22 results on '"Naccache N"'
Search Results
2. Health-related quality of life and its association with outcomes in adults with congenital heart disease and heart failure: Insight from FRESH-ACHD registry
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Ly, R., primary, Karsenty, C., additional, Hascoët, S., additional, Radojevic, J., additional, Godart, F., additional, Domanski, O., additional, Vaksmann, G., additional, Amédro, P., additional, Naccache, N., additional, Boubrit, A., additional, Bataille, V., additional, and Ladouceur, M., additional
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- 2023
- Full Text
- View/download PDF
3. Effect of prone position without volume expansion on pulse pressure variation in spinal surgery : a prospective observational study
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Jabbour, H, primary, Abou Haidar, M, additional, Jabbour, K, additional, Abi Lutfallah, A, additional, Abou Zeid, H, additional, Ghanem, I, additional, Naccache, N, additional, and Ayoub, E, additional
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- 2021
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4. Compared presentation, management and long-term outcomes after acute myocardial infraction in men and women <50 years of age. The FAST-MI programme
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Danchin, N, primary, Puymirat, E, additional, Eltchaninoff, H, additional, Manzo-Silberman, S, additional, Marchand, S, additional, Bataille, V, additional, Drouet, E, additional, Naccache, N, additional, Ferrieres, J, additional, Schiele, F, additional, and Simon, T, additional
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- 2020
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5. P4569Differential prognostic impact of blood glucose levels at the acute stage of myocardial infarction according to HbA1c. The FAST-MI programme
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Danchin, N, primary, Puymirat, E, additional, Ducrocq, G, additional, Henry, P, additional, Collet, J P, additional, Genee, O, additional, Joseph, T, additional, Belle, L, additional, Naccache, N, additional, Ferrieres, J, additional, Schiele, F, additional, and Simon, T, additional
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- 2019
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6. Integrating obstetrical simulation into the medical curriculum: one more gap in women’s health for low-income countries
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Kesrouani, A., primary, Nemr, E., additional, Nasr, M., additional, Naccache, N., additional, and AbouJaoude, S., additional
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- 2019
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7. Characteristics of patients with chronic heart failure according to new ESC guidelines derived-LVEF classification
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Saval, M., Tribouilloy, Christophe, Piccard, F., Eicher, J. C., Roubille, F., Trochu, J. N., Roul, G., Naccache, N., Bataille, V., de Groote, P., Logeart, D. Damien, Damy, T., Isnard, R., CHU Amiens-Picardie, Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Université de Nantes (UN), Centre d’Investigation Clinique de Nantes (CIC Nantes), Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), DESSAIVRE, Louise, and Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN)
- Subjects
[SDV] Life Sciences [q-bio] ,[SDV]Life Sciences [q-bio] ,ComputingMilieux_MISCELLANEOUS - Abstract
International audience
- Published
- 2017
8. Characteristics of patients with acute heart failure according to new ESC guidelines derived-LVEF classification
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Logeart, D. Damien, Damy, T., Isnard, R., Saval, M., Degroote, P., Roubille, F., Tribouilloy, Christophe, Trochu, R., Piccard, F., Roul, G., Bataille, V., Naccache, N., Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Institute of Astronomy [Leuven], Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CHU Amiens-Picardie, Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), and DESSAIVRE, Louise
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[SDV] Life Sciences [q-bio] ,[SDV]Life Sciences [q-bio] ,ComputingMilieux_MISCELLANEOUS - Abstract
International audience
- Published
- 2017
9. Prevalence and determinants of pulmonary arterial hypertension (PAH) in acute and chronic heart failure (CHF). FRESH study from GICC
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Damy, T. Thibaud, Isnard, R., Saval, M., Tribouilloy, Christophe, Picard, F., Eicher, J. C., Roubille, F., Trochu, J. N., Roul, G., de Groote, P., Berthelot, E., Bataille, V., Naccache, N., Bauer, F., Logeart, D., Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), CHU Amiens-Picardie, Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Department of Neurology [Genève], Hôpitaux Universitaires de Genève (HUG), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Université de Nantes (UN), Centre d’Investigation Clinique de Nantes (CIC Nantes), Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes), Nouvelles Cibles Pharmacologiques de la Protection Endothéliale et de l'Insuffisance Cardiaque (EnVI), CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and DESSAIVRE, Louise
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[SDV] Life Sciences [q-bio] ,[SDV]Life Sciences [q-bio] ,ComputingMilieux_MISCELLANEOUS - Abstract
International audience
- Published
- 2017
10. What are differences in characteristics of heart failure patients according to new ESC guidelines derived-LVEF classification?
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Logeart, D., primary, Damy, T., additional, Isnard, R., additional, Saval, M., additional, De Groote, P., additional, Tribouilloy, C., additional, Trochu, J.N., additional, Piccard, F., additional, Roul, G., additional, Moussi, T. Si, additional, and Naccache, N., additional
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- 2018
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11. Prevalence and determinants of pulmonary arterial hypertension (PAH) in acute and chronic heart failure (CHF). FRESH study from GICC
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Damy, T., primary, Isnard, R., additional, Salvat, M., additional, Tribouilloy, C., additional, Picard, F., additional, Eicher, J., additional, Roubille, F., additional, Trochu, J., additional, Roul, G., additional, De Groote, P., additional, Berthelot, E., additional, Naccache, N., additional, Bauer, F., additional, and Logeart, D., additional
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- 2018
- Full Text
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12. French National observatory on pulmonary hypertension measured by right heart catheterism in heart failure. First report of PHHF observatory. A study from GICC
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Damy, T., primary, Berthelot, E., additional, Eicher, J., additional, Trochu, J., additional, Bauer, F., additional, Picard, F., additional, Salvat, M., additional, Naccache, N., additional, and Lamblin, N., additional
- Published
- 2018
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13. Les modalités de prescription d’analgésiques opiacés par les médecins de l’Hôtel-Dieu de France de Beyrouth
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Noufi, P., primary, Khoury, E., additional, Ayoub, E., additional, Naccache, N., additional, and Richa, S., additional
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- 2016
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14. Very long-term outcomes after acute myocardial infarction in young men and women: Insights from the FAST-MI program.
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Weizman O, Tea V, Marijon E, Eltchaninoff H, Manzo-Silberman S, Leclercq F, Albert F, Bataille V, Drouet E, Naccache N, Puymirat E, Ferrières J, Schiele F, Simon T, and Danchin N
- Subjects
- Male, Adult, Humans, Female, Treatment Outcome, Risk Factors, Sex Factors, Percutaneous Coronary Intervention adverse effects, Myocardial Infarction diagnosis, Myocardial Infarction epidemiology, Myocardial Infarction therapy, Coronary Artery Disease
- Abstract
Aims: Conflicting data exists about long-term outcomes in young women and men experiencing acute myocardial infarction (AMI)., Methods: The FAST-MI program consists of three nationwide French surveys carried out 5years apart from 2005 to 2015, including consecutive patients with AMI over a 1-month period with up to 10-year follow-up. The present analysis focused on adults≤50 yo according to their gender., Results: Women accounted for 17.5% (335) of the 1912 patients under 50 yo and had a similar age as men (43.9±5.1 vs. 43.9±5.5years, P=0.92). They received less percutaneous coronary interventions (PCI) than men (85.9% vs. 91.3%, P=0.005), even in ST-elevation myocardial infarction (83.6% vs. 93.5%, P<0.001). Recommended secondary prevention medications were less frequently prescribed at discharge in women (40.6% vs. 52.8%, P<0.001), a trend that persisted in 2015 (59.1% vs. 72.8% in 2015, P<0.001). Still, ten-year survival was similar in men (90.5%) and women (92.3%) (crude HR: 0.86 [95% CI: 0.55-1.35], P=0.52, adjusted HR: 0.63 [95% CI: 0.38-1.07], P=0.09); similar results were found for ten-year survival among hospital survivors (91.2% in men vs. 93.7% in women, adjusted HR: 0.87 [95% CI: 0.45-1.66], P=0.66). Of the 1684 patients alive at hospital discharge with morbidity follow-up≥6months available, death, AMI or stroke at 8years occurred in 12.9% men and 11.2% in women (adjusted HR: 0.90 [95% CI: 0.60-1.33], P=0.59)., Conclusions: Young women with AMI undergo less cardiac interventions and are less often prescribed secondary prevention treatment than men, even when significant coronary artery disease is present, but keep a similar long-term prognosis after AMI. Optimal management of these young patients, regardless of gender, is necessary to ensure best outcomes after this major cardiovascular event., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)
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- 2023
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15. Health-Related Quality of Life and Its Association With Outcomes in Adults With Congenital Heart Disease and Heart Failure: Insight From FRESH-ACHD Registry.
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Ly R, Karsenty C, Amedro P, Cohen S, Domanski O, Godart F, Radojevic J, Vaksmann G, Naccache N, Boubrit A, Bataille V, Hascoet S, and Ladouceur M
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- Adult, Humans, Male, Middle Aged, Female, Quality of Life, Prospective Studies, Registries, Heart Defects, Congenital complications, Heart Defects, Congenital therapy, Heart Failure epidemiology, Heart Failure therapy, Heart Failure complications
- Abstract
Background Quality of Life (QoL) is a prognostic factor in heart failure (HF) of patients with acquired cardiac disease. The aim of this study was to determine the predictive value of QoL on outcomes in adults with congenital heart disease (ACHD) and HF. Methods and Results Quality of life of 196 adults with congenital heart disease with clinical heart failure (HF) (mean age: 44.3±13.8 years; 51% male; 56% with complex congenital heart disease; 47% New York Heart Association class III/IV) included in the prospective multicentric registry FRESH-ACHD (French Survey on Heart Failure-Adult with Congenital Heart Disease) was assessed using the 36-Item Short Form Survey (SF-36), a patient-reported survey. The primary end point was defined by all-cause death, HF-related hospitalization, heart transplantation, and mechanical circulatory support. At 12 months, 28 (14%) patients reached the combined end point. Patients with low quality of life experienced major adverse events more frequently (logrank P =0.013). On univariate analysis, lower score at physical functioning (hazard ratio [HR], 0.98 [95% CI, 0.97-0.99]; P =0.008), role limitations related to physical health (HR, 0.98 [95% CI, 0.97-0.99]; P =0.008), and general health dimensions of the SF-36 (HR, 0.97 [95% CI, 0.95-0.99]; P =0.002) were significantly predictive of cardiovascular events. However, after multivariable analysis, SF-36 dimensions were no longer significantly associated with the primary end point. Conclusions Patients with congenital heart disease with HF and poor quality of life experience severe events more frequently, making quality of life assessment and rehabilitation programs essential to alter their trajectory.
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- 2023
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16. Current treatment of symptomatic aortic stenosis in elderly patients: Do risk scores really matter after 80 years of age?
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Bouleti C, Michel M, Jobbe Duval A, Hemery T, Nicol PP, Didier R, Zeyons F, Zouaghi O, Tchetche D, Delon C, Delomez M, Dibie A, Attias D, Le Breton H, Cormier B, Obadia JF, Tribouilloy C, Lansac E, Chevreul K, Naccache N, Eltchaninoff H, Gilard M, and Iung B
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- Aged, Aged, 80 and over, Female, Humans, Male, Prospective Studies, Risk Assessment, Risk Factors, Severity of Illness Index, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis surgery, Heart Valve Prosthesis Implantation adverse effects
- Abstract
Background: According to the guidelines, surgical aortic valve replacement (SAVR) is recommended in patients at low surgical risk (EuroSCORE II<4%), whereas for other patients, the decision between transcatheter aortic valve implantation (TAVI) and surgery should be made by the Heart Team, with TAVI being favoured in elderly patients., Aim: The RAC prospective multicentre survey assessed the respective contributions of age and surgical risk scores in therapeutic decision making in elderly patients with severe symptomatic aortic stenosis., Methods: In September and October 2016, 1049 consecutive patients aged ≥ 75 years were included in 32 centres with on-site TAVI and surgical facilities. The primary endpoint was the decision between medical management, TAVI or SAVR., Results: Mean age was 84±5 years and 53% of patients were female. The surgical risk was classified as high (EuroSCORE II>8%) in 18% of patients, intermediate (EuroSCORE II 4-8%) in 34% and low (EuroSCORE II≤4%) in 48%. TAVI was preferred in 71% of patients, SAVR in 19% and medical treatment in 10%. The choice of TAVI over SAVR was associated with older age (P<0.0001) and a higher EuroSCORE II (P=0.008). However, the weight of EuroSCORE II in therapeutic decision making markedly decreased after the age of 80 years. Indeed, 77% of patients aged ≥ 80 years were referred for TAVI, despite a low estimated surgical risk., Conclusions: The impact of risk scores depends strongly on age, and decreases considerably after 80 years, most patients being referred for TAVI, independent of their estimated surgical risk. Despite medical advancements, 10% of patients were still denied any intervention., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)
- Published
- 2021
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17. Magnesium and Ketamine Reduce Early Morphine Consumption After Open Bariatric Surgery: a Prospective Randomized Double-Blind Study.
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Jabbour H, Jabbour K, Abi Lutfallah A, Abou Zeid H, Nasser-Ayoub E, Abou Haidar M, and Naccache N
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- Analgesics, Analgesics, Opioid, Double-Blind Method, Humans, Magnesium, Morphine, Pain, Postoperative drug therapy, Pain, Postoperative prevention & control, Prospective Studies, Bariatric Surgery, Ketamine, Obesity, Morbid surgery
- Abstract
Backgrounds: Optimal pain management in bariatric patients is crucial for early recovery. This study aims to evaluate the effects of magnesium and ketamine combination on morphine consumption after open bariatric surgery (primary outcome), as well as on postoperative pain scores and occurrence of side effects., Method: A total of 60 patients undergoing elective open gastric bypass were randomized into 3 groups. All patients received the same general anaesthesia protocol. The magnesium and ketamine group (Mg + K) received an IV bolus of magnesium 50 mg/kg and ketamine 0.2 mg/kg followed by continuous infusion of magnesium (8 mg/kg/h) and ketamine (0.15 mg/kg/h) until extubation. The ketamine group (K) received the same bolus and infusion of ketamine, together with a bolus and continuous infusion of normal saline. The placebo group (P) received normal saline. All patients received 48 h of paracetamol 1 g IV q6h and morphine sulphate 0.1 mg/kg subcutaneous q6h PRN. Morphine consumption, VAS pain scores and occurrence of side effects were recorded for 48 h postoperatively., Results: Patients in group (Mg + K) (2.4 ± 2.62 mg) and in group (K) (2.8 ± 2.66 mg) had significantly lower morphine consumption in the PACU compared with the patients in group (P) (4.85 ± 4.51 mg) (p = 0.045). Patients in group (Mg + K) consumed significantly less morphine the first 24 postoperative hours, with a relative reduction of 87% and 21% compared with group (K) and group (P) respectively (p = 0.028). However, this difference was not observed at 48 h. No significant difference was shown between the three groups in terms of nausea and vomiting, time to extubation or excessive sedation., Conclusion: The association of magnesium and ketamine bolus followed by infusion in open bariatric surgery appears to be safe and decreases morphine requirements in the first 24 h compared with both ketamine alone and placebo.
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- 2020
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18. Safety and Efficacy of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Used for Analgesia After Bariatric Surgery: A Retrospective Case-Control Study.
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Abou Zeid H, Kallab R, Najm MA, Jabbour H, Noun R, Sleilati F, Chucri S, Dagher C, Sleilaty G, and Naccache N
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- Adolescent, Adult, Aged, Analgesics adverse effects, Anti-Inflammatory Agents, Non-Steroidal adverse effects, Female, Humans, Male, Middle Aged, Morphine administration & dosage, Morphine therapeutic use, Prospective Studies, Retrospective Studies, Young Adult, Analgesics therapeutic use, Anti-Inflammatory Agents, Non-Steroidal therapeutic use, Bariatric Surgery adverse effects, Obesity, Morbid surgery, Pain, Postoperative drug therapy
- Abstract
Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are cornerstone in multimodal analgesia protocols. This point is of great value in morbidly obese patients due to the high prevalence of restrictive pulmonary disease and obstructive sleep apnea. The aim of this study was to test the hypothesis that NSAIDs do not increase acute bariatric surgery complications while optimizing postoperative analgesia., Methods: Databases of two medical centers were retrospectively reviewed to find all patients who underwent bariatric surgery between 1 January 2017 and 31 December 2017. Inclusion criteria were BMI greater than 30 kg/m
2 and age of 16-75 years old. Patients who suffered from severe organ failure or coagulation disorders were excluded. Patient's demographics, obesity-related diseases (diabetes, hypertension, dyslipidemia), postoperative pain scores, and morphine consumption in PACU, as well as early and late surgical complications, were collected. Patients included from the first institution (where NSAIDs analgesia was prohibited: control group) were compared to patients from the second institution (where NSAIDs analgesia was mandatory: case group)., Results: The study population included 270 patients, 134 in the control group, and 136 in the case group. NSAIDs usage produced better analgesia with significant reduction in morphine consumption and PACU length of stay. Also, incidence of surgical complications was the same in the two groups., Conclusions: NSAIDs administration do not increase postoperative complication rate after bariatric surgery. Although NSAID administration provided better analgesia and shorter PACU stay, future prospective studies are needed to confirm these encouraging results and to evaluate their impact on postoperative rehabilitation.- Published
- 2019
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19. Anaesthetic management in a patient with progressive supranuclear palsy.
- Author
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Lutfallah AA, Dagher C, Naccache N, and Yazbeck P
- Abstract
Competing Interests: There are no conflicts of interest.
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- 2018
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20. French Registry on Acute ST-elevation and non-ST-elevation Myocardial Infarction 2015 (FAST-MI 2015). Design and baseline data.
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Belle L, Cayla G, Cottin Y, Coste P, Khalife K, Labèque JN, Farah B, Perret T, Goldstein P, Gueugniaud PY, Braun F, Gauthier J, Gilard M, Le Heuzey JY, Naccache N, Drouet E, Bataille V, Ferrières J, Puymirat E, Schiele F, Simon T, and Danchin N
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- Aged, Aged, 80 and over, Cardiovascular Agents therapeutic use, Comorbidity, Data Accuracy, Female, France epidemiology, Hospital Mortality, Hospitalization, Humans, Male, Middle Aged, Non-ST Elevated Myocardial Infarction diagnosis, Non-ST Elevated Myocardial Infarction mortality, Non-ST Elevated Myocardial Infarction therapy, Patient Selection, Percutaneous Coronary Intervention, Prospective Studies, Risk Factors, ST Elevation Myocardial Infarction diagnosis, ST Elevation Myocardial Infarction mortality, ST Elevation Myocardial Infarction therapy, Thrombolytic Therapy, Time Factors, Treatment Outcome, Non-ST Elevated Myocardial Infarction epidemiology, Registries, Research Design, ST Elevation Myocardial Infarction epidemiology
- Abstract
Background: The FAST-MI programme, consisting of 1-month surveys of patients admitted to hospital for acute myocardial infarction (AMI) in France, has run since 2005., Aim: To gather data on the characteristics, management and outcomes of patients hospitalized for AMI at the end of 2015 in France and to provide comparisons with the previous surveys., Methods: Consecutive adults with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment-elevation myocardial infarction (NSTEMI) with symptom onset≤48hours were included over a 1-month period, with a possible extension of recruitment for 1 additional month. Patients with AMI following cardiovascular procedures were excluded. In all, 204 centres participated in the survey (114 community hospitals, 40 academic, 48 private clinics, 2 army hospitals), representing 78% of French centres managing AMI patients. Inclusion started from 5 October 2015. Data were collected on-site from source files by external research technicians, using an electronic case record form with automatic quality checks. Centralized biology was organized in voluntary centres to collect RNA and DNA samples, serum and stools. Long-term follow-up was organized centrally with interrogation of municipal registry offices, physicians and by direct contact with the patients or their families., Results: A total of 5291 patients were included over the entire recruitment period, with 3813 included during the first month (STEMI: 49%, NSTEMI: 51%). Mean age was 66±14 years, 29% were≥75 years of age, 28% were women; 80% presented with typical chest pain. In STEMI patients, 6% received intravenous fibrinolysis and 71% underwent primary PCI. The hospital death rate was 2.7% (STEMI: 2.8%, NSTEMI: 2.5%)., Conclusions: Recruitment was in line with expectations and the first data show that management has continued to evolve since the 2010 survey, with continued improvement in hospital outcomes., (Copyright © 2017. Published by Elsevier Masson SAS.)
- Published
- 2017
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21. [Patterns of prescription of opioid analgesics in Hôtel-Dieu de France of Beyrouth].
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Noufi P, Khoury E, Ayoub E, Naccache N, and Richa S
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- Adult, Age Factors, Aged, Analgesics, Non-Narcotic therapeutic use, Attitude of Health Personnel, Chronic Pain drug therapy, Female, France, Health Care Surveys, Humans, Male, Middle Aged, Opioid-Related Disorders, Pain drug therapy, Physicians, Analgesics, Opioid therapeutic use, Drug Prescriptions statistics & numerical data, Practice Patterns, Physicians' statistics & numerical data
- Abstract
Objectives: Use of chronic opioid therapy has increased substantially over the past few years, even though opioid therapy is associated with potentially serious harms, including opioid-related adverse effects and outcomes. Prescription of opioids for chronic pain, particularly nonmalignant chronic pain, remains controversial. In the midst of this controversy, patterns of actual prescription and influences on these patterns are not well understood. This study aims to describe the frequency of prescription of opioid analgesics in a university hospital, the attitudes of doctors towards this category of drugs, and the follow-up modalities of patients taking these drugs. The study also explores the association between the practitioners' characteristics and the modalities of prescription., Design and Methods: A survey was delivered to 112 doctors and surgeons in the hospital during the four months between August and December 2013 and it was returned by 55 (49.0%). The survey consists of three parts. The first part addresses the frequency and reluctance of doctors' prescription of opioids and other analgesics for acute and chronic pain. The second part studies the doctors' attitudes and concerns towards opioids. It explores the belief of the doctors in the efficacy of this category of drugs, their confidence in prescribing such medications and the eventual side effects they might worry about. The third part of the survey studies the modalities of evaluation prior to the prescription and the modalities of follow-up of the patients receiving a long-term opioid treatment., Results: Overall, 76.4% of doctors reported they sometimes, frequently, or always, prescribe opioids, which, using the Wilcoxon test, proved to be a significantly lower frequency than for prescribing of minor analgesics or nonsteroidal anti-inflammatory drugs (NSAIDS). Similarly, 60.1% reported a reluctance to prescribe opioids for chronic nonmalignant pain, which was a significantly greater reluctance than for cancer pain. The age and sex of the participants were unrelated to prescribing, but those with specialty training and use of practice guidelines were more likely to prescribe opioids and were less reluctant to do so. A majority of practitioners felt that opioids are effective for the treatment of chronic nonmalignant pain and that they have the sufficient training to prescribe them adequately; however, they still worry about the long-term prescription of opioids, particularly fearing the psychological dependence this treatment might cause. Using a series of Spearman correlation tests, we found that practitioners who thought they were adequately trained and who believed in the efficacy of long-term opioid treatment were more likely to prescribe them but that the worries about side effects decreased the frequency of prescription. A significant proportion of practitioners do not evaluate addiction risk factors of patients before prescribing opioids. The results concerning the modalities of follow-up of prescription were very heterogeneous with 87% of practitioners not explaining and 65% not screening for adverse effects. We similarly found that the frequency of follow-up and the management of patients who were exhibiting signs of dependence were very diverse., Conclusion: The results of this study were compatible with those of other recent studies about opioid prescription. The doctors practicing in the university hospital Hôtel-Dieu de France de Beyrouth present comparable prescription patterns, independent of their personal or professional characteristics, and they are more confident in their prescription when professionally trained for it. However, they exhibit a notable heterogeneity in their attitudes towards opioids and in their modalities of evaluating patients receiving long-term treatment. These results suggest a need for additional training in the management of this category of drugs., (Copyright © 2016. Published by Elsevier Masson SAS.)
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- 2016
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22. Genotyping test with clinical factors: better management of acute postoperative pain?
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Hajj A, Peoc'h K, Laplanche JL, Jabbour H, Naccache N, Abou Zeid H, Yazbeck P, and Khabbaz LR
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- ATP Binding Cassette Transporter, Subfamily B genetics, Adult, Aged, Alleles, Female, Humans, Male, Middle Aged, Morphine administration & dosage, Morphine therapeutic use, Pain Measurement methods, Pain, Postoperative prevention & control, Polymorphism, Genetic genetics, Receptors, Opioid, mu genetics, Genotype, Pain, Postoperative genetics
- Abstract
Individualization of acute postoperative pain treatment on an evidence-based decision process is a major health concern. The aim of this study is to investigate the influence of genetic and non-genetic factors on the variability of response to morphine in acute postoperative pain. A group of nighty-five patients undergoing major surgery were included prospectively. At 24 h, a logistic regression model was carried out to determine the factors associated with morphine doses given by a Patient Controlled Analgesia device. The dose of morphine was associated with age (p = 0.011), patient weight (p = 0.025) and the duration of operation (p = 0.030). This dose decreased with patient's age and duration of operation and increased with patient's weight. OPRM1 and ABCB1 polymorphisms were significantly associated with administered dose of morphine (p = 0.038 and 0.012 respectively). Patients with at least one G allele for c.118A>G OPRM1 polymorphism (AG/GG) needed 4 times the dose of morphine of AA patients. Additionally, patients with ABCB1 CT and CC genotypes for c.3435C>T polymorphism were 5.6 to 7.1 times more prone to receive higher dose of morphine than TT patients. Our preliminary results support the evidence that OPRM1/ABCB1 genotypes along with age, weight and duration of operation have an impact on morphine consumption for acute postoperative pain treatment.
- Published
- 2015
- Full Text
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