air volume were significantly correlated between M0 and M12, but not between M0 and M3, for both readers. Compared to other scores, volume had the best intraclass correlation coefficient and reproducibility, according to the Bland-Altman analysis. No correlation was found between SNOT-22 and CT scores before and after surgery, except between M12 and M0 for one reader. CONCLUSION: The correlation between CT scan and symptoms is low or absent. The measurement of sinonasal air volume is best correlated with the symptoms after surgery, with the best inter-observer agreement.

[Monitoring vancomycin in an intensive care unit: A retrospective survey on 66 patients]. / Monitorage de la vancomycine en réanimation : étude rétrospective de 66 patients.

OBJECTIVES: The study objectives were to check whether recommended vancomycin doses were related to pharmacological objectives for intensive care patients: steady-state plasma concentration (SSc) and ratio SSc/MIC (Minimal Inhibiting Concentration). The authors tried to identify variability factors for vancomycin plasmatic concentrations at peak. PATIENTS AND METHODS: This monocentric, observational, and retrospective survey was performed on 66 intensive care patients treated by antibiotics including vancomycin, alone or in combination, as a curative treatment for a severe infection with Gram-positive bacteria. Vancomycin was dosed at 15mg/kg during the first hour, then 40 to 60mg/kg per 24hour. Vancomycin SSc and bacteria MIC were recorded. The SSc/MIC ratio was determined and was considered efficient when superior to 8. RESULTS: Forty-two percent of vancomycin SSc were within the effectiveness rate. Twenty-three percent of SSc/MIC ratios were superior to 8. The rate of clinical recovery was 71 %. The length of antibiotherapy was identified as positively interacting with biological effectiveness, unlike severe sepsis, a factor of negative interaction on vancomycin SSc in this study. CONCLUSION: Less than half of the SSc and less than a quarter of the SSc/MIC ratios were at effective rates in our study. Therefore, adequacy between dosage, administration, and monitoring should be reviewed.

[Monitoring aminoglycosides in an Intensive Care Unit]. / Monitorage des aminosides en réanimation.

OBJECTIVES: This monocentric, observational and retrospective survey was performed to check the appropriateness between aminoglycoside prescriptions and inhibitor quotient to be reached, in Intensive Care Unit (ICU) patients. We identified variability factors for aminoglycoside plasmatic concentrations at peak such as standardized index of gravity (IGS2 scale), age, sex, weight, and severity of sepsis. PATIENTS AND METHOD: Eighty-seven ICU patients received an antibiotic combination mandatorily including an aminoglycoside (amikacin or gentamicin) as curative treatment for a severe infection. Prescribed dosages were 15mg/kg for amikacin and 5mg/kg for gentamicin. The maximal concentration (Cmax) and minimal inhibiting concentration (MIC) of involved bacteria were recorded. The aminoglycoside ratio Cmax/MIC, called inhibitor quotient, was determined. The inhibitor quotient was considered efficient when superior to 10. The Cmax for aminoglycoside first peak was also compared with the theoretical Cmax to be reached. RESULTS: In the aminoglycoside Cmax, 50.3% were efficient (59.6% for amikacin Cmax and 38.9% for gentamicin Cmax). In 46% of the cases, the inhibitor quotient was efficient; 12.6% of Cmax reached the theoretical Cmax. Factors identified as negatively interacting with biological efficiency were: Gram-positive bacteria or anaerobic bacteria infections and planned surgery. CONCLUSION: In the inhibitor quotients, 49.7% were at inefficient rates, even when the recommended aminoglycoside dosage for was given. Therefore, dose and administration should be updated.

[A serious and unexpected infectious complication after transrectal prostate biopsy]. / Une complication infectieuse grave inattendue après biopsie transrectale de prostate.

Serious infectious complications may appear after a surgical procedure despite antimicrobial prophylaxis. We report a case of Escherichia Coli meningitis after a prostate puncture biopsy. Many factors may have contributed to this rare complication such as fluoroquinolone resistance, and/or the bacterium's ability to cross the brain blood barrier. The patient was not found susceptible to severe infections.