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Giroux M, Émond M, Nadeau A, Boucher V, Carmichael PH, Voyer P, Pelletier M, Gouin É, Daoust R, Berthelot S, Lamontagne ME, Morin M, Lemire S, Sirois MJ. Functional and cognitive decline in older delirious adults after an emergency department visit. Age Ageing 2021; 50:135-140. [PMID: 32894748 DOI: 10.1093/ageing/afaa128] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND the aim of this study was to evaluate the impact of emergency department (ED) stay-associated delirium on older patient's functional and cognitive status at 60 days post ED visit. METHODS this study was part of the multi-centre prospective cohort INDEED study. This project took place between March 2015 and July 2016 in five participating EDs across the province of Quebec. Independent non-delirious patients aged ≥65, with an ED stay ≥8 hours, were monitored for delirium until 24 hours post ward admission. A 60-day follow-up phone assessment was conducted. Participants were screened for delirium using the Confusion Assessment Method. Functional and cognitive statuses were assessed at baseline and at the 60-day follow-up using OARS and TICS-m. RESULTS a total of 608 patients were recruited, 393 of which completed the 60-day follow-up. The Confusion Assessment Method was positive in 69 patients (11.8%) during ED stay or within the first 24 hours following ward admission. At 60 days, delirium patients experienced an adjusted loss of -2.9/28 [95%CI: -3.9, -2.0] points on the OARS scale compared to non-delirious patients who lost -1.6 [95%CI: -1.9, -1.3] (P = 0.006). A significant adjusted difference in cognitive function was also noted at 60 days, as TICS-m scores in delirious patients decreased by -1.6 [95%CI: -3.5, 0.2] compared to non-delirious patients, who showed a minor improvement of 0.5 [95%CI: -0.1, 1.1] (P = 0.03). CONCLUSION seniors who developed ED stay-associated delirium have lower baseline functional and cognitive status than non-delirious patients, and they will experience a more significant decline at 60 days post ED visit.
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Affiliation(s)
- Marianne Giroux
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
| | - Marcel Émond
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
- Département de médecine d'urgence, CHU de Québec-Université Laval, Québec, Canada
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec, Canada
| | - Alexandra Nadeau
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
| | - Valérie Boucher
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, Canada
| | | | - Philippe Voyer
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
| | - Mathieu Pelletier
- Université Laval, Québec, Canada
- Centre Intégré de Santé et de Services Sociaux de Lanaudière, Joliette, Canada
| | - Émilie Gouin
- Centre Hospitalier Régional de Trois-Rivières, Trois-Rivières, Canada
| | - Raoul Daoust
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Simon Berthelot
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Université Laval, Québec, Canada
- Département de médecine d'urgence, CHU de Québec-Université Laval, Québec, Canada
| | - Marie-Eve Lamontagne
- Université Laval, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, Canada
| | - Michèle Morin
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec, Canada
| | - Stéphane Lemire
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
| | - Marie-Josée Sirois
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Université Laval, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec, Canada
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Beauchamp-Chalifour P, Belzile EL, Racine LC, Nolet MP, Lemire S, Jean S, Pelet S. The long-term postoperative trajectory of geriatric patients admitted for a hip fracture: A prospective observational cohort study. Orthop Traumatol Surg Res 2020; 106:621-625. [PMID: 32371014 DOI: 10.1016/j.otsr.2019.11.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 09/23/2019] [Accepted: 11/08/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Worldwide, 1.3 million patients sustain a hip fracture every year. In Canada, 23 621 patients over 60 have been admitted with a hip fracture in 2003. Few authors have yet investigated the full postoperative trajectory of patients admitted for a hip fracture, in terms of orientation. HYPOTHESIS Most geriatric patients undergoing surgery for a hip fracture will not be able to return to their original residence at one-year of follow-up. OBJECTIVE To characterize the full one-year postoperative trajectory of patients admitted for a hip fracture, in terms of orientation. PATIENTS AND METHODS This is a prospective observational cohort study of geriatric patients undergoing surgery for a hip fracture from 2011 to 2017 in an academic center. A total of 254 patients were enrolled in this cohort. Demographic data and scores were collected throughout the hospitalisation. Patients' residences were assessed pre-fracture and at 1, 3, 6 and 12-month post-hospitalisation. RESULTS Most patients evolved in one of the following trajectories at one-year; (1) 30% (n=63) went back at home, (2) 11% (n=22) went back to a senior residence, (3) 16% (n=36) needed rehabillitation, (4) 13% (n=28) were discharged to a different location than prior to admission and (5) 18% (n=37) were deceased. Patients evolving in trajectory 1 were younger (mean, 80.8±11.1, p<0.0001). Patients evolving in trajectory 5 had lower MNA1 scores (mean, 19.9±5.2, p.<0.0001) and lower MMSE2 scores (mean, 16.0±10.9, p<0.0001). The delay between discharge from the attending staff and real departure from the hospital was correlated to low MNA scores (-0.35627, p<0.0001), low MMSE scores (-0.35910, p=0.0004) and associated with the need for a rehabilitation center (trajectory 3) (mean, 2.67±4.36 days, p=0.0002). DISCUSSION The postoperative evolution of geriatric patients with a hip fracture will continue to worsen due to the aging of the population. However, this study highlights important issues such as nutritional assessment, cognitive disorders and access to rehabilitation centers. LEVEL OF EVIDENCE II, prospective cohort study.
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Affiliation(s)
- Philippe Beauchamp-Chalifour
- Faculty of Medicine, Department of Surgery, Division of Orthopaedic Surgery, Laval University, Quebec, Canada; Centre de recherche FRQS du CHU de Québec-Hôpital Enfant-Jésus, 1401, 18(e) rue, G1 J 1Z4, Québec, Canada
| | - Etienne L Belzile
- Faculty of Medicine, Department of Surgery, Division of Orthopaedic Surgery, Laval University, Quebec, Canada; Department of Orthopedic Surgery, CHU de Québec-Hôpital Enfant-Jésus, 1401, 18(e) rue, G1 J 1Z4 Québec, Canada; Centre de recherche FRQS du CHU de Québec-Hôpital Enfant-Jésus, 1401, 18(e) rue, G1 J 1Z4, Québec, Canada
| | - Louis-Charles Racine
- Centre de recherche FRQS du CHU de Québec-Hôpital Enfant-Jésus, 1401, 18(e) rue, G1 J 1Z4, Québec, Canada
| | - Marie-Pier Nolet
- Faculty of Medicine, Department of Surgery, Division of Orthopaedic Surgery, Laval University, Quebec, Canada
| | - Stéphane Lemire
- Faculty of Medicine, Department of Surgery, Division of Orthopaedic Surgery, Laval University, Quebec, Canada; Department of Orthopedic Surgery, CHU de Québec-Hôpital Enfant-Jésus, 1401, 18(e) rue, G1 J 1Z4 Québec, Canada; Centre de recherche FRQS du CHU de Québec-Hôpital Enfant-Jésus, 1401, 18(e) rue, G1 J 1Z4, Québec, Canada
| | - Sonia Jean
- Centre de recherche FRQS du CHU de Québec-Hôpital Enfant-Jésus, 1401, 18(e) rue, G1 J 1Z4, Québec, Canada
| | - Stéphane Pelet
- Faculty of Medicine, Department of Surgery, Division of Orthopaedic Surgery, Laval University, Quebec, Canada; Department of Orthopedic Surgery, CHU de Québec-Hôpital Enfant-Jésus, 1401, 18(e) rue, G1 J 1Z4 Québec, Canada; Centre de recherche FRQS du CHU de Québec-Hôpital Enfant-Jésus, 1401, 18(e) rue, G1 J 1Z4, Québec, Canada.
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Boucher V, Lamontagne ME, Nadeau A, Carmichael PH, Yadav K, Voyer P, Pelletier M, Gouin É, Daoust R, Berthelot S, Morin M, Lemire S, Minh Vu TT, Lee J, Émond M. Unrecognized Incident Delirium in Older Emergency Department Patients. J Emerg Med 2019; 57:535-542. [DOI: 10.1016/j.jemermed.2019.05.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
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Émond M, Boucher V, Carmichael PH, Voyer P, Pelletier M, Gouin É, Daoust R, Berthelot S, Lamontagne ME, Morin M, Lemire S, Minh Vu TT, Nadeau A, Rheault M, Juneau L, Le Sage N, Lee J. Incidence of delirium in the Canadian emergency department and its consequences on hospital length of stay: a prospective observational multicentre cohort study. BMJ Open 2018. [PMID: 29523559 PMCID: PMC5855334 DOI: 10.1136/bmjopen-2017-018190] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE We aim to determine the incidence of delirium and describe its impacts on hospital length of stay (LOS) among non-delirious community-dwelling older adults with an 8-hour exposure to the emergency department (ED) environment. DESIGN This is a prospective observational multicentre cohort study (March-July 2015). Patients were assessed two times per day during their entire ED stay and up to 24 hours on hospital ward. SETTING The study took place in four Canadian EDs. PARTICIPANTS 338 included patients: (1) aged ≥65 years; (2) who had an ED stay ≥8 hours; (3) were admitted to hospital ward and (4) were independent/semi-independent. MAIN OUTCOMES AND MEASURES The primary outcomes of this study were incident delirium in the ED or within 24 hours of ward admission and ED and hospital LOS. Functional and cognitive status were assessed using validated Older Americans Resources and Services and the modified Telephone Interview for Cognitive Status tools. The Confusion Assessment Method was used to detect incident delirium. Univariate and multivariate analyses were conducted to evaluate outcomes. RESULTS Mean age was 76.8 (±8.1), 17.7% were aged >85 years old and 48.8% were men. The mean incidence of delirium was 12.1% (n=41). Median IQR ED LOS was 32.4 (24.5-47.9) hours and hospital LOS was 146.6 (75.2-267.8) hours. Adjusted mean hospital LOS was increased by 105.4 hours (4.4 days) (95% CI 25.1 to 162.0, P<0.001) for patients who developed an episode of delirium compared with non-delirious patient. CONCLUSIONS An incident delirium was observed in one of eight independent/semi-independent older adults after an 8-hour ED exposure. An episode of delirium increases hospital LOS by 4 days and therefore has important implications for patients and could contribute to ED overcrowding through a deleterious feedback loop.
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Affiliation(s)
- Marcel Émond
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Département de médecine d’urgence, CHU de Québec-Université Laval, Québec, Canada
- Medicine, Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, Québec, Canada
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Québec, Canada
| | - Valérie Boucher
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Medicine, Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, Canada
| | | | - Philippe Voyer
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, Québec, Canada
- Nursing, Université Laval, Québec, Canada
| | - Mathieu Pelletier
- Medicine, Université Laval, Québec, Canada
- Centre Intégré de Santé et de Services Sociaux de Lanaudière, Joliette, Canada
| | - Émilie Gouin
- Centre Hospitalier Régional de Trois-Rivières, Trois-Rivières, Canada
| | - Raoul Daoust
- Centre de recherche de l’Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
- Medicine, Université de Montréal, Montréal, Canada
| | - Simon Berthelot
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Département de médecine d’urgence, CHU de Québec-Université Laval, Québec, Canada
- Medicine, Université Laval, Québec, Canada
| | - Marie-Eve Lamontagne
- Medicine, Université Laval, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, Canada
| | - Michèle Morin
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Medicine, Université Laval, Québec, Canada
| | - Stéphane Lemire
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Medicine, Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, Québec, Canada
| | - Thien Tuong Minh Vu
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montréal, Canada
- Centre hospitalier de l’Université de Montréal, Montréal, Canada
- Institut de gériatrie de l’Université de Montréal, Montréal, Canada
| | - Alexandra Nadeau
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Medicine, Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, Canada
| | | | - Lucille Juneau
- Centre Intégré Universitaire de Services Sociaux et de Santé de la Capitale-Nationale, Québec, Canada
| | - Natalie Le Sage
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Département de médecine d’urgence, CHU de Québec-Université Laval, Québec, Canada
- Medicine, Université Laval, Québec, Canada
| | - Jacques Lee
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Health Sciences Center, Toronto, Canada
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Brachat A, Liebundguth N, Rebischung C, Lemire S, Schärer F, Hoepfner D, Demchyshyn V, Howald I, Düsterhöft A, Möstl D, Pöhlmann R, Kötter P, Hall MN, Wach A, Philippsen P. Analysis of deletion phenotypes and GFP fusions of 21 novel Saccharomyces cerevisiae open reading frames. Yeast 2000; 16:241-53. [PMID: 10649453 DOI: 10.1002/(sici)1097-0061(200002)16:3<241::aid-yea517>3.0.co;2-t] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
As part of EUROFAN (European Functional Analysis Network), we investigated 21 novel yeast open reading frames (ORFs) by growth and sporulation tests of deletion mutants. Two genes (YNL026w and YNL075w) are essential for mitotic growth and three deletion strains (ynl080c, ynl081c and ynl225c) grew with reduced rates. Two genes (YNL223w and YNL225c) were identified to be required for sporulation. In addition we also performed green fluorescent protein (GFP) tagging for localization studies. GFP labelling indicated the spindle pole body (Ynl225c-GFP) and the nucleus (Ynl075w-GFP) as the sites of action of two proteins. Ynl080c-GFP and Ynl081c-GFP fluorescence was visible in dot-shaped and elongated structures, whereas the Ynl022c-GFP signal was always found as one spot per cell, usually in the vicinity of nuclear DNA. The remaining C-terminal GFP fusions did not produce a clearly identifiable fluorescence signal. For 10 ORFs we constructed 5'-GFP fusions that were expressed from the regulatable GAL1 promoter. In all cases we observed GFP fluorescence upon induction but the localization of the fusion proteins remained difficult to determine. GFP-Ynl020c and GFP-Ynl034w strains grew only poorly on galactose, indicating a toxic effect of the overexpressed fusion proteins. In summary, we obtained a discernible GFP localization pattern in five of 20 strains investigated (25%). A deletion phenotype was observed in seven of 21 (33%) and an overexpression phenotype in two of 10 (20%) cases.
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Affiliation(s)
- A Brachat
- Lehrstuhl für Angewandte Mikrobiologie, Biozentrum, Universität Basel, Klingelbergstrasse 70, CH-4056 Basel, Switzerland
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Béair G, Vincent C, Lemire S, Coderre D. Laboratory and Field Assays with Entomopathogenic Nematodes for the Management of Oblique Banded Leafroller Choristoneura rosaceana (Harris) (Tortricidae). J Nematol 1999; 31:684-689. [PMID: 19270936 PMCID: PMC2620410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
The activity of steinernematid entomopathogenic nematodes against Choristoneura rosaceana was evaluated under laboratory and field conditions. In petri dish trials, all instars were susceptible to Steinernema carpocapsae AII strain with LD(50) values of 13, 5, 3, and 2 infective juveniles for the third-, fourth-, fifth-, and sixth-stage larvae, respectively. Steinernema riobrave 335, S. feltiae UK, S. carpocapsae AII, and S. glaseri 326 caused 85, 55, 45, and 8% mortality of third instars when exposed to the concentration of 25 infective juveniles per dish. When third instars were exposed to S. carpocapsae AII for 0, 1, 4, 8, 12, and 24 hours, larval mortality was 12, 13, 21, 47, 64, and 87%, respectively. At least 8 hours' exposure was required to cause a significant increase in mortality when compared with the control (water) and the 1 and 4-hour exposures. None of the tested adjuvants provided a significant improvement in the average total number and the average number of living S. carpocapsae AII per unit leaf area when compared to the water control. Under field conditions, foliar applications of S. carpocapsae AII at the rate of 2 x 10 infective juveniles/ha provided 37, 19, and 13% larval control. At present, efficacy level and treatment cost preclude nematode applications as a sole treatment against this pest.
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Romieu I, Ramirez M, Meneses F, Ashley D, Lemire S, Colome S, Fung K, Hernandez-Avila M. Environmental exposure to volatile organic compounds among workers in Mexico City as assessed by personal monitors and blood concentrations. Environ Health Perspect 1999; 107:511-5. [PMID: 10378996 PMCID: PMC1566663 DOI: 10.1289/ehp.99107511] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Benzene, an important component in gasoline, is a widely distributed environmental contaminant that has been linked to known health effects in animals and humans, including leukemia. In Mexico City, environmental benzene levels, which may be elevated because of the heavy traffic and the poor emission control devices of older vehicles, may pose a health risk to the population. To assess the potential risk, portable passive monitors and blood concentrations were used to survey three different occupational groups in Mexico City. Passive monitors measured the personal exposure of 45 workers to benzene, ethylbenzene, toluene, o-xylene and m-/p-xylene during a work shift. Blood concentrations of the above volatile organic compounds (VOCs), methyl tert-butyl ether, and styrene were measured at the beginning and the end of a work shift. Passive monitors showed significantly higher (p > 0.0001) benzene exposure levels among service station attendants (median = 330 microg/m3; range 130-770) as compared to street vendors (median = 62 microg/m3; range 49-180) and office workers (median = 44 microg/m3, range 32-67). Baseline blood benzene levels (BBLs) for these groups were higher than those reported for similar populations from Western countries (median = 0.63 microg/L, n = 24 for service station attendants; median = 0.30 microg/L, n = 6 for street vendors; and median = 0.17 microgr;g/L, n = 7 for office workers). Nonsmoking office workers who were nonoccupationally exposed to VOCs had BBLs that were more than five times higher than those observed in a nonsmoking U.S. population. BBLs of participants did not increase during the work shift, suggesting that because the participants were chronically exposed to benzene, complex pharmacokinetic mechanisms were involved. Our results highlight the need for more complete studies to assess the potential benefits of setting environmental standards for benzene and other VOCs in Mexico.
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Affiliation(s)
- I Romieu
- PanAmerican Health Organization, Mexico DF, Mexico.
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Gaudreau R, Le Gouill C, Métaoui S, Lemire S, Stankovà J, Rola-Pleszczynski M. Signalling through the leukotriene B4 receptor involves both alphai and alpha16, but not alphaq or alpha11 G-protein subunits. Biochem J 1998; 335 ( Pt 1):15-8. [PMID: 9742207 PMCID: PMC1219746 DOI: 10.1042/bj3350015] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
COS-7 cells transfected with the leukotriene (LT) B4 receptor (BLTR) cDNA were unable to produce LTB4-induced inositol phosphates (IPs) in spite of the presence of endogenous Galphai, Galphaq and Galpha11 proteins. Co-transfection of BLTR with Galpha16, however, resulted in high levels of IP production, which were 17-, 10- and 6-fold higher than with co-transfected Galpha11, Galphaq and Galpha14, respectively. Co-transfection of BLTR with phospholipase C (PLC) beta2, on the other hand, resulted in efficient IP production and co-transfection of BLTR with both Galpha16 and PLCbeta2 resulted in a greater than additive response.
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Affiliation(s)
- R Gaudreau
- Immunology Division, Department of Pediatrics, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, QC J1H 5N4 Canada
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Beck IT, Champion MC, Lemire S, Thomson AB, Anvari M, Armstrong D, Bailey RJ, Barkun AN, Boivin M, Bursey RF, Chaun H, Chiba N, Cockeram AW, Connon JJ, Da Costa LR, Faloon TR, Fedorak RN, Gillies RR, Goeree R, Hunt RH, Inculet RI, Klein A, Leddin DJ, Love JR, Worobetz LJ. The Second Canadian Consensus Conference on the Management of Patients with Gastroesophageal Reflux Disease. Can J Gastroenterol 1997; 11 Suppl B:7B-20B. [PMID: 9347173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
UNLABELLED The Second Canadian Consensus Conference on the Management of Patients with Gastroesophageal Reflux Disease (GERD) was organized by the Canadian Association of Gastroenterology to address major advances in the understanding of the pathophysiology of GERD, to review the new methods of investigation and therapy introduced since the first conference in 1992 and to examine the issue of relevant health economics. The changes that have taken place over the past four years have been sufficiently dramatic to necessitate reassessment of the recommendations made following the first conference. The second conference dealt with the investigation and treatment of uncomplicated GERD and the complex issues of esophageal and extraesophageal complications such as chest pain, Barrett's esophagus, and reflux-related pulmonary and laryngeal disorders. The role of laparoscopic surgery was also discussed. A decision tree for investigation and treatment of patients with GERD was developed. The 38 participants represented a broad spectrum of experience, location of practice and special interests. The distribution of participants conformed to the recommendations of the Canadian Medical Association guidelines for consensus documents in that there should be input from all possible interested parties. A list of the state-of-the-art lectures presented during the conference, the small group sessions, the session chairpersons and participants are appended to this document. CONCLUSIONS. UNCOMPLICATED GERD: GERD with alarm symptoms must be investigated immediately. There was no consensus about when to investigate uncomplicated GERD, ie, whether to perform endoscopy immediately or after initial therapy fails. There was controversy regarding 'step up' (H2 receptor antagonist [H2RA] or prokinetic [PK] first therapy) versus 'step down' therapy (proton pump inhibitor [PPI] first therapy). The majority decision was for short term 'step up' therapy and investigation if symptoms do not improve or recur. Maintenance therapy should be carried out with the initial therapy that was effective. H2RAs and PKs may suffice for maintenance therapy in milder GERD; however, for severe esophagitis, PPIs should be used. SURGERY Indications for laparoscopic surgery should be the same as for conventional antireflux operations. NONCARDIAC ANGINA-LIKE CHEST PAIN: After exclusion of nonesophageal causes, the majority decided that eight weeks of therapy with a PPI should be performed, while some suggested work-up before a therapeutic test. In the absence of response or recurrence, esophagogastroduodenoscopy (EGD) and, depending on the circumstances, 24 h ambulatory pH/motility may be indicated. BARRETT'S ESOPHAGUS: Only patients who, in case of future discovery of cancer or dysplasia, are able or willing to undergo therapy should have surveillance. In the absence of dysplasia EGD should be performed every two years, and in the presence of mild dysplasia every three to six months. All agreed that for severe dysplasia, esophagectomy or poor risk patients, esophageal mucosal ablation is indicated. ESTRAESOPHAGEAL COMPLICATONS (EECs): Asthma, chronic cough and posterior laryngitis were considered EECs. Although PPIs may decrease symptoms, improvement alone is not diagnostic of the presence of EEC. Ambulatory pH studies with two pH probes or ambulatory pH/motility may be useful in establishing causation. HEALTH ECONOMICS There are limited data for an economic comparison among the different drugs or between medical and surgical therapy.
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Affiliation(s)
- I T Beck
- Hotel Dieu Hospital, Kingston, Ontario
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Lemire S. Assessment of clinical severity and investigation of uncomplicated gastroesophageal reflux disease and noncardiac angina-like chest pain. Can J Gastroenterol 1997; 11 Suppl B:37B-40B. [PMID: 9347176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Heartburn, suggesting gastroesophageal reflux, is common. Epidemiological studies have shown that 36% to 44% of adults experience heartburn at least once a month, 14% weekly and 7% once a day. Heartburn and regurgitations are the typical symptoms of gastroesophageal reflux disease (GERD). When present as predominant symptoms, they are quite specific but not very sensitive. Clinical severity of GERD does not predict the severity of the underlying condition. The diagnostic approach to patients with GERD depends on the clinical presentation and the question to be answered -Is abnormal reflux present? Is there mucosal injury? Are symptoms due to reflux? Several techniques such as barium swallow, endoscopy, ambulatory pH monitoring, esophageal manometry and 24 h pH/motility can be used to answer those questions. Barium swallow is not much help in diagnosing reflux esophagitis because reflux can occur in more than 25% of asymptomatic patients. It is most useful in demonstrating structural abnormalities such as strictures and hiatal hernia. The importance of hiatal hernia in the pathogenesis of GERD has been controversial. Recent studies suggest that GERD patients with hiatal hernia present with greater extent of reflux and more severe esophagitis. Endoscopy is the best diagnostic study for mucosal evaluation. Ambulatory 24 h pH monitoring is indicated for patients with atypical symptoms of reflux such as chest pain or pulmonary symptoms, or those who do no respond to therapy. The evaluation of duodenogastroesophageal reflux or alkaline reflux can be measured, but the clinical importance of this test remains controversial. Esophageal manometry allows measurement of the lower esophageal sphincter pressure (LES) and the evaluation of esophageal peristalsis. There is a lack of correlation between LES and reflux esophagitis. The role of peristaltic dysfunction in GERD is unclear, but the high percentage of abnormal contractions suggests a more severe form of GERD. Esophageal motility study can document the presence of effective esophageal peristalsis in patients before antireflux surgery. Twenty-four hour pH/motility is not yet available widely. It is useful in patients who have several daily attacks. There is a correlation with acid reflux in approximately 40% of events. Investigation of noncardiac angina-like chest pain is best achieved by standard esophageal manometry combined with provocative testing. Most laboratories performing these studies use acid perfusion and pharmacostimulation with either bethanechol or edrophonium to reproduce the patient's chest pain during esophageal manometry. Esophageal balloon distension is considered to give the highest yield as a provocative test in patients with angina-like chest pain. It is believed that abnormal esophageal nociception is not simply related to underlying motor dysfunction but also to the presence of a visceral sensory abnormality.
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Mony M, Lavoie S, Lemire S. [Zollinger-Ellison syndrome: long-term treatment with ranitidine]. Union Med Can 1986; 115:149-50. [PMID: 3705262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Lemire S. [Early detection of cancer in ulcerative colitis]. Union Med Can 1983; 112:858-63. [PMID: 6649189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Rioux JE, Bastide AF, Lemire S. [Laparoscopy in gynecology. II. Analysis of 150 consecutive laparoscopies]. Union Med Can 1971; 100:310-5. [PMID: 4251822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Rioux JE, Bastide AF, Lemire S. [Laparoscopy in gynecology. I. General concepts]. Union Med Can 1970; 99:698-706. [PMID: 4252118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Lemire S. [Candida albicans vaginitis: clinical aspects and chlordantoin therapy]. Can Med Assoc J 1968; 99:211-3. [PMID: 5671127 PMCID: PMC1924362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Lemire S, Iber FL. Pancreatic secretion in rats with protein malnutrition. Johns Hopkins Med J 1967; 120:21-5. [PMID: 6018953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Lemire S, Cocco AE. Visualization of the left colon with the fiber optic gastroduodenoscope. Gastrointest Endosc 1966; 13:29-30. [PMID: 5957000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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