Bulletin de la Societe des sciences medicales du Grand-Duche de Luxembourg最新文献

Introduction: The present data results from a retrospective analysis of 3331 check-ups made in the preventive medicine department of the "ZithaKlinik", named "ZithaGesondheetsZentrum". These check-ups are done for the employee's of several firm's and institutions. According to gender and age, several tests and examinations are performed and the results are given to the person's general practitioner or another doctor of his choice. We will present a global synthesis of all the results but also a follow-up study of persons having performed 2 check-ups or more over a 5-year period.

Population: In the cross-sectional part, the analysis is done on 3331 individual check-ups (1447 woman, 1884 men). The average age is 50.3 years +/- 11.4. In the follow-up study, 478 persons (191 women, 287 men) had at least 2 (maximum 5) check-ups in the 5-year period of our observation. Initial age was 54.1 +/- 10.9 years for woman and 51.4 +/- 11.4 for men, respectively 56.4 +/- 10.9 and 53.7+/- 11.2 at their last check-up.

Results: An alarming number of persons present with a weight or obesity problem (according to age ranging from 22.0% overweight and 7.3% obese from 18-29 years, respectively 37.5% and 11.3% from 30-49 years, finally 44.0% and 20.6% in the range 50-69 years). Associated risk factors and pathologies (Hypertension, Dyslipidemia, NASH, diabetes type 2 and complete metabolic syndromes) are extremely frequent and getting more so with growing age. Furthermore, physical activity is insufficient in grossly 2/3 of the studied population. The only positive point is a tendency of decreasing tobacco use in all age groups. The follow-up study is frustrating because most of the examined criteria get worse in-between check-ups instead of getting better with changes in lifestyle in an informed population.

Conclusions: Asymptomatic diseases or risk factors for non-communicable diseases are extremely frequent in the population examined. The follow-up data shows that huge parts of this group are not sufficiently conscientious of their problems to act up and change their life-style or seek adapted pharmacological prevention. Absolute number of risk factors (prevalence) or pathologies rise evidently with age but incidence (newly discovered pathologies after a first, second or a record of 21 check-ups with our services) rises less. Life-style changes are rare or insufficient to change the pathological value back to normal or therapeutically range. Even with several biases (retrospective design, selection bias, ...) our study puts similar problems forward in the population as ORISCAV. The astonishing (better than national records) results in tobacco use is probably due to a selection of more health-oriented patients and of a higher socio-educative-economic level. Alcohol abuse was very low but probably due to inadequate screening methods. A better health promotion advocating healthier

Objective: Excessive food intake has been linked to many factors including taste preference and the presence of psychopathology. The purpose of this study was to investigate the association between sweet and salty taste preference and psychopathology in patients with severe obesity.

Methods: A consecutive series of patients applying for bariatric surgery was recruited for the study. Taste preference was self-reported. Psychopathology was assessed using the revised version of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). 190 patients were included in the study.

Results: In comparison with patients who had salty taste preference, patients with sweet taste preference had significantly higher elevations on the depression (OD: 4.090, p = 0.010) and the hysteria (OD: 2.951, p = 0.026) clinical scales of the MMPI-2.

Conclusion: The results suggest the presence of an association between taste preference and psychopathology. The findings may be of interest for clinicians who are involved in the treatment of obesity. In particular, they may wish to pay increased attention to patients with sweet taste preference or who have a strong attraction for both sweet and salty foods, in order to detect psychopathology and to adapt the treatment.

We investigated an increase of human cases of Salmonella Enteritidis occurring from August until November 2010 in Belgium, Luxembourg and Germany involving an estimated three hundred laboratory confirmed cases. Molecular typing indicated that the increase in Luxembourg and Belgium was due a particular strain having phage type 14b, MLVA pattern 4-7-3-13-10-2-2 and fully susceptible to the Enternet panel of antibiotics. MLVA and phage typing were found to have similar discriminatory power on a collection of 40 Belgian and Luxembourg strains isolated during 2010. Epidemiological investigations in Luxembourg suggested eggs as a possible source for some cases, although supermarket eggs tested were negative. No other EU countries observed a substantial increase of cases, although three smaller outbreaks in Germany were also due to a strain with the same phage type and MLVA pattern. In 2010 the EU directive banning battery cages came into force in Germany followed by a dioxin food scare incident. Given that the EU Laying Hens Directive will come into force across all Member States in 2012, a closer monitoring of Salmonella contamination of imported eggs at retail and wholesale level is recommended.

Memory impairments are common in elderly. General practitioners are in first line to detect and manage these troubles, for which many countries published recommendations. For Alzheimer disease there are currently four treatments, none of which is healing. Some countries limited the first prescription of those medicines to specialists whereas in Luxembourg, every practitioner is allowed to prescribe them, but has to ask health insurance first. Consequently, it is important that general practitioners know what to do. The aim of our paper is to study the management done by the general practitioners in Luxembourg, the way they feel about it and the way they see the specific medicines for Alzheimer disease. Therefore, we have sent a questionnaire to every general practitioner in Luxembourg. We found that 87% of the practitioners realize at least one cognitive impairment test. More than half of them check for depression and 22.6% also add an autonomy assessment scale, even though all these tests are done by the dependence insurance. The involvement of general practitioners in the diagnosis of dementia is important as more than half of them have a statistically adequate number of demented patients. About two third of the practitioners do systematically start a specific medicine for Alzheimer disease. The management of cognitive impairment is difficult for general practitioners of Luxembourg, particularly the disclosure of diagnosis and management of behavioural and psychological symptoms.

The OPTIMISE study (NCT00681850) has been run in six European countries, including Luxembourg, to prospectively assess the effect of benchmarking on the quality of primary care in patients with type 2 diabetes, using major modifiable vascular risk factors as critical quality indicators. Primary care centers treating type 2 diabetic patients were randomized to give standard care (control group) or standard care with feedback benchmarked against other centers in each country (benchmarking group). Primary endpoint was percentage of patients in the benchmarking group achieving pre-set targets of the critical quality indicators: glycated hemoglobin (HbAlc), systolic blood pressure (SBP) and low-density lipoprotein (LDL) cholesterol after 12 months follow-up. In Luxembourg, in the benchmarking group, more patients achieved target for SBP (40.2% vs. 20%) and for LDL-cholesterol (50.4% vs. 44.2%). 12.9% of patients in the benchmarking group met all three targets compared with patients in the control group (8.3%). In this randomized, controlled study, benchmarking was shown to be an effective tool for improving critical quality indicator targets, which are the principal modifiable vascular risk factors in diabetes type 2.

Hypothesis: To measure and evaluate clinical scores and various inflammation parameters for providing a better outcome assessment of patients with secondary peritonitis.

Design: Prospective study.

Setting: ICU of a university and a university affiliated hospital.

Patients: Fifty-six patients with severe secondary peritonitis were enrolled in this study executed within 4 years.

Measurements and main results: Blood samples were taken preoperatively and 2, 6, 8, 12, 18, 24, 30, 36, 42 and 48 hours post operation, thereafter every 12th hour until day 5 respectively once daily until day 14. Etiology of peritonitis, clinical score systems (APACHE II, MOF and SOFA), and 27 mainly with activity tests or enzyme-immunoassays measurable inflammation parameters were simultaneously analyzed and stratified into lethal outcome (n = 11) or survival (n = 45), respectively. The etiological distribution of peritonitis was identical among both groups. Proportion of intraperitoneal fungi, E. coli, and bacteroids was substantially higher during the primary operation in the group with lethal outcome. With increasing significance initial and follow-up APACHE II, MOF and SOFA scores provided higher values in this group. Various plasma/serum parameters of hemostasis, leukocyte proteolytic system, acute phase reaction, cytokine system, cell adhesion, opsonization, and main organ functions showed significantly different values between both groups at the preoperative stage and/or during observation period I (day 0-4). Logistic regression analysis revealed the SOFA score and neopterin concentration as the combination with the best sensitivity (63.6%) and specificity (93.2%) for predicting the patients' survival even at the preoperative stage. For the observation period I, the combination of SOFA score and TNF receptor II showed the highest predictive sensitivity (72.7%) and specificity (95.6%).

Conclusion: Evaluation of the severity of secondary peritonitis using a scoring system with high prognostic relevance could conceivably result in an earlier and adequate application of intensive care such as hemofiltration, administration of immunoglobulins and serial abdominal lavage to improve successful outcome.

Background: The CC-chemokine receptor 5 (CCR5) is regulating inflammatory pathways and may thus be implicated in the development and progression of heart failure (HF). A 32 base pair deletion of the ccr5 gene, called CCR5delta32, prevents the expression of CCR5 at the cell surface. We analyzed the association between the CCR5delta32 deletion and the risk and severity of myocardial infarction (MI) in a cohort of patients from Luxembourg.

Methods: Using TaqMan allelic discrimination assay, we genotyped a total of 1080 patients undergoing coronary angiography. This population contained 3 groups of patients: controls with atypical chest pain, abnormal stress testing but normal coronary angiography (n = 154), patients with angina who underwent uncomplicated primary coronary intervention (n = 230), and patients with acute MI (n = 696). In MI patients, left ventricular ejection fraction (LVEF) was determined 1-month after MI with echocardiography.

Results: The frequency of the CCR5delta32 deletion was 16.3% in the global population, and was similar between controls, patients with angina and MI patients. The deletion was not associated with variations of plasma levels of creatine phosphokinase and troponin T, nor it was associated with LVEF, New York Heart Association class or 2-year mortality. The frequency of the deletion was comparable between MI patients with LV dysfunction (EF < or = 40%, n = 82) and no LV dysfunction (EF > 40%, n = 402).

Conclusions: The frequency of the CCR5delta32 deletion in Luxembourg is similar to that observed in other European countries and is not associated with the risk of developing MI and LV dysfunction.

Lung cancer is the leading cause of cancer-related death in the world and in Luxembourg. As a part of "The health science initiative focused on personalized medicine", Luxembourg aims to participate by developing diagnostics to improve the detection and treatment of lung cancer. In line with this objective, this study made a review of evolution of lung cancer in Luxembourg from 1981 to 2008 and compared this statistics to the situation in the Nordic countries, Europe in general and the World. Incidence data of the national morphological tumour registry and mortality data of the service of statistics of the national ministry of health is depicted in charts with trend lines, in the framework of a statistical evaluation of relevant parameters. The data indicate that while male lung cancer incidence decreased in Luxembourg, the incidence in women and its mortality have doubled over the 28-year span considered. Notwithstanding this increase, the female lung cancer incidence and mortality remain low compared to the Nordic countries and Europe. Interestingly, the study also potentially suggests that the lung cancer pattern follows the smoking pattern in incidence and mortality.

Background: Intracoronary infusion of autologous bone marrow cells (CTX) has been shown to improve myocardial function in post infarct patients and in patients with chronic ischemic cardiomyopathy. Long term results of CTX are unknown.

Methods and results: In this small pilot study, eleven patients with chronic ischemic cardiomyopathy and ejection fraction (EF) of 19 +/- 1% were treated with CTX and followed for 7 years. Four patients died during follow-up, all because of progressive heart failure. All patients received an implantable cardioverter defibrillator (ICD) during the course of the study but only 1 patients developed ventricular tachycardia after CTX. One patient received resynchronization therapy. The overall clinical benefit of CTX was modest (NYHA 3.0 +/- 0.1 pre and 2.5 +/- 0.2 post CTX, p= 0.06). CTX was not associated with reverse remodeling. However, left ventricular EF (19 +/- 1% pre and 18 +/- 6% post) and left ventricular end-diastolic volumes (289 +/- 71 ml pre and 294 +/- 123 ml post) remained remarkably stable over 7-year follow-up in the survivors of this very sick population.

Conclusions: During 7-year follow-up, CTX was associated with stabilization of EF and ventricular volumes but without significant clinical benefit or evidence of reverse remodeling.

Background: Genome-wide association and linkage studies have identified multiple susceptibility loci for obesity.

Objective: We hypothesized that such loci may affect weight loss and comorbidity amelioration outcomes following a gastric-bypass.

Design: A total of 200 obese patients who underwent a gastric bypass surgery were genotyped for single-nucleotide polymorphisms (SNPs) in insulin induced gene 2 (INSIG2) and melanocortin 4 receptor (MC4R) obesity genes.

Results: After a follow-up of 18 month, the patients (192) data of weight excess loss (72%) and co-morbidities (Hypertension -62- and Diabetes -39-) were analyzed and compared. 26 Patients with SNP were found (9 MC4R and 17 INSIG2). No significant differences in weight excess loss and amelioration of comorbidities were revealed.

Conclusions: The data suggest no influence of weight excess loss and amelioration of co-morbidities after gastric-bypass by genetic susceptibility.