The experience of healthcare professionals treating adolescents with eating disorders in psychiatric and pediatric inpatient units for adolescents: A qualitative study

OBJECTIVES

The recommended treatment for Eating Disorders (EDs) is multidisciplinary and multimodal. Nonetheless, the complex linkage of the different disciplines involved is not necessarily simple. We analyzed the experience of healthcare professionals faced with psychiatric and psychological symptoms in adolescents with EDs in two "multidisciplinary" inpatient units embedded predominantly in different paradigms - one pediatric and one psychiatric.

METHODS

Qualitative analysis of 20 healthcare staff members' interviews from different professional backgrounds working in inpatient units for EDs in Montreal (Canada) and Paris (France).

RESULTS

The "Complex patients" theme discusses the need for a global approach to the multiplicity of symptoms presented by these patients. "Management and its limits" describes the daily management of psychiatric symptoms in both units. "Psychiatry and Adolescent medicine: from opposition to collaboration" describes the different levels at which these disciplines work together and how this cooperation may be evolving.

CONCLUSIONS

The complex entanglement intrinsic in EDs of the patients' somatic, psychosocial, psychiatric, and adolescent problems requires collaboration between disciplines, but the modalities of this collaboration are multiple and evolve non-linearly in specialized treatment units. A multilevel approach must be offered, with the degree of collaboration (multidisciplinary, interdisciplinary and transdisciplinary) appropriate to the complexity of each adolescent's issues.

Pediatric deep neck infections: Clinical description and analysis of therapeutic management

OBJECTIVES

The aim of our study was to describe clinical presentations, bacteriological results, and therapeutic management in a pediatric population presenting with acute pharyngeal suppuration. A further aim was to identify clinical, bacteriological, and radiological predictors of success associated with exclusive medical treatment.

METHOD

A retrospective study was carried out including patients under 18 years of age hospitalized between January 1, 2015 and December 31, 2017 in our center for acute pharyngeal suppuration. We identified three groups of patients: group A, treated with exclusive intravenous antibiotics; group B, surgically treated after 48 h of appropriate antibiotic therapy, due to persistent fever and/or clinical worsening and/or persistence of a collection on follow-up imaging; group C, surgically treated as first-line therapy in association with intravenous antibiotics. A total of 83 patients were included: 36 in group A, 12 in group B, and 35 in group C. These three groups were compared for several variables: age of the patients, polynuclear neutrophil counts, diameter of the collections (the largest diameter found on imaging), duration of antibiotic therapy, delay before return to apyrexia, and hospitalization duration.

RESULTS

A neck mass and torticollis were present, respectively, in 48.8 and 47.6% of cases. No breathing difficulties were reported. Streptococcus pyogenes was the most frequently identified microorganism. The average diameter of the collections from patients treated surgically as first-line therapy (group C) was significantly larger than that of the patients treated with antibiotics (group A) (27.89 mm vs. 18.73 mm, respectively, p = 0.0006). All the patients who required surgery despite 48 h of appropriate antibiotic therapy (group B) had collections with diameters greater than or equal to 15 mm. There was no significant difference between the groups concerning hospitalization duration.

CONCLUSION

Exclusive medical treatment is associated with a high cure rate, mainly for collections with small diameter. We recommend special attention to patients treated with first-line exclusive intravenous antibiotic therapy and with a collection diameter greater than or equal to 15 mm.

Severe neutropenia in an anorexic adolescent girl: a stigma of underfeeding syndrome?

PURPOSE

We describe a case of severe, prolonged neutropenia in an adolescent girl hospitalized for anorexia nervosa (AN) which occurred during a refeeding procedure in the absence of refeeding syndrome.

METHODS

This case report includes retrospective anamnestic, clinical and biological data from the patient's medical record. A literature review was conducted on the haematological changes described in the undernutrition and refeeding periods, and also on recent data for underfeeding syndrome in patients with anorexia nervosa.

CONCLUSION

Leuconeutropenia is an adaptive condition observed in undernutrition in AN, usually rapidly and completely reversible in the course of refeeding and weight gain. We describe a rare case of severe, prolonged neutropenia despite appropriate care in the absence of refeeding syndrome and without gelatinous bone marrow transformation. We suggest that neutropenia in adolescent anorexia nervosa could be a stigma of underfeeding syndrome resulting from an overly cautious refeeding strategy.

LEVEL OF EVIDENCE

Level V, descriptive study.

[Adjustment of healthcare and telemedicine in times of lockdown and COVID-19 pandemic: Feedback from a "Maison des Adolescents" (Teenager's House)]

La crise sanitaire de la COVID-19 a imposé une réorganisation majeure de l’offre de soins en France. Considérant la nécessité de maintenir des soins pour les adolescents souffrant de troubles physiques ou psychiques, les Maisons des Adolescents ont dû adapter en urgence leurs pratiques afin de maintenir au maximum la continuité des soins pour les adolescents et leurs familles. À travers le cas d’une adolescente qui a présenté une dégradation clinique de son anorexie mentale durant le confinement, nous présentons les réorganisations des soins au sein des différentes unités (consultations–hôpital de jour–unité d’hospitalisation temps plein) d’une Maison des Adolescents parisienne au cours de la pandémie de COVID-19. À partir de la littérature existante, nous discutons les avantages et limites de la télémédecine et les enjeux pratiques pour l’organisation future des soins pour les adolescents. Contrairement à la médecine pédiatrique ou pédopsychiatrique, il n’existe pas de protocole décrivant la mise en place de la télémédecine en médecine et psychiatrie de l’adolescent. Il est urgent d’approfondir les évaluations de l’utilisation de la télémédecine pour les adolescents. Ce type de recherche permettra d’améliorer les connaissances sur l’efficacité, l’acceptabilité et les limites de l’utilisation d’un dispositif de téléconsultation en psychiatrie de l’adolescent, en contexte de crise. Certaines modalités de soins à distance mises en place pendant la crise pourraient ainsi être maintenues dans le temps et s’inscrire en routine dans le domaine de la médecine et psychiatrie de l’adolescent.

Tracheal injury complicating Sistrunk's thyroglossal cyst surgery

INTRODUCTION

Airway injury is a very rare complication of thyroglossal duct cyst surgery in children. The wound is most frequently located at the larynx, due to a confusion between the hyoid bone and the thyroid cartilage.

OBSERVATION

This is the first report of a tracheal injury complicating Sistrunk's procedure in a 3 year old child, revealed by respiratory distress. Conservative treatment was suggested, requiring a tracheostomy lasting 49 days, leading to decanulation and complete anatomical and functional recovery.

CONCLUSION

This report highlights the specificity of pediatric laryngotracheal anatomy.

Contribution of drug-induced sleep endoscopy to the management of pediatric obstructive sleep apnea/hypopnea syndrome

OBJECTIVES

The role of drug-induced sleep endoscopy (DISE) in the management of obstructive sleep apnea/hypopnea syndrome (OSAHS) is not precisely defined in children. The primary objective of this study was to describe DISE-induced revision of airway obstruction site location and the ensuing treatment changes in children with OSAHS. Secondary objectives were to analyze the correlation of number of obstruction sites found on DISE with apnea-hypopnea index (AHI) and with type of OSAHS.

MATERIAL AND METHODS

A retrospective single-center study included 31 children (mean age: 5.5±2.6years) undergoing DISE for management of OSAHS between 2015 and 2018. Revisions of airway obstruction site location and in treatment were noted. The correlation of number of obstruction sites with AHI and with type of OSAHS was analyzed.

RESULTS

Airway obstruction site location was reconsidered in 77% of children (n=24), modifying treatment in 45.2% (n=14). There was no significant correlation between number of obstruction sites and AHI: Spearman coefficient 0.20 (P=0.26). Patients with type-III OSAHS did not show more obstruction sites than others: respectively, 2.0 versus 1.8 (P=0.40).

CONCLUSION

DISE induced significant revision of the location and change in treatment of obstruction sites in children with OSAHS. Systematic implementation, especially in type-I OSAHS, would allow more precise pre-therapeutic classification and treatment adapted to actual airway obstruction.

Guidelines of the French Society of Otorhinolaryngology (SFORL): Nonsteroidal anti-inflammatory drugs (NSAIDs) and pediatric ENT infections. Short version

OBJECTIVES

To present the guidelines of the French Society of Otolaryngology-Head and Neck Surgery concerning the use of non-steroidal anti-inflammatory drugs (NSAIDs) in pediatric ENT infections.

METHODS

Based on a critical analysis of the medical literature up to November 2016, a multidisciplinary workgroup of 11 practitioners wrote clinical practice guidelines. Levels of evidence were classified according to the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) system: GRADE A, B, C or "expert opinion". The first version of the text was reworked by the workgroup following comments by the 22 members of the reading group.

RESULTS

The main recommendations are: NSAIDs are indicated at analgesic doses (e.g. 20-30 mg/kg/day for ibuprofen) in combination with paracetamol (acetaminophen) in uncomplicated pediatric ENT infections (acute otitis media, tonsillitis, upper respiratory infections, and maxillary sinusitis) if: o pain is of medium intensity (visual analogue scale (VAS) score 3-5 or "Evaluation Enfant Douleur" (EVENDOL) child pain score 4-7) and insufficiently relieved by first-line paracetamol (residual VAS≥3 or EVENDOL≥4); o pain is moderate to intense (VAS 5-7 or EVENDOL 7-10). When combined, paracetamol and ibuprofen are ideally taken simultaneously every 6h. It is recommended: (1) o not to prescribe NSAIDs in severe or complicated pediatric ENT infections; (2) o to suspend NSAIDs treatment in case of unusual clinical presentation of the infection (duration or symptoms); (3) o not to prescribe NSAIDs for more than 72h.

Combined genetic approaches yield a 48% diagnostic rate in a large cohort of French hearing-impaired patients

Hearing loss is the most common sensory disorder and because of its high genetic heterogeneity, implementation of Massively Parallel Sequencing (MPS) in diagnostic laboratories is greatly improving the possibilities of offering optimal care to patients. We present the results of a two-year period of molecular diagnosis that included 207 French families referred for non-syndromic hearing loss. Our multi-step strategy involved (i) DFNB1 locus analysis, (ii) MPS of 74 genes, and (iii) additional approaches including Copy Number Variations, in silico analyses, minigene studies coupled when appropriate with complete gene sequencing, and a specific assay for STRC. This comprehensive screening yielded an overall diagnostic rate of 48%, equally distributed between DFNB1 (24%) and the other genes (24%). Pathogenic genotypes were identified in 19 different genes, with a high prevalence of GJB2, STRC, MYO15A, OTOF, TMC1, MYO7A and USH2A. Involvement of an Usher gene was reported in 16% of the genotyped cohort. Four de novo variants were identified. This study highlights the need to develop several molecular approaches for efficient molecular diagnosis of hearing loss, as this is crucial for genetic counselling, audiological rehabilitation and the detection of syndromic forms.

Human health risk assessment on the consumption of fruits and vegetables containing residual pesticides: A cancer and non-cancer risk/benefit perspective

Pesticide residues in food is a public health concern. This study aimed to evaluate health risk and benefit associated with chronic consumption of fruits and vegetables (F&V) containing residual pesticides in the province of Quebec, Canada. Based on a representative sample of Quebecers (n=4727, aged 1-79) enrolled in the Canadian nutrition survey, population's mean chronic dietary exposure through consumption of F&V was evaluated for 169 different pesticide active ingredients (PAI), including 135 for which toxicological reference values (TRV) were available in the literature. Total lifetime cancer risk was estimated to be 3.3×10^-4 considering the 28 substances for which an oral slope factor was also available. Non-cancer risk quotients greater than 1 were obtained at the 95th percentile of children's exposure for 10 of the 135 PAIs, and considering the most severe pesticide-specific TRV. Dithiocarbamates and imazalil are the authorized PAI that contribute the most to cancer and non cancer risk; they are therefore identified as "priority" PAI. For each estimated case of cancer triggered by PAI exposure, at least 88 cases were deemed prevented by the consumed F&V, based on the population's etiological fraction of the cancer risk that F&V prevent. Concluding, chronic health risks investigated are low and health benefits of F&V consumption by far outweigh the PAI-related risk. However, risk estimates are not negligeable and uncertainties remain. Thus, reducing PAI exposure through F&V consumption with a particular focus on "priority" PAI mentionned above, while maintaining an abundant and varied F&V diet, is desirable.

Very high concentrations of n-3 fatty acids in peri-and postmenopausal Inuit women from Greenland

OBJECTIVES

The objectives of this study were to examine the profile of relative concentrations in plasma phospholipids of n-3 fatty acids among peri- and postmenopausal Inuit women living in Greenland and to verify their relationships with ischemic heart disease risk factors and more particularly, with concentrations of plasma triacylglycerols.

STUDY DESIGN

This study was part of a survey conducted in 2000, which aimed to assess the prevalence of osteoporosis and the associated risk factors among peri- and postmenopausal Greenland Inuit women.

METHODS

The study population consisted of 153 women aged 49-69 years (mean +/- SD: 55.3 +/- 4.4 y) randomly selected. Data were obtained through an interview (questionnaire on lifestyle habits, medical history etc) and a clinical session (physiologic and anthropologic measurements). Plasma samples were used to measure the fatty acid composition of plasma phospholipids.

RESULTS

The mean body mass index of women was 27.9 +/- 6.1. Seventy-five percent were smokers and 9% were currently on hormone replacement therapy. Relative concentrations of total n-3 fatty acids were very high (13.8%, 95% CI: 13.1-14.6), with docosahexanoic and eicosapentanoic acids accounting for 4.7% and 7.2%, respectively. The ratio of n-3:n-6 fatty acids was 0.67. n-3 fatty acids were inversely correlated to triacylglycerols.

CONCLUSION

These data show that peri- and post-menopausal Greenland Inuit women have very high plasma concentrations of n-3 fatty acids that protect them from ischemic heart disease.

Abstract P1-01-14: Do estrogen receptor negative and progesterone receptor positive breast tumors really exist? Attitude for not making them real

Background: Breast tumors with negative estrogen receptor (ER-) and positive progesterone receptor (PR+) are rare (from 0 to 3.4 % according to the studies), and their existence is contested. These markers determine cancer molecular subtypes which play a determinant role for both the management and the prognosis of breast cancers. It is then essential to document the real existence of ER-/PR+ tumors. The present study aimed at determining if ER-/PR+ tumors share more basal or luminal characteristics.

Methods: Between 2000 and 2015, 50 patients with ER-/PR+ breast tumors, representing 0.6 % of all breast cancers diagnosed in our institution, were included in this study. Their clinical (age, node status), morphological (size, histological type, Elston and Ellis (EE) grade, necrosis, inflammation, pushing margins, central scar, mitotic index) and immunohistochemical characteristics (ER, PR, HER2, CK5/6 and EGFR status) were compared with those of 50 luminal and 50 triple negative (TN) tumors randomly selected in our lab database. At the time this abstract is written, the Ki67 index determination is still in progress. Five of these ER-/PR+ tumors were also given a molecular test (Nanostring). Qualitative variables were compared using Chi2 or Fisher test, quantitative variables were compared using Student or Mann & Whitney tests. To take into account for multiple comparisons, p-values less than 0.025 were considered as significant.

Results: The results are summarized in table 1. For almost all the analyzed criteria, ER-/PR+ tumors present statistical difference with luminal ones. On the contrary, they share most of TN tumors characteristics. The 5 molecular analyzes performed on ER-/PR+ samples showed the following phenotypes: 3 basal, 1 HER2 enriched and 1 luminal. For this last one, new immunohistological analyzes reveal in fact an ER+ staining.

Table 1: Study results ER-/PR+ tumorsER+ tumorsTN tumorsp ER-/PR+ vs ER+p ER-/PR+ vs TNSize (mm)23.12525.20.00440.4822Histological type0.00120.2424 ductal9480.4100  lobular219.60  neuro-endocrine40 Differentiation<10-40.4497 well09.80  moderately12.548.818  poorly87.541.582 EE grade<10-40.1016 14.135.34  236.74918  359.215.778 EE differentiation<10-40.3197 105.90  214.341.222  385.752.978 EE nuclear atypia<10-40.2227 102  234.774.522  365.325.576 EE mitosis<10-40.0123 124.580.418  230.613.710  344.95.972 Mitotic index (mitoses/mm2)9.52.210.2<10-40.1252Necrosis465.952<10-40.5484Inflammation0.00030.0011 yes30224  no4474.516  weak2623.560 CK5/6 +78.74.280.4<10-40.8378EGFR +44.74.252.2<10-40.4697HER2 +29.87.800.0051<10-4Results are given in %, excepting mitotic index and size

Conclusion: This study tends to support that ER-/PR+ tumors may not exist and are likely to be TN cancers or less frequently false negative ER+ tumors. In a practical point of view, we think that 1) when a tumor shows ER-/PR+ and TN characteristics, it is probably a false positive PR staining, and the tumor has to be considered as a TN one, 2) when an ER-/PR+ tumor don't fit the triple negative tumors characteristics, ER must be retested in order to exclude a true luminal tumor.

Citation Format: Molly D, Bertaut A, Blanchet C, Beltjens F, Charon-Barra C, Loustalot C, Desmoulins I, Arnould L. Do estrogen receptor negative and progesterone receptor positive breast tumors really exist? Attitude for not making them real. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-01-14.

Mucosal relapse of visceral leishmaniasis in a child treated with anti-TNFα

Visceral leishmaniasis is an enzootic parasitosis present across the Mediterranean Basin. Some consider it an opportunistic parasite. We report the case of a girl treated with anti-tumour necrosis factor alpha (anti-TNFα) for juvenile idiopathic arthritis who had previously presented with visceral leishmaniasis. Two and a half years later, she presented a tumour-like mass in the nasal mucous membrane caused by Leishmania parasites. Leishmania infantum is classically responsible for visceral leishmaniasis, but pure mucocutaneous leishmaniasis has also been described. To our knowledge, this is the first observation of a recurrence of visceral leishmaniasis in the mucocutaneous form. The occurrence of atypical forms and presentations in those on anti-TNF therapy should be considered.

A new case of pediatric laryngeal foraminal cyst: diagnostic challenges and association with hemi-facial microsomia

Laryngeal cysts are heterogeneous in their clinical presentation and several classifications have been proposed. Here, we report the case of a foraminal laryngeal cyst in a 6 year-old child who also has hemi facial microsomia (HFM). The cyst was treated surgically with laryngotracheal endoscopy followed by cervicotomy. Histological analysis revealed different types of cystic wall epithelium. This case is the first report of a laryngeal cyst associated with HFM in the literature. We discuss the diagnostic challenges of these specific cystic pathologies, and their pathogenesis as part of an oculo-auriculo-vertebral spectrum. Several hypotheses are proposed, based mainly on characterization of their embryological origin.

Nodular recurrence and hypothyroidism following partial thyroidectomy for benign nodular thyroid disease in children and adolescents

OBJECTIVES

Diagnostic and therapeutic processing of a thyroid nodule in children and adolescents may require lobectomy-isthmusectomy (LI) or nodule-resection (NR). Very few data in the literature report the long-term evolution of the remaining thyroid lobe in a defined pediatric population. In this study, we aimed to answer the following questions: Does a nodule recurrence occur in the remainder lobe? Is a post-operative thyroxine treatment necessary?

MATERIAL AND METHODS

This retrospective study describes 28 patients under 18 who underwent LI (22 cases) or NR (6 cases) from January 2004 to March 2012. Ten of them were lost to follow up, 18 could be assessed (4 NR (22%) and 14 LI (78%) - mean follow-up 45±31 months). All patients benefited of post-operative thyroid ultrasonography, and regular endocrinologic follow-up. The following data were analysed: emergence of new thyroid nodules, evolution of pre-existing nodules, occurrence of post-operative hypothyroidism and requirement for completion thyroidectomy.

RESULTS

The mean age at the time of surgery was 14.3±1.9 years. Two patients (11%) had pre-existing nodules in the remaining thyroid gland, none of which showed an increase in size after surgery. De novo nodules developed in five patients (27.8%). Three patients who underwent LI (21.4%) needed thyroxine treatment for post-operative hypothyroidism. One patient (5.5%) needed completion thyroidectomy.

CONCLUSIONS

In this children and adolescents population, after performing LI or NR, remaining thyroid tissue stays free of nodules in 72.2% of the cases. A post-operative thyroxin treatment is necessary in 21.4% of cases after LI.

Relation between dietary acrylamide exposure and biomarkers of internal dose in Canadian teenagers

Acrylamide (AA) is a probable human carcinogen found in several foods. Little information is available regarding exposure of adolescents, a subgroup potentially consuming more AA-rich foods. We investigated the relationship between dietary AA intake and levels of biomarkers of exposure (urinary metabolites and hemoglobin adducts) in 195 non-smoking teenagers of Montreal Island aged 10-17 years. Dietary habits and personal characteristics were documented by questionnaire. AA and its metabolites were quantified in 12-h urine collections by LC-MS/MS. Hemoglobin adducts from 165 blood samples were also analyzed by LC-MS/MS. Most prevalent urinary metabolites were NACP and NACP-S, with respective geometric mean concentrations of 31.2 and 14.2 μmol/mol creatinine. Geometric mean concentrations of AAVal and GAVal (hemoglobin adducts of AA and glycidamide (GA) with N-terminal valine residues) were 45.4 and 45.6 pmol/g globin, respectively. AA intake during the 2 days before urine collection was a significant predictor of NACP+NACP-S urinary concentrations (P<0.0001). AA intakes during the month before blood collection (P<0.0001) and passive smoking (P<0.05) were associated with adduct levels. Levels of hemoglobin adducts were above biomonitoring equivalent values corresponding to a 1 × 10(-4) excess cancer risk, which may indicate the need to reduce AA exposure in the population.

Audiological findings in 100 USH2 patients

Bilateral sensorineural hearing loss (HL), classically described as mild to severe with a typically down-sloping audiometric configuration, is the earliest symptom occurring in Usher syndrome type II (USH2). Audiological findings were analyzed in a total of 100 USH2 patients (92 families) divided into three groups according to the gene involved: 88 USH2A, 10 GPR98 and 2 DFNB31 patients. A fine analysis of audiograms was performed (pure tone average, degree of severity, configuration). The median age of HL diagnosis was 5 years (range 8 months-31 years) although the median age at USH2 diagnosis was 34.5 (range 8-76). Moderate HL was predominant (76%) and a gently down-sloping configuration characterized most audiograms (66%). No statistically significant difference was found between USH2A and GPR98 patients but a tendency was clearly noted for more GPR98 patients to present with severe hearing loss. It is not possible to predict the mutated gene from audiograms.

Is marine mammal fat or fish intake most strongly associated with omega-3 blood levels among the Nunavik Inuit?

Here we determined the relationship between red blood cell (RBC) omega-3 (n-3) long-chain polyunsaturated fatty acids (LC-PUFAs) and usual dietary marine food product intake among 630 Nunavik Inuit adults. Marine food product intake was determined by a food frequency questionnaire (FFQ) and fatty acids were quantified in RBC membranes. Multiple linear regression was undertaken to determine the relationship between marine food product intake and RBC n-3 LC-PUFAs (dependent variable). Mean RBC n-3 LC-PUFA level was 9.16 ± 0.11% [SEM]. The highest correlations noted with RBC n-3 LC-PUFAs were for marine mammal fat (r(s)=0.41, P<0.0001) and fish (r(s)=0.35, P<0.0001). Age, total marine mammal fat and fish intakes were the variables that contributed the most to predicted RBC n-3 LC-PUFAs and explained 34%, 15% and 5%, respectively, of its variances. Our study indicates that marine mammal fat intake is more important than fish in accounting for RBC n-3 LC-PUFA levels among the Nunavik Inuit.

Plasma omega-3 and psychological distress among Nunavik Inuit (Canada)

Marine omega-3 (n-3) fatty acid eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids have been associated with beneficial effects in mental health. Cultural and social changes have been related to a decline in mental health of the Inuit, but the role of diet has received scant attention. We examined the relationship between psychological distress (PD) and plasma n-3 among 368 Nunavik Inuit aged 18-74 years who took part in a survey in 1992. Participants were categorized as high-level PD if they scored over the 80th percentile of the PD Index Santé-Québec Survey (PDISQS-14), and non-distressed subjects were those who scored less than this cutoff. Compared with the non-distressed group, n-3 concentrations in the PD group were significantly lower in women but not in men. Compared with the lowest tertile of EPA + DHA, the odds ratios for high-level PD among women were 0.32 (95% CI: 0.13-0.82) for the second, and 0.30 (95% CI: 0.10-0.90) for the third tertile, after controlling for confounders. In males, there were no significant associations between EPA+DHA and PDISQS-14 scores. Our findings suggest that marine n-3 may play a role in PD among Inuit women. The gender difference observed in our analysis must be examined more carefully in future studies.

Risk and benefits from consuming salmon and trout: A Canadian perspective

Recent reports on the presence of persistent organic chemicals in wild and farmed salmon have left consumers and health professionals confused regarding the safety of regular fish consumption. The objectives of this study were (1) to compare concentrations of key contaminants and the essential nutrients omega-3 fatty acids between farmed and wild salmon and trout, and (2) to balance risks and benefits from regularly consuming these species. Concentrations of mercury, polychlorinated biphenyls, dioxins and furans as well as omega-3 fatty acids were determined in fillets from farmed salmon and trout bought in various markets located in Quebec, Canada, as well as in fillets from wild salmonids obtained from fishermen and various Canadian agencies. While differences were observed between market (farmed) and wild fish with regard to the concentrations of mercury and polychlorinated biphenyls, overall the concentrations of contaminants were low, such that the regular consumption of these fish would not cause tolerable daily intakes to be exceeded. Our results indicate that salmon and trout sold in Quebec markets, which as in markets located elsewhere in North America originate for the most part from Chilean farms, can be consumed regularly to achieve optimal nutritional benefits from omega-3 fatty acids, without incurring significant contaminant related health risks.

[Usher type I syndrome in children: genotype/phenotype correlation and cochlear implant benefits]

OBJECTIVE

To assess the benefit of cochlear implant in children presenting an Usher type 1 syndrome (speech understanding, speech production intelligibility, academic performance) and to search any correlation between the phenotype and the genotype in this population.

MATERIALS AND METHODS

Retrospective case series analysis about 13 implanted Usher type I children. Cochlear implantation was performed from 1995 to 2005. Our population was divided in three groups: group 1 (implantation between 1 and 3 years of age); group 2 (implantation between 4 and 7 years of age) and group 3 (implantation between 14 and 17 years of age). Postoperative speech perception, speech production intelligibility and education settings were evaluated.

RESULTS

Molecular genetic analysis was performed in 11 patients and pathogenic mutations were identified in all cases: (mutation in myosin 7A gene in 5 cases; mutation in cadherin 23 gene in 6 cases). Four new mutations 2 in the MYO7A gene and 2 in the CDH23 gene never reported before were found. Walking delay and hearing level were not statistically correlated with the genotype abnormalities found. The speech discrimination skills, the speech production intelligibility and the academic performance were better in the group 1 children than the group 2 children after cochlear implantation. All the children of group 1 but one were in mainstreaming education. Specific language impairment was identified in two children of group 1. The group 3 children could not achieve open-set perceptive tasks after implantation--only closed-set word test can be done and their speech production remained unintelligible after cochlear implantation.

CONCLUSION

Molecular analysis of Usher type I syndrome can ascertain the diagnosis in spite of the genetic heterogeneity. In this study, clinical symptoms weren't correlated with genotypic mutations. Speech discrimination skills, speech production quality, and academic performance were correlated with the age at implant.

Fatty acid composition of wild and farmed Atlantic salmon (Salmo salar) and rainbow trout (Oncorhynchus mykiss)

The goal of this study was to examine the FA composition of wild and farmed Atlantic salmon (AS) and rainbow trout (RT). FA profiles were obtained by GC/FID. Results showed that lipid and n-3 highly unsaturated FA contents of farmed and wild AS were similar. Total n-3 and n-6 PUFA were significantly higher in farmed AS than in wild AS. Farmed RT contained more fat and less n-3 PUFA than wild RT. Our results show that farmed salmonids provide high levels of n-3 HUFA to consumers.

Impact of Waist Circumference on the Relationship Between Blood Pressure and Insulin

Hyperinsulinemia has been suggested to be involved in the etiology of obesity-associated hypertension. The objective of the present study was to quantify, in a population-based study, the respective contributions of excess adiposity (body mass index [BMI]), waist circumference (WC), fasting insulin levels, and insulin sensitivity to the variation of resting blood pressure. The Quebec Health Survey was used to obtain fasting plasma insulin and glucose levels and resting blood pressure as well as anthropometric measurements in a representative sample of 907 men and 937 women. When the sample was divided into tertiles of BMI and further stratified on the basis of the 50th percentile of WC (88 cm in men), nonobese men in the first BMI tertile (<23.2 kg/m 2 ) but with abdominal obesity were characterized by an increased systolic blood pressure (SBP) compared with nonobese men with low WC (130±18 versus 120±11 mm Hg; mean±SD; P =0.075). The SBP was comparable to SBP values measured among men in the top BMI tertile (129±14 mm Hg for BMI ≥26.6 kg/m 2 ). When subjects were classified into tertiles of fasting insulin and WC, no association between insulin levels and blood pressure was noted, once the variation in WC was considered. Insulin sensitivity (estimated with homeostasis model assessment [HOMA]) did not explain variation in blood pressure in men, whereas the contribution of HOMA in women was of marginal clinical significance ( R 2 of <1.3%; P <0.0001). These results suggest that the documented association between obesity, fasting insulin, insulin sensitivity, and blood pressure is largely explained by concomitant variation in WC.

Vitamin A concentration in umbilical cord blood of infants from three separate regions of the province of Québec (Canada)

BACKGROUND

Inuit women from Northern Québec have been shown to consume inadequate quantities of vitamin A. This study was conducted to evaluate the prevalence of blood vitamin A deficiency in newborns from 3 distinct populations of the province of Québec.

METHODS

594 newborns were included in this study (375 Inuit newborns from northern Québec (Nunavik), 107 Caucasian and Native newborns from the Lower Northern Shore of the Saint-Lawrence River (LNS) and 112 newborns from Southern Québec where clinical vitamin A deficiency is uncommon). Mothers were recruited at delivery and vitamin A (retinol) was analyzed from umbilical cord blood samples by reversed-phase high-pressure liquid chromatography.

RESULTS

Nunavik and LNS newborns had significantly lower mean vitamin A concentrations in cord blood compared to Southern Québec participants (15.7 microg/dL, 16.8 microg/dL and 20.4 microg/dL respectively). The differences observed were similar when adjusted for sex and birthweight. Results also showed that 8.5% of Nunavik newborns and 12.2% of LNS newborns were below 10.0 microg/dL, a level thought to be indicative of blood vitamin A deficiency in neonates.

CONCLUSION

These data suggest that a carefully planned vitamin A supplementation program during pregnancy in Nunavik and LNS might be indicated to promote healthy infant development.

Leisure physical activity is associated with quantitative ultrasound measurements independently of bone mineral density in postmenopausal women

The purpose of this study was to assess the magnitude of the relationship between leisure physical activity and bone status as measured either by an Achilles ultrasound bone densitometer (QUS) or dual-energy X-ray absorptiometry (DXA) in postmenopausal women. We studied 1162 French Canadian postmenopausal women, aged 33-84 years (mean age 58 years), for QUS parameters [broadband ultrasound attenuation (BUA), speed of sound (SOS), and stiffness index (SI)] measured at the right calcaneus, and bone mineral density (BMD) measured at the lumbar spine and femoral neck. Multivariate regression analyses revealed that leisure physical activity level was an independent predictor of the heel QUS parameters and of femoral neck BMD. No such association was observed for BMD of the lumbar spine. Heel QUS parameters (BUA, SOS, SI) and femoral neck BMD adjusted for interfering covariables showed a statistically significant difference between sedentary (less than three sessions/month) and active women (three or more sessions/week) (P < or = 0.001). Furthermore, after adjusting each heel QUS parameters for the mean lumbar spine BMD value, the association observed between leisure physical activity and QUS remained significant. These results suggest that regular leisure physical activity could influence QUS parameters, independently of BMD, and that quantitative ultrasound could be a suitable outcome measure in exercise studies in postmenopausal women.

Blood pressure among the Inuit (Eskimo) populations in the Arctic

AIMS

Studies of blood pressure among various Inuit (Eskimo) populations in the Arctic have given inconsistent results. Most studies reported lower blood pressure among the Inuit as compared with the predominantly white national populations. This has been attributed to traditional subsistence practices and lifestyle. This study compared the blood pressure among the major Inuit population groups with other populations and examined the associations with factors like age, gender, obesity and smoking.

METHODS

The study comprised four Inuit populations from Alaska, Canada, and Greenland with participation rates ranging from 51% to 73%. In a cross-sectional design, 2,509 randomly selected adults from 31 villages were examined. Blood pressure, anthropometric measurements, smoking, and medication were recorded.

RESULTS

Mean systolic blood pressures ranged from 116 to 124 mm Hg among men and 110 to 118 among women in the four populations. Mean diastolic blood pressures ranged from 75 to 78 mm Hg among men and from 71 to 73 among women. Systolic blood pressure increased with age. Male gender, obesity, being a non-smoker, and being on anti-hypertensive treatment were associated with high systolic and diastolic blood pressure. Adjusted for age, body mass index, smoking, and anti-hypertensive treatment, blood pressure differed among the populations (p </= 0.001). Mean systolic blood pressure was low among the Inuit compared with most European populations of the INTERSALT study, but higher than in several Asian populations and the Amazonian Indians.

CONCLUSIONS

Inuit blood pressures rank intermediate on a global scale but low in comparison with most European populations. The Inuit population is not homogeneous, and this is reflected in blood pressure differences among the four regional subgroups. The role of the traditional diet, a rural lifestyle with a low level of psychosocial stress, and genetics must be further explored.

Fish consumption and blood lipids in three ethnic groups of Québec (Canada)

The purpose of this study was to compare fish intake and plasma phospholipid concentrations of n-3 fatty acids, in particular of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), among representative population samples of Québecers, James Bay Cree, and Inuit of Nunavik (Canada). The relationships between these concentrations and cardiovascular disease (CVD) risk factors were also investigated and compared in the three populations. In 1990-1992, the study subjects had participated in the extensive Santé Québec health surveys conducted in southern Québec, James Bay, and Nunavik. Significant differences in levels of CVD risk factors were found among these three populations. Globally, Inuit showed the lowest risk status for CVD compared with Cree and Québecers, despite the high prevalence of cigarette smoking and obesity. Daily fish intakes varied significantly among the three groups, averaging 13, 60, and 131 g for Québecers, Cree, and Inuit, respectively. Concentrations of EPA + DHA in plasma phospholipids were highest among Inuit (8.0%), second-highest among Cree (3.9%), and lowest among Québecers (1.8%). When the three populations were grouped together, there was a positive association between concentrations of EPA + DHA stratified into quartiles and HDL cholesterol, with a significant relation in quartile 4 (EPA + DHA > or = 4.04%). An inverse relation was also found between EPA + DHA and triacylglycerols in quartile 4. Our results indicate that increased consumption of fish as a source of n-3 fatty acids is beneficially associated with levels of HDL cholesterol and triacylglycerols.

Fat, fishing patterns, and health among the Bardi people of north Western Australia

Research into the resource use strategies of the Bardi Aboriginal People of One Arm Point, Western Australia, found that they maximize the consumption of specific beneficial marine FA. The Bardi assess the relative fatness of fish and animal species in their environment, procuring fish and marine species only when they are considered to be at their fattest stage: during specific seasons; at specific physiological life stages, or through on-site evaluation. In June 1999 and September 2000, samples of fish, dugong, oyster, and turtle were collected by Bardi fishermen, focusing specifically on species considered to be high in fat content and very popular among the Bardi. Nine species were analyzed for total lipids and FA profile, which were determined by capillary GLC. Comparative lipid analysis established that the Bardi hunters' selection process between species and within species and the selection of specific fish fat deposits increase the levels of beneficial F made available to the community. Bardi fishing and hunting patterns meet a demand for fat within the community and may protect many species of fish whose spawning season is inversely related to the accumulation of the specific gut fat deposits sought by the Bardi. These fat deposits make up for the relatively low levels of fat in the flesh of tropical fish. The Bardi model provides important insights into the nature of human-environment interaction and expands our understanding of the role that warmer-water fisheries can play in human health.

Prevalence of metabolic alterations predictive of cardiovascular disease risk in the Québec population

BACKGROUND

It is well established that cardiovascular diseases (CVD) are the most important cause of morbidity and mortality in North America and in industrialized countries. Furthermore, the presence of CVD risk factors is widespread in Canada, and two-thirds of adult Canadians present at least one traditional risk factor for CVD.

OBJECTIVE

To quantify the prevalence of metabolic alterations predictive of an increased risk of CVD in a representative sample of the Québec population.

METHODS

A representative sample of the Québec population was obtained through the Québec Health Survey 1990. The cohort of 1844 subjects (907 men and 937 women), aged from 18 to 74 years, completed the evaluation, which consisted of interviews, validated questionnaires for personal and family history of CVD risk factors, and a physical examination. Anthropometric measurements, blood pressure, fasting plasma lipoprotein-lipid levels as well as fasting glucose and insulin concentrations were obtained.

RESULTS

Thirty one per cent of the Québec population had a normal body weight defined by body mass index (BMI) less than 25 kg/m2 with a healthy metabolic profile (glycemia less than 6.1 mmol/L, total cholesterol less than 5.2 mmol/L, low density lipoprotein-cholesterol less than 3.4 mmol/L, triglycerides less than 2.3 mmol/L and high density lipoprotein-cholesterol greater than 0.90 mmol/L). On the other hand, 28% of the population was treated for known metabolic chronic diseases (CVD, diabetes, dyslipidemias and hypertension), whereas the remaining 33% of the Québec population (BMI greater than 25 kg/m2) were characterized by an altered metabolic profile predictive of an increased CVD risk. Furthermore, 75% of men and 70% of women with an altered metabolic profile presented at least two CVD risk factors. Overall, women tended to display a significantly healthier metabolic risk profile than men (P<0.05).

CONCLUSIONS

According to our results, only 31% of the Québec population is nonobese without major alterations in their metabolic risk profile. Indeed, 61% of Quebecers are either characterized by chronic diseases or by an altered metabolic profile increasing their risk for the development of CVD and type 2 diabetes. Such a high prevalence should be a source of concern justifying the development of simple screening tools for early identification of the asymptomatic carriers of this cluster of metabolic abnormalities.

[Transmandibular buccopharyngectomy after radiotherapy for orpharyngeal cancer]

MATERIALS & METHODS

We present a retrospective study of 95 patients with recurrence of oropharyngeal carcinoma after exclusive radiotherapy. The treatment consisted in a salvage composite resection in all cases.

RESULTS & DISCUSSION

Since the use of muscular flaps, the post-operative complications have been relatively minimised but the carcinologic results were disappointing: only 20% of patients were alive free of disease at 5 years. The main prognostic factors for overall survival were the stage rT of the relapse, the histologic invasion of the nodes and the quality of the resection. The anatomic site of relapse did not influence the survival.

CONCLUSION

Our serie confirms the high frequency of second primary tumors in oropharyngeal cancers. Rigorous selection of patients for exclusive radiotherapy is mandatory to decrease the number of relapses and might avoid salvage surgery.

Prevalence of 'hypertriglyceridemic waist' in men who participated in the Quebec Health Survey: association with atherogenic and diabetogenic metabolic risk factors

BACKGROUND

A triad of metabolic markers (high insulin and apolipoprotein B levels, and small, dense, low density lipoprotein particles) is associated with a substantially increased risk of coronary artery disease (CAD) in men. Also, the simultaneous presence of an elevated waist circumference (90 cm or greater) and moderate hypertriglyceridemia (triglyceride concentration 2.0 mmol/L or higher) in men has been shown to be associated with this atherogenic metabolic triad, with a probability of more than 80%.

OBJECTIVES

To quantify the prevalence of the 'hypertriglyceridemic waist' phenotype in a sample of adult men and to compare the metabolic risk profile of nondiabetic men with hypertriglyceridemic waist with the CAD risk profile of patients with type 2 diabetes.

METHODS

The sample of people who participated in the Quebec Health Survey was used to obtain representative data on the prevalence and distribution of cardiovascular disease risk factors in the Quebec population. Fasting plasma lipoprotein-lipid, insulin and glucose concentrations were measured, and anthropometric measurements were taken in a sample of 907 men.

RESULTS

Among men who participated in the Quebec Health Survey, 19% had an elevated waist circumference (90 cm or greater) plus elevated triglyceride levels (2.0 mmol/L or higher). Men with this hypertriglyceridemic waist phenotype were characterized by the highest values for fasting plasma insulin, and the highest total cholesterol to high density lipoprotein cholesterol ratios. They also displayed a metabolic risk profile that was deteriorated to the same extent as that of men with diabetes who had participated in the survey.

CONCLUSIONS

The results of the the present study of men who participated in the Quebec Health Survey provide further evidence that the simultaneous measurement and interpretation of waist circumference and fasting triglyceride concentrations may improve the physician's ability to identify abdominally obese men with atherogenic and diabetogenic profiles. Furthermore, this high risk clinical phenotype is highly prevalent (about 20%) among adult men.

Cardiovascular disease risk factors and n-3 fatty acid status in the adult population of James Bay Cree

BACKGROUND

Canadian native populations, which traditionally consume large amounts of fish, have lower rates of mortality from heart disease than do Canadian nonnative populations, which have low fish intakes. Fish oils rich in n-3 fatty acids may have a protective effect against cardiovascular disease (CVD) risk factors.

OBJECTIVES

The purposes were to examine the profile of plasma phospholipid concentrations of the n-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) among James Bay Cree and to verify the relation between these concentrations and CVD risk factors.

DESIGN

The study population consisted of 917 subjects aged 18-74 y who participated in the 1991 Santé Québec Health Survey. Data were obtained through home interviews and clinic visits. Plasma samples were analyzed for phospholipid fatty acid composition.

RESULTS

The mean fish consumption on the day before the survey was 60 g among the adult Cree population. Expressed as a percentage of total fatty acids, relative concentrations of EPA and DHA were 0.65% and 2.80%, respectively. n-3 Fatty acids were higher among coastal residents than among inland residents. A positive association was observed between plasma HDL and n-3 fatty acids. EPA and EPA+DHA were inversely associated with triacylglycerols. Among subjects aged 50-74 y, an inverse association between EPA and EPA:AA and total:HDL cholesterol was observed.

CONCLUSIONS

n-3 Fatty acids may favorably influence some CVD risk factors. The Cree population must be encouraged to maintain their traditional fish-based diet, which may be one of the factors protecting them against mortality from CVD.

Expression of an alpha7 duplicate nicotinic acetylcholine receptor-related protein in human leukocytes

We examined the potential expression and function of alpha7 nicotinic acetylcholine receptors (nAChRs) in leukocytes. RT-PCR with alpha7 specific primers revealed the presence of the receptor mRNA in leukocytes. Immunoblotting and immunofluorescence experiments demonstrated the expression of a protein that is recognized by alpha7 specific antibodies. However, nicotine and acetylcholine (ACh) failed to elicit current in leukocytes. Binding experiments with alpha-bungarotoxin rhodamine conjugated were negative, illustrating the absence of a high-affinity binding site. RT-PCR analysis revealed the selective expression of the dupalpha7 mRNA. These data indicate that leukocytes express in their membrane the dupalpha7 protein but its physiological role remains to be identified.

[Anorexia nervosa and Crohn disease: diagnostic intricacies and difficulties. 3 cases]

INTRODUCTION

Diagnosis of anorexia nervosa is readily evoked in young girls who associate decreased food intake and weight loss. Among the differential diagnoses of anorexia, it is important to underline the preponderant place occupied by Crohn's disease.

OBSERVATIONS

We report three cases of young 18 to 25 year-old girls, initially treated for anorexia nervosa in a psychiatric department. Diagnosis of Crohn's disease was made within 5 to 13 years. The clinical and biological characteristics are reported for each case.

COMMENTS

In view of the frequency of digestive disorders concomitant to eating disorders, the distinction between anorexia and digestive disease is particularly delicate. It requires appropriate somatic and biological assessment that, when confronted with clinical and/or biological atypia, may query the initial diagnosis of anorexia.