Emergency consultations for male adolescents: Somatic and psychological characteristics and profiles of regular users. A retrospective chart review.

INTRODUCTION: Male adolescents' mental health has been understudied compared to their female counterparts and is not well known among health professionals. This is particularly problematic in emergencies because the number of such patients is increasing. OBJECTIVES: To identify the type of demand for care and the characteristics of male adolescents' emergency room visits. To describe the sociodemographic data and clinical characteristics of regular users. METHOD: This is a retrospective study of all medical records of male adolescents aged 14-18, admitted between 2014 and 2015 to the pediatric emergency room of a Swiss university hospital. Sociodemographic and clinical data (e.g., degree of urgency, diagnosis, length of stay, emergency service use, and emergency discharge destinations) were collected. Descriptive and multivariate analyses were performed using STATA 13.1 software. RESULTS: Over the 2-year study period, 2045 male adolescents consulted in emergency departments for a total of 3199 admissions. The average age was 15.6 years (SD, 1). Most consultations were non-urgent (93%) and the reasons included musculoskeletal (43%), dermatological (13%), and digestive (10%) complaints. Forty-two male adolescents (2%) had four or more visits within the 2-year period and were considered regular users; they were also more likely to have psychological complaints (adjusted OR, 5.04; 95% CI, 1.81-13.72) and comorbidities (adjusted OR, 2.55; 95% CI, 1.25-5.21) when compared to their counterparts with fewer than four visits. CONCLUSION: Since regular users are at greater risk of having psychological complaints and comorbidities during their first emergency room visit, a systematic assessment of these adolescents' mental health levels and overall health indicators is recommended.

Role of B cells in the pathogenesis of systemic sclerosis.

Systemic sclerosis (SSc) is an orphan disease characterized by progressive fibrosis of the skin and internal organs. Aside from vasculopathy and fibrotic processes, its pathogenesis involves an aberrant activation of immune cells, among which B cells seem to play a significant role. Indeed, B cell homeostasis is disturbed during SSc: the memory subset is activated and displays an increased susceptibility to apoptosis, which is responsible for their decreased number. This chronic loss of B cells enhances bone marrow production of the naïve subset that accounts for their increased number in peripheral blood. This permanent activation state can be explained mainly by two mechanisms: a dysregulation of B cell receptor (BCR) signaling, and an overproduction of B cell survival signals, B cell activating factor (BAFF) and a proliferation-inducing ligand (APRIL). These disturbances of B cell homeostasis induce several functional anomalies that participate in the inflammatory and fibrotic events observed during SSc: autoantibody production (some being directly pathogenic); secretion of pro-inflammatory and pro-fibrotic cytokines (interleukin-6); direct cooperation with other SSc-involved cells [fibroblasts, through transforming growth factor-ß (TGF-ß) signaling, and T cells]. These data justify the evaluation of anti-B cell strategies as therapeutic options for SSc, such as B cell depletion or blockage of B cell survival signaling.

[Bilateral Kienbock's disease in adolescents. Apropos of a surgically treated case]. / Maladie de Kienböck bilatérale chez l'adolescent. A propos d'un cas traité chirurgicalement.

The authors report a case of bilateral idiopathic stage III Kienböck's disease. Treatment was surgical and consisted in a shortening osteotomy of the radius, with excellent clinical results. X-rays showed that osteonecrosis was stopped and both lunate bones were gradually remodelled.

Pharmacokinetics of molsidomine and of its active metabolite, SIN-1 (or linsidomine), in the elderly.

The pharmacokinetics of molsidomine were investigated in six young (25.5 +/- 0.6 years) and in six elderly healthy volunteers (81.1 +/- 3.1 years). After a 2 mg oral administration, molsidomine elimination half-life was prolonged in elderly subjects (1.9 +/- 0.2 h versus 1.2 +/- 0.1 h, P less than 0.05) because of a decrease in its plasma clearance (15.1 +/- 3.2 l.h-1 versus 41.8 +/- 2.5 l.h-1 (P less than 0.01) in young volunteers). The elimination half-life of the active metabolite, SIN-1 or linsidomine was also prolonged in elderly subjects (1.8 +/- 0.2 h versus 1.0 +/- 0.08 h, P less than 0.05). AUCs of both molsidomine and SIN-1 were increased in the elderly subjects, but the increase in the former was greater (x 3.4) than the increase in the latter (x 1.6). These results suggest that pharmacokinetics and metabolism of molsidomine are impaired in elderly subjects.