The plant natural product 2-methoxy-1,4-naphthoquinone stimulates therapeutic neural repair properties of olfactory ensheathing cells.

Olfactory ensheathing cells (OECs) are crucial for promoting the regeneration of the primary olfactory nervous system that occurs throughout life. Transplantation of OECs has emerged as a promising therapy for nervous system injuries, in particular for spinal cord injury repair. Functional outcomes in both animals and humans are, however, highly variable, primarily because it is difficult to rapidly obtain enough OECs for transplantation. Compounds which can stimulate OEC proliferation without changing the phenotype of the cells are therefore highly sought after. Additionally, compounds which can stimulate favourable cell behaviours such as migration and phagocytic activity are desirable. We conducted a medium-throughput screen testing the Davis open access natural product-based library (472 compounds) and subsequently identified the known plant natural product 2-methoxy-1,4-naphthoquinone as a stimulant of OEC viability. We showed that 2-methoxy-1,4-naphthoquinone: (i) strongly stimulates proliferation over several weeks in culture whilst maintaining the OEC phenotype; (ii) stimulates the phagocytic activity of OECs, and (iii) modulates the cell cycle. We also identified the transcription factor Nrf2 as the compound's potential molecular target. From these extensive investigations we conclude that 2-methoxy-1,4-naphthoquinone may enhance the therapeutic potential of OECs by stimulating proliferation prior to transplantation.

Unusual diagnoses made by convex-probe endobronchial ultrasound-guided transbronchial needle aspiration.

Endobronchial ultrasound-guided transbronchial needle biopsy (EBUS-TBNA) has proven to be an effective and minimally invasive tool to diagnose and stage lung cancer. However, its use for the diagnosis of rare mediastinal and lung pathologies has been rarely described. Hereby we describe a retrospective chart review of our EBUS-TBNA database for unusual diagnosis made between July 2012 and October 2016. Those conditions considered unusual for EBUS-TBNA diagnosis were identified and their medical records reviewed.

Evidence-based guides in tracheostomy use in critical patients

Objetivos: Proporcionar guías de traqueostomía para el paciente crítico, basadas en la evidencia científica disponible, y facilitar la identificación de áreas en las cuales se requieren mayores estudios. Métodos: Un grupo de trabajo formado con representantes de 10 países pertenecientes a la Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva y a la Latin American Critical Care Trial Investigators Network(LACCTIN) desarrollaron estas recomendaciones basadas en el sistema Grading of Recommendations Assessment, Development and Evaluation (GRADE). Resultados: El grupo identificó 23 preguntas relevantes entre las 87 preguntas planteadas inicialmente. En la búsqueda inicial de la literatura se identificaron 333 estudios, de los cuales se escogieron un total de 226. El equipo de trabajo generó un total de 19 recomendaciones: 10 positivas (1B = 3, 2C = 3, 2D = 4) y 9 negativas (1B = 8, 2C = 1). En 6 ocasiones no se pudieron establecer recomendaciones. Conclusión: La traqueostomía percutánea se asocia a menor riesgo de infecciones en comparación con la traqueostomía quirúrgica. La traqueostomía precoz solo parece reducir la duración de la ventilación mecánica pero no la incidencia de neumonía, la duración de la estancia hospitalaria o la mortalidad a largo plazo. La evidencia no apoya el uso de broncoscopia de forma rutinaria ni el uso de máscara laríngea durante el procedimiento. Finalmente, el entrenamiento adecuado previo es tanto o más importante que la técnica utilizada para disminuir las complicaciones.(AU)

OBJECTIVES: Provide evidence based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. METHODS: A task force composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified of which 226 publications were chosen. The task force generated a total of 19 recommendations: 10 positive (1B=3, 2C=3, 2D=4) and 9 negative (1B=8, 2C=1). A recommendation was not possible in six questions. CONCLUSION: Percutaneous techniques are associated with a lower risk of infections compared to surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used.(AU)

Evidence-based guides in tracheostomy use in critical patients. / Guías basadas en la evidencia para el uso de traqueostomía en el paciente crítico.

OBJECTIVES: Provide evidence based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. METHODS: A task force composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified of which 226 publications were chosen. The task force generated a total of 19 recommendations: 10 positive (1B=3, 2C=3, 2D=4) and 9 negative (1B=8, 2C=1). A recommendation was not possible in six questions. CONCLUSION: Percutaneous techniques are associated with a lower risk of infections compared to surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used.

Balanitis xerótica obliterante en el adulto: A propósito de un caso / Balanitis xerotica obliterans: A case report in an adult

El liquen escleroso y atrófico (LE y A) del pene, también conocido como balanitis xerótica obliterante (BXO), es una enfermedad inflamatoria crónica del pene que puede ocurrir a cualquier edad. La inflamación conduce a la formación de placas hipocrómicas, más comúnmente en el prepucio o en el glande. En general puede causar fimosis, prurito, dolor por las fisuras, disuria, restricción de la micción, dispareunia y disfunción sexual significativa. Comunicamos un caso de BXO asociado a vitiligo en un paciente de 78 años, quien consultó por dispareunia. Fue derivado a Urología para resolución quirúrgica, donde se realizó una postectomía, cuyo estudio era compatible con una BXO. Muchos hallazgos obtenidos en los últimos años apuntan cada vez más, hacia un origen autoinmune de esta enfermedad. El uso de corticoides tópicos de alta potencia es todavía la mejor terapéutica, siendo la cirugía un buen tratamiento en casos muy severos, con fimosis importante o aquellos que no responden al uso de corticoides o inhibidores de la calcineurina, como el tacrolimus o pimecrolimus.

Lichen sclerosus et atrophicus (ALE) of the penis, also known as balanitis xerotica obliterans (BXO) is a chronic inflammatory disease of the penis that can occur at any age. The inflammation leads to the formation of hypochromic plaques, most commonly in the foreskin or on the glans. BXO can cause phimosis, pruritus, pain, dysuria, urinary restriction, dyspareunia, and significant sexual dysfunction. We present a case of BXO associated to vitiligo in a 78 years old patient, who consulted for dyspareunia. It was referred to urologist for surgical resolution, where circumcision was performed with biopsy compatible with BXO. In recent years studies have found that it could exists, an autoimmune ethiopathogenic factor of the disease. The topical use of high power corticosteroids is still the first choice and surgery remains a good treatment in severe cases (ex. phimosis) or those who do not respond to steroids.

Validación del test de troponinas en plasma a partir de una población sana: una experiencia local / Validation of normal values for troponin i plasma levels in a chilean population

Introducción: Las troponinas corresponden a proteínas estructurales del miocardiocito, su presencia en plasma se utiliza como marcador de injuria miocárdica. El test troponinas en plasma se utiliza actualmente para detectar daño miocárdico en pacientes en quienes se sospecha un infarto agudo al miocardio; para este propósito se toma como referencia valores de referencia validados en poblaciones de Inglaterra o Estados Unidos. Objetivo: El propósito de este estudio obtener valores de referencia para nuestra población local. Métodos y resultados: Se efectuó una determinación de troponina I en 500 sujetos sanos, se obtuvo el valor promedio de troponina I para esta población y el valor percentil 99 para esta población que se considera internacionalmente como el valor de referencia para determinar el límite normal, el valor P99 resultó significativamente menor en mujeres respecto a hombres. Conclusión: En conclusión, se han obtenido valores de referencia para aplicar el test de troponina I en nuestro medio local.

Background: Troponins are myocardiocyte proteins; their plasma level is used as a marker for myocardial injury. In the diagnosis of myocardial infarction values currently used as cut points are those validated elsewhere (USA, UK). Aim: In this study we aimed to determine normal limits of Troponin I in a sample of Chilean subjects. Methods and results: 500 healthy subjects had their troponin I levels measured, computing the mean and 99 percentile (p99) values. Both parameters were significantly lower in females compared to males (mean ± SD 0.089 +/- 0.047 vs 0.102 +/- 0.063, p<0.01; p99 0.02 vs 0.03, respectively). Conclusion: These troponin I values may be used to assess the likelihood of myocardial infarction in Chilean subjects.

[Possibility to screen COPD in emergency department]. / Faisabilité d'un dépistage de la BPCO aux urgences.

INTRODUCTION: The COPD is a stake of public health because of its prevalence in the world, its morbi-mortality and its considerable cost (2,2 billion euros/year in France). An early screening allows for a fast and effective intervention. MATERIAL AND METHOD: The prospective study with in the emergency department of Roanne included smokers and ex-smokers, more than 10PY for the 40 years old and older, more than 20PY for the others, and/or symptomatic of COPD. Screening rested on a questionnaire filled out by the patient. Are excluded patients already diagnosed with COPD. This screening is carried out with the FEV1/FEV6. The criterion of principal judgment rests on the time taken for screening and acceptability by the patients. RESULTS: One hundred and twenty-two patients were included, 6.5% refused screening. The average time of screening was 4.8 minutes. There were 27 positive patients with the FEV1/FEV6, 14 came to make the classic spirometry. Only 10.53% have a FEV1/FEV6<0.73. On the whole, 15.86% do not have a COPD, 75,25% are at the risk of COPD, 5,94% have a COPD stage 1, 1,98% are stage 2, 0.99% stage 3 and none stage 4. DISCUSSION: The study thus showed that a screening of the COPD in the emergency rooms is possible because of the simple and reproductible process. Its shows, however its limits since the number of inclusion decrease during days of strong attendance in emergency rooms. CONCLUSION: The screening of the COPD as foreseen in the study is possible.

Insulin therapy for diabetes mellitus: treatment regimens and associated costs.

AIMS: To describe insulin therapy in patients with diabetes, to determine treatment costs and to compare costs among treatment regimens. METHODS: This observational study was performed by 734 French pharmacists. Adult patients filling an insulin prescription were invited to participate. Participants provided information on their diabetes history and management. Levels of intensification of insulin therapy were determined by the number of injections in type 1 diabetes mellitus (T1DM) patients, and by the different schemes used in type 2 (T2DM) patients, such as basal/intermediate-acting insulin only, and regimens using both basal and rapid-acting insulin. Costs were evaluated according to official medication costs, nurse visits and glucose monitoring kits. RESULTS: A total of 361 patients with T1DM and 1902 with T2DM were enrolled in the survey. Patients with T1DM more frequently took 1-2 injections per day (46.3% of patients) and used single-dose basal insulin together with ≥1 dose of rapid insulin (43.8%). Patients with T2DM used multiple treatment regimens, with 58 different combinations documented. Most took basal/intermediate insulin only (42.5%) or combinations of basal/intermediate and rapid insulins (52.7%). Mean cost of insulin therapy was €27.4/week for T1DM and €45.4/week for T2DM. In T1DM, insulin was the biggest cost component and increased with the number of injections/day. In T2DM, nurse visits were the most important cost contributors irrespective of treatment regimen. Overall, the cost of insulin therapy increased with the complexity of the insulin schemes. CONCLUSION: Considerable heterogeneity is found in insulin treatment regimens used in everyday diabetes care. Payers should consider the full costs associated with the use of insulin rather than the cost of insulin alone. Treatment algorithms to harmonize insulin therapy should help to improve care, while encouraging patients to self-inject insulin should help to reduce costs.

Prevalence of faecal incontinence and analysis of its impact on quality of life and mental health.

AIM: Faecal incontinence is a significant healthcare problem, with an estimated prevalence of up to 5% of the general population. Little is known about its prevalence among patients attending primary care. METHOD: A cross-sectional multicentre study was undertaken. Adult patients attending 10 primary health centres were interviewed. Faecal incontinence was defined as involuntary leakage of flatus, liquid or solid stool at least once in the preceding 4 weeks. Health-related and disease-specific quality of life was assessed using the 36-item Short-Form Health Survey and the Fecal Incontinence Quality of Life scale, respectively. Mental health status was assessed using the 28-item General Health Questionnaire. An adjusted multivariate analysis was performed to study the association of faecal incontinence with the presence of altered mental health status. RESULTS: A total of 518 subjects (mean age 60.3 years) were studied. The prevalence of faecal incontinence was 10.8%. Altered mental health status was found in 51.8% of patients with faecal incontinence and in 30.5% of those without (P = 0.001). Faecal incontinence was a significant independent factor for altered mental health status (odds ratio, 2.088; 95% CI 1.138-3.829; P = 0.017). CONCLUSION: The prevalence of faecal incontinence in primary care is high, with a significant impact on quality of life and mental health status.

Improving diabetes management with electronic medical records.

Most primary-care physicians have adopted electronic medical records (EMRs) for the management of patients in ambulatory care. Observational trials suggest that the use of EMRs improves the achievement of the recommended standards of diabetes care and intermediate outcomes. A French group of general practitioners has shown, in a randomized controlled trial of diabetes care, the beneficial effects of a follow-up module integrated into an EMR. Electronic reminders, eHealth technology and e-mail messaging to patients integrated into the EMR have also been reported to have a beneficial effect on diabetes care. Some recommendations have been devised for the meaningful use of EMRs to improve the process and, possibly, intermediate outcomes of diabetes care as well. Another potential benefit to consider is the extraction and aggregation of data to create diabetes registers. Large regional and national diabetes registers have been set up in the US and Europe for various purposes, including patient recall, description of care patterns and outcomes, improvement of practices, drug safety, observational research and retrospective trials. In France, the government initiative towards an Internet-based personal health record (PHR) provides an appropriate framework for implementing and sharing the information needed to improve diabetes care, such as electronic summaries of health information, personalized health plans (PHPs), and standardized and structured hospital-discharge forms. All of these materials can be generated from EMRs. The widespread and optimalized use of EMRs for diabetes care with links to the national diabetes register and the capacity to supply PHRs are major considerations. Achieving these goals requires a common initiative comprising primary care and diabetes scientific societies in cooperation with diabetes patients'associations.

Feasibility of screening for silent myocardial ischaemia according to the ALFEDIAM-SFC 2004 Guidelines in a population of diabetic patients.

BACKGROUND: Screening tests have to meet a number of criteria, including feasibility. The aim of this study was to estimate the proportion of the French diabetic population that is eligible for screening for silent myocardial ischaemia (SMI), and to evaluate the feasibility of such screening in the Franche-Comté region. METHODS: Data were taken from the Echantillon National Témoin Représentatif de la Population Diabétique (ENTRED, a Representative National Sample of the Diabetic Population 2001 study), which was based on questionnaires filled out by 3646 diabetic patients. All screening tests carried out in the region of Franche-Comté in eastern France in 2003 were recorded (n=19,216). RESULTS: The guidelines issued by the ALFEDIAM-SFC in 2004 were applied to the ENTRED population and identified 645 diabetic patients (17%) as eligible for SMI screening. When applied to the region of Franche-Comté, the recommendations would have required screening 7480 diabetic patients over a period of 3years, involving 1246 exercise stress tests and 1246 myocardial perfusion or stress echocardiography studies annually. However, more than 14,653 exercise stress, 4248 myocardial perfusion and 315 stress echocardiography tests were carried out in the region in 2003 among diabetic and non-diabetic patients, thus largely covering the screening requirements. On the other hand, ENTRED 2001 data also showed that 60% of patients who reported existing coronary disease would not have met screening criteria. CONCLUSION: The number of examinations carried out in the region of Franche-Comté greatly exceeded the number of patients required for screening. However, practical feasibility is not the only criterion needed to guarantee the quality of a large-scale screening programme. Our results raise the question of the relevance of the current screening selection criteria.

Sexual activity in diabetic patients treated by continuous subcutaneous insulin infusion therapy.

BACKGROUND AND AIMS: As concerns over interference with sexual activity may be an obstacle to initiating pump therapy in diabetic patients, the aim of the study was to assess the impact of continuous subcutaneous insulin infusion (CSII) therapy on sexual activity. PATIENTS AND METHODS: Patients filled out a questionnaire on their demographic data, diabetes history, pump-treatment history, metabolic control, inconvenience/convenience of the pump and catheter, and information on sexual activity. RESULTS: A total of 271 diabetic patients (aged 44+/-17 years, 51% women, 22% single), treated with CSII for 4.2+/-5.9 years and with a diabetes duration of 19+/-11 years, filled out the questionnaire. Their HbA(1c) was 7.7+/-1.1%, with 2.4+/-2.1 mild hypoglycaemic episodes over the past week, and their frequency of sexual activity was: never 29.9%; <1/month 12.3%; >1/month and <1/week 18.2%; and >1/week 39.6%. Age and cohabitation were independently correlated with frequency of sexual activity (P<0.0001 and P<0.0003, respectively), but not diabetes duration or complications. To the question "Does the pump have an influence on your sexual activity?", The answer was "no" in 90% and "yes" in 10%. However, intercourse frequency was significantly decreased in the latter (P=0.04). On multivariate analyses, this negative influence of CSII was correlated with HbA(1c) (P<0.05), discomfort with the pump (P<0.05) and the number of mild hypoglycaemic episodes (P<0.01). CONCLUSION: Frequency of sexual activity appears to be unaffected by pump therapy or diabetes, but is decreased by the expected characteristics-namely, age and being single. Also, only 10% of patients believe that CSII is an obstacle during sexual activity and, in particular, because of the catheter.

Faecal incontinence after seton treatment for anal fistulae with and without surgical division of internal anal sphincter: a systematic review.

OBJECTIVE: The challenge of surgery for anal fistula is to eradicate the fistula track while maintaining anal continence. Seton placement is recommended to reduce postoperative faecal incontinence but interestingly a great range of functional impairment after surgery has been published. The aim of this study was to analyse the influence of intra-operative internal anal sphincter division during tight or cutting seton technique for cryptogenic anal fistula, on the results of recurrence and postoperative faecal incontinence. METHOD: A systematic literature review was performed to identify published series from 1966 to May 2007 of patients with anal fistula treated by a tight or cutting seton technique. The published series has been divided in to those where preservation of internal anal sphincter was performed (PIAS group) or where intra-operative surgical division was undertaken in the time of seton placement (SIAS group) .The main endpoints of the review were to study anal fistula recurrence rate and postoperative faecal incontinence. RESULTS: Eighteen studies including 19 series and 448 patients were analysed in detail. Recurrence rate was 5.0% and 3.0% in PIAS and SIAS group respectively. Overall faecal incontinence rate was 5.6% in PIAS group and 25.2% in SIAS group. CONCLUSION: Although based on low-evidence studies, intra-operative preservation of internal anal sphincter at the time of seton insertion for anal fistula seems to reduce the postoperative faecal incontinence without a substantial increase in recurrence rates.

Real-life application and validation of flexible intensive insulin-therapy algorithms in type 1 diabetes patients.

AIMS: Flexible intensive insulin therapy (FIT) has become the reference standard in type 1 diabetes. Besides carbohydrate counting (CHO), it requires the use of algorithms to adjust prandial insulin doses to the number of CHO portions. As recourse to standard algorithms is usual when initiating FIT, the use of personalized algorithms would also allow more precise adjustments to be made. The aim of the present study was to validate personalized prandial algorithms for FIT as proposed by Howorka et al. in 1990. METHODS: We conducted a 4-month observational study of 35 patients with type 1 diabetes, treated with FIT for at least 6 months, who were already using Howorka's prandial algorithms (meal-related and correctional insulin doses for blood glucose increases induced by CHO). These patients were asked to use a personal digital assistant (PDA) phone with an electronic diary (instead of a paper one) to take advantage of the computerized data-collection system to assess the quality of postprandial metabolic control. RESULTS: Whatever the number of CHO portions, mean postprandial blood glucose values remained close to the target of 7.8mmol/L, and the compensatory algorithm allowed precise correction of preprandial hyperglycaemia. In fact, the algorithms for meal-related and correctional insulin doses at the end of the study did not differ significantly from those initially calculated, but they generally differed from one patient to another. CONCLUSION: In type 1 diabetic patients treated with FIT, the use of individualized parameters permits fast and accurate adjustment of mealtime insulin doses, leading to good control of the postprandial state.

Adaptation and validation of the Bristol scale stool form translated into the Spanish language among health professionals and patients.

BACKGROUND: stool type represents an important semiologic part of medical interviews. The Bristol Scale Stool Form is a clinical tool to evaluate stool consistency and form. The aim of this study was to translate and adapt the Bristol Scale Stool Form into Spanish. Differences in validation results between health professionals and patients surveyed were also evaluated. METHODS: the study population included 79 physicians, 79 nurses, and 78 patients. Subjects were invited to match a randomly selected text defining one of the seven stool types in the scale with one of seven drawings described originally. A random selection of samples was offered for re-test reliability. RESULTS: the overall Kappa index was 0.708. Thirty-two subjects repeated the test for a test-retest assessment in a mean interval of 7.76 days, and the percentage concordance between definition and image was 84.4% with a Kappa index of 0.816. There were no differences in the validation study between physicians, nurses, and patients. CONCLUSIONS: this study has shown that the Spanish version of the Bristol Scale Stool Form is reliable for use as a tool to evaluate stool consistency and form.

Irritable bowel syndrome is more frequent in patients hospitalized for ischaemic colitis: results of a case-control study.

It has been suspected that there is an epidemiological link between irritable bowel syndrome (IBS) and ischaemic colitis (IC). We performed a retrospective case-control study to compare the frequency of IBS in patients hospitalized for IC compared with that of patients with peptic ulcer bleeding. Cases were patients with a first episode of IC and controls were patients with a first episode of peptic ulcer bleeding, matched to cases for sex and 10-year age-class. Diagnosis of IBS was based on medical information extracted from hospital medical files and a standard self-questionnaire. The association between IBS and IC was tested using Mc Nemar's paired odds ratio (OR); confidence interval at 95% (CI 95%) was calculated; Mantel-Haenzel's Chi(2) was applied. A total of 113 cases and 113 matched controls were studied. There were 37 males and 76 females and the mean age was 69 +/- 15 years in each group. The prevalence of IBS in cases was 16.9%vs 1.8% in controls. The risk of IBS was 11.05 times higher among cases than in controls (P < 0.001); CI 95%: (2.45-49.74). A total of 87 pairs with complete data were used for OR calculation. The risk of IBS was 7.5 times higher in cases than in controls (P = 0.002); CI 95%: (1.72-32.80). This case-control study shows that IBS is more frequent in IC patients than in controls.

Adaptation and validation of the Bristol scale stool form translated into the Spanish language among health professionals and patients

Background: stool type represents an important semiologic part of medical interviews. The Bristol Scale Stool Form is a clinical tool to evaluate stool consistency and form. The aim of this study was to translate and adapt the Bristol Scale Stool Form into Spanish. Differences in validation results between health professionals and patients surveyed were also evaluated. Methods: the study population included 79 physicians, 79 nurses, and 78 patients. Subjects were invited to match a randomly selected text defining one of the seven stool types in the scale with one of seven drawings described originally. A random selection of samples was offered for re-test reliability. Results: the overall Kappa index was 0.708. Thirty-two subjects repeated the test for a test-retest assessment in a mean interval of 7.76 days, and the percentage concordance between definition and image was 84.4% with a Kappa index of 0.816. There were no differences in the validation study between physicians, nurses, and patients. Conclusions: this study has shown that the Spanish version of the Bristol Scale Stool Form is reliable for use as a tool to evaluate stool consistency and form(AU)

An alternative management for high-risk patients with rectal prolapse.

INDICATION: The management of rectal prolapse in presence of high-risk comorbidities can be challenging. We report the use of an anal plug as a noninvasive alternative in patients with contraindication of surgery. METHOD: This small device opens up in about 30 s to fit the contour of the lower rectum avoiding faecal leakage or in our case, the rectal prolapse. Although the plug is poorly tolerated in some cases, this device may be used up to 12 h per day and no adverse effects have been reported. COMPARISON WITH OTHER METHODS: Nonsurgical alternatives described in the literature, such as sclerotherpy in children, are not routinely used in the adult population. The main advantage of the anal plug is its simplicity and safety as in the series published for the treatment of faecal incontinence no adverse events were described. CONCLUSION: An anal plug for rectal prolapse is an alternative in high-risk patients or during the time before surgical treatment.

Prevalence of macrovascular complications and cardiovascular risk factors in people treated for diabetes and living in France: the ENTRED study 2001.

AIM: The aim of this study is to estimate the prevalence of macrovascular complications and cardiovascular risk factors among people with diabetes living in France and to compare these prevalences with other national estimates. METHODS: We randomly sampled 10,000 people who received one or more reimbursements for insulin or oral hypoglycaemic treatment from the major national medical insurance system during the period October-December 2001; 3646 of the 10,000 people completed a questionnaire; for a subgroup of 1718 people, their care providers completed a medical questionnaire. RESULTS: The prevalence of diagnosed macrovascular complications was of 17% according to patients (angina or myocardial infarction, 15%; coronary revascularization, 9%) and of 20% overall, according to physicians (angina or myocardial infarction, 16%; coronary revascularization, 6%; stroke, 5%). Macrovascular complications were more frequent in people with type 2 than type 1 diabetes, reflecting an age effect. The prevalences of cardiovascular risk factors in type 1 and type 2 diabetes were: current smoking, 35 and 14%; overweight, 28 and 42%; obesity, 9 and 36%; blood pressure superior to 130/80 mmHg, 29 and 59%; LDL cholesterol superior or equal to 3.4 mmol/l, 18 and 26%, respectively. CONCLUSIONS: Compared with other European countries, elevated blood pressure is more frequent in people with diabetes living in France; compared with US estimates, the prevalence of macrovascular complications is lower, glucose control better and blood pressure control poorer in France. These data, observed in a country with widespread access to care and at low cost to the patient, nevertheless demonstrate an urgent need for improving the cardiovascular risk profile of people with type 1 and type 2 diabetes, both with and without macrovascular complications.

French medical practice in type 2 diabetes: the need for better control of cardiovascular risk factors.

AIMS: In type 2 diabetes (T2D), to describe treatments to prevent cardiovascular disease, to compare current practice to French guidelines, and to identify factors associated with recommended treatments. METHODS: In the Echantillon National Témoin Représentatif des Personnes Diabétiques (ENTRED) study, 10,000 adults treated for diabetes (any type) were randomly selected from the French National Health Insurance System database. Deliveries during the last quarter of 2001 of treatments to prevent cardiovascular disease were extracted. Questionnaires were mailed to these people and their care providers. Final populations included 3324 people with T2D and their 1553 care providers. RESULTS: Overall, 18% reported coronary heart disease (CHD) and 44% others were classified as having a high cardiovascular risk; 68% received one or more antihypertensive treatment: ACE inhibitor/angiotensin receptor blocker (ARB), 44%; diuretic, 35%; calcium channel blocker, 25%; beta-blocker, 24%. Among those receiving antihypertensive treatment, 59% had blood pressure greater than 130/80mmHg. Overall, 42% received a hypolipidaemic treatment: statin, 25%; fibrate, 18%. About half the people with a high cardiovascular risk had LDL cholesterol greater than 1g/L, but only 32% were given a statin. Among people with an abnormal albumin/creatinine ratio (11%), 59% received an ACE inhibitor/ARB. Among those with CHD, 35% received the two treatments recommended in 1999 (beta-blockers and antiplatelet agents); in multivariate analyses, this two-treatment delivery was positively associated with male gender, self-reported hypertension and consulting a cardiologist. CONCLUSION: Cardiovascular risk profiles reported by providers in T2D people are high. Despite recent progress, there is a need for major improvement in practices intended to prevent cardiovascular disease in these people, especially in those at greatest CHD risk.