Anne-Sophie Julien

Effects of Insulin Glargine and Liraglutide Therapy on Liver Fat As Measured by Magnetic Resonance in Patients With Type 2 Diabetes: A Randomized Trial

OBJECTIVE This study determined the effects of insulin versus liraglutide therapy on liver fat in patients with type 2 diabetes inadequately controlled with oral agents therapy, including metformin. RESEARCH DESIGN AND METHODS Thirty-five patients with type 2 diabetes inadequately controlled on metformin monotherapy or in combination with other oral antidiabetic medications were randomized to receive insulin glargine or liraglutide therapy for 12 weeks. The liver proton density fat fraction (PDFF) was measured by MRS. The mean liver PDFF, the total liver volume, and the total liver fat index were measured by MRI. The Student t test, the Fisher exact test, and repeated-measures ANOVA were used for statistical analysis. RESULTS Insulin treatment was associated with a significant improvement in glycated hemoglobin (7.9% to 7.2% [62.5 to 55.2 mmol/mol], P = 0.005), a trend toward a decrease in MRS-PDFF (12.6% to 9.9%, P = 0.06), and a significant decrease in liver mean MRI-PDFF (13.8% to 10.6%, P = 0.005), liver volume (2,010.6 to 1,858.7 mL, P = 0.01), and the total liver fat index (304.4 vs. 209.3 % ⋅ mL, P = 0.01). Liraglutide treatment was also associated with a significant improvement in glycated hemoglobin (7.6% to 6.7% [59.8 to 50.2 mmol/mol], P < 0.001) but did not change MRS-PDFF (P = 0.80), liver mean MRI-PDFF (P = 0.15), liver volume (P = 0.30), or the total liver fat index (P = 0.39). CONCLUSIONS The administration of insulin glargine therapy reduced the liver fat burden in patients with type 2 diabetes. However, the improvements in the liver fat fraction and glycemia control were not significantly different from those in the liraglutide group.

Clinical characteristics and outcome of patients with Clostridium difficile infection diagnosed by PCR versus a three-step algorithm

Clinical features of Clostridium difficile infections (CDI) detected by PCR, but not by conventional methods, are poorly understood. We compared the clinical features of CDI cases detected by PCR only and cases detected by both PCR and a three-step algorithm. We performed a retrospective cohort study of patients fulfilling a standardized definition over a 13-month period. Stool specimens were tested in parallel by PCR and an algorithm based on enzyme immunoassay and cytotoxicity assay (EIA/CCA). Clinical features of CDI cases detected by PCR only and cases detected by PCR and EIA/CCA were compared by univariate logistic regression. In all, 97 patients (31 PCR+ and 66 PCR+EIA/CCA+) met the inclusion criteria. Compared with cases detected by both PCR and EIA/CCA, CDI cases detected by PCR only were younger (65.4 versus 76.3 years; p 0.001), had a lower absolute neutrophil count (mean, 9.4 × 10(9) /L versus 12.5 × 10(9) /L; p 0.04), were less likely to receive oral vancomycin (2/31 versus 25/66; p 0.005) or combination therapy (0/31 versus 16/66; p 0.04), and had fewer complications (6/31 versus 29/66; p 0.02), despite presenting a higher number of bowel movements on the day of diagnosis (median, 6.0 versus 3.0; p 0.02). They had also a lower C. difficile faecal bacterial load (mean, 5.04 versus 6.89 log10 CFU/g; p <0.001). The CDI cases detected by PCR only and cases detected by both PCR and EIA/CCA have different clinical features, but whether these two populations can be managed differently remains to be determined.

Prediction and validation of hemodialysis duration in acute methanol poisoning

The duration of hemodialysis (HD) in methanol poisoning (MP) is dependent on the methanol concentration, the operational parameters used during HD, and the presence and severity of metabolic acidosis. However, methanol assays are not easily available, potentially leading to undue extension or premature termination of treatment. Here we provide a prediction model for the duration of high-efficiency HD in MP. In a retrospective cohort study, we identified 71 episodes of MP in 55 individuals who were treated with alcohol dehydrogenase inhibition and HD. Four patients had residual visual abnormality at discharge and only one patient died. In 46 unique episodes of MP with high-efficiency HD the mean methanol elimination half-life (T1/2) during HD was 108 min in women, significantly different from the 129 min in men. In a training set of 28 patients with MP, using the 90th percentile of gender-specific elimination T1/2 (147 min in men and 141 min in women) and a target methanol concentration of 4 mmol/l allowed all cases to reach a safe methanol of under 6 mmol/l. The prediction model was confirmed in a validation set of 18 patients with MP. High-efficiency HD time in hours can be estimated using 3.390 × (Ln (MCi/4)) for women and 3.534 × (Ln (MCi/4)) for men, where MCi is the initial methanol concentration in mmol/l, provided that metabolic acidosis is corrected.

Predictors of intention not to use cannabis among young adults who attend adult education centers

Cannabis use among young people and the consequences of such use on their health and their school attainment concern a number of health care providers, teachers, and parents. This study attempts to document cannabis use among youth attending adult education centers in the province of Quebec, Canada, and to identify factors associated with their intention not to use cannabis in the next month. An extended version of the theory of planned behavior was applied. A total of 260 young adults, randomly recruited in nine adult education centers, completed the questionnaire. Of these, 133 reported having used cannabis in the past year. In this sub-sample more than one-third (30.3%) use cannabis every day. The intention prediction model demonstrated that perceived behavioral control and attitude are two determinant variables. The intention not to use cannabis is also related to anticipated regret and frequency of use. The results of this study revealed several options for helping young people not to use cannabis during their school career.

Psychosocial Factors and Beliefs Related to Intention to Not Binge Drink Among Young Adults

AIMS The objective of the study was to identify psychosocial factors and salient beliefs associated with the intention of young people to not binge drink in the next month, applying an extended version of the theory of planned behavior. METHODS Among 200 youths randomly recruited from adult education centers in the province of Quebec, Canada, 150 completed a questionnaire. Of these, 141 youths reported having used alcohol in the last year-analyses were performed on this sub-sample. RESULTS The prediction model demonstrated that perceived behavioral control (odds ratio, OR = 2.60, 95% confidence interval, CI 1.59-4.23; P = 0.0001), attitude (OR = 2.49, 95% CI 1.14-5.43; P = 0.02) and moral norm (OR = 1.88, 95% CI 1.23-2.88; P = 0.004) are three determinant variables of intention to not binge drink in the next month. The intention is also related to cannabis use in the last month (OR = 0.17 95% CI 0.05-0.53; P = 0.002). Young people who believe that if they do not binge drink in the next month, they will have a lower risk of getting depressed (OR = 1.53, 95% CI 1.23-1.90; P = 0.0001), and those who believe they will be able to not binge drink even if they are at a party (OR = 1.58, 95% CI 1.29-1.94; P < 0.0001), are more likely to have a positive intention. CONCLUSION Despite some methodological limitations, this study revealed several options for helping young people to not binge drink during their school career.

Contemporary outcomes of palliative transurethral resection of the prostate in patients with locally advanced prostate cancer

BACKGROUND Advanced prostate cancer may cause significant local complications which affect quality of life, including bladder outlet obstruction and hematuria. We performed a detailed review of our outcomes of palliative transurethral resection of the prostate (pTURP) in the era of taxane chemotherapy and potent androgen receptor antagonists at our tertiary-care institution. METHODS Using hospital coding data, we identified patients with a diagnosis of prostate cancer who underwent a TURP at Hotel-Dieu Hospital in Quebec City between 2006 and 2016 for detailed chart review. Co-morbidities were classified using the Charlson comorbidity index (CCI). Cox regression analyses assessed predictors of perioperative mortality and morbidity. RESULTS Of 137 patients identified, 58 were included in our study. Median age was 68 years; 27 (47%) men had castration-resistant prostate cancer and 28 (48%) were metastatic at time of pTURP. Mean follow-up from the first pTURP was 2.2 years, with an estimated 5-year overall survival of 16.3% (95% CI: 6.5%-29.8%). Castration-resistant prostate cancer, CCI ≥5, and age predicted poorer survival. Primary indication for pTURP was bladder outlet obstruction (69%) or hematuria (22%). Postoperative Clavien 0, 1, 2, 3, 4, 5 complications occurred in 20 (34%), 16 (28%), 18 (31%), 3 (5%), 0, and 1 (2%) patients, respectively. Overall, 17 (27%) men underwent ≥1 redo pTURPs and 16 (28%) eventually had an indwelling catheter. Nephrostomy tubes or ureteral stents in place before pTURP remained indefinitely in all cases. CONCLUSIONS We conclude palliative TURP remains an important surgical option to relieve bladder outlet obstruction in patients with locally advanced prostate cancer, but is ineffective to relieve ureteral obstruction.

Cleft Palates and Occlusal Outcomes in Pierre Robin Sequence

Objective To assess the dental class occlusion and lateral cephalometry of children with conservatively treated Pierre Robin sequence (PRS) and to identify associations between these findings and prepalatoplasty cleft palate measurements. Study Design Retrospective cohort study. Subjects and Methods Among 22 patients with PRS, the following data were prospectively collected: demographics and preoperative cleft palate measurements. After patients reached age 6 years, an orthodontist assessed dental occlusion class and performed a lateral cephalometric analysis. PRS cephalometric data were compared with reference population values. Bivariate logistic regression was used to test the association with malocclusion class. Results are presented as odds ratios with 95% profile likelihood confidence intervals. The association between cleft measurements and cephalometric parameters was tested with Spearman’s correlation (rs). Results All 22 patients had bimaxillary hypoplasia and were prone to hyperdivergency, with a 41% rate of dental class III malocclusion. An increased anterior growth of the still retrusive mandible mostly accounts for the occurrence of the class III malocclusion in PRS (class II SNB = 74.3° vs class III SNB = 77.6°, P = .04). A larger cleft at the time of the cleft repair (mean, 11 months) was associated with increased mandibular retrusion (smaller SNB angle, rs = −0.5, P = .02). Conclusions The 41% rate of class III malocclusion among these conservatively treated patients needs to be considered in the choice of the initial airway approach. The future impact of early mandibular advancement will have to be determined.

Accelerometry to measure physical activity in toddlers: Determination of wear time requirements for a reliable estimate of physical activity

ABSTRACT Accelerometry is widely used to evaluate physical activity in toddlers however recommendations regarding wear time are needed to understand physical activity behaviours in this age group. This study aimed to determine the minimum wear time to reliably evaluate physical activity in toddlers. Children from the 3D Birth Cohort (n = 255, 49.8% boys, 2.1 ± 0.2 years) were asked to wear an accelerometer (GT3X+, ActiGraph) for 7 days. Physical activity was expressed in active time (min/day) and counts per minute (CPM). Single day intraclass correlation coefficients (ICCs) were calculated to assess the effect of varying minimal wear time on reliability estimates. The Spearman-Brown formula was used to determine wear time required to achieve reliability levels of 70%, 80% and 90%. For active time, a reliability of 72.1% was achieved with wearing the accelerometer for ≥ 4 days of ≥ 6 h, which comprised 85.9% of the sample. For CPM, ≥ 4 days of ≥ 6 h provided a reliability of 74.7% and comprised 85.9% of the children. Results differed slightly when girls and boys were analysed separately, but restricting analyses to children with a weekend day did not. In summary, a minimum of 4 days with ≥ 6 h of accelerometry data provides a reliable estimate of physical activity in 2-year toddlers.

Effects of 6-Month Vitamin D Supplementation on Insulin Sensitivity and Secretion: A Randomized, Placebo-Controlled Trial

Objective: To determine whether vitamin D3 supplementation improves insulin sensitivity, using the hyperinsulinemic-euglycemic clamp. Design: This single-center, double-blind, placebo-controlled trial randomized 96 participants at high risk of diabetes or with newly diagnosed type 2 diabetes to vitamin D3 5,000 IU daily or placebo for 6 months. Methods: We assessed at baseline and 6 months: 1) primary aim: peripheral insulin sensitivity (M-value using a 2-h hyperinsulinemic-euglycemic clamp); 2) secondary aims: other insulin sensitivity (HOMA2%S, Matsuda) and insulin secretion (insulinogenic index, C-peptide area under the curve, HOMA2-B) indices using a 2h-oral glucose tolerance test (OGTT); ß-cell function (disposition index: M-value x insulinogenic index); fasting and 2-h glucose post-OGTT; HbA1c; anthropometry. Results: Baseline characteristics were similar between groups (% or mean±SD): women 38.5%; age 58.7±9.4 years; BMI 32.2±4.1 kg/m2; prediabetes 35.8%; diabetes 20.0%; 25hydroxyvitamin D (25(OH)D) 51.1±14.2 nmol/L. At 6 months, mean 25(OH)D reached 127.6±26.3 nmol/L and 51.8±16.5 nmol/L in the treatment and placebo groups, respectively (p<0.001). A beneficial effect of vitamin D3 compared with placebo was observed on Mvalue (mean change (95% CI): 0.92 (0.24 to 1.59) versus -0.03 (-0.73 to 0.67); p=0.009) and disposition index (mean change (95% CI): 267.0 (-343.4 to 877.4) versus -55.5 (-696.3 to 585.3); p=0.039) after 6 months. No effect was seen on other outcomes. Conclusions: In individuals at high risk of diabetes or with newly diagnosed type 2 diabetes, vitamin D supplementation for 6 months significantly increased peripheral insulin sensitivity and ß-cell function, suggesting that it may slow metabolic deterioration in this population. Page 3 of 42 Accepted Manuscript published as EJE-19-0156.R2. Accepted for publication: 03-Jul-2019 Copyright

Association of Resident Duty Hour Restrictions, Level of Trainee, and Number of Available Residents with Mortality in the Neonatal Intensive Care Unit

Objective This article assesses the effect of reducing consecutive hours worked by residents from 24 to 16 hours on yearly total hours worked per resident in the neonatal intensive care unit (NICU) and evaluates the association of resident duty hour reform, level of trainee, and the number of residents present at admission with mortality in the NICU. Study Design This is a 6‐year retrospective cohort study including all pediatric residents working in a Level 3 NICU (N = 185) and infants admitted to the NICU (N = 8,159). Adjusted odds ratios (aOR) were estimated for mortality with respect to Epoch (2008‐2011 [24‐hour shifts] versus 2011‐2014 [16‐hour shifts]), level of trainee, and the number of residents present at admission. Results The reduction in maximum consecutive hours worked was associated with a significant reduction of the median yearly total hours worked per resident in the NICU (381 hour vs. 276 hour, p < 0.01). Early mortality rate was 1.2% (50/4,107) before the resident duty hour reform and 0.8% (33/4,052) after the reform (aOR, 0.57; 95% confidence interval [CI], 0.33‐0.98). Neither level of trainee (aOR, 1.22; 95% CI, 0.71‐2.10; junior vs. senior) nor the number of residents present at admission (aOR, 2.08; 95% CI, 0.43‐10.02, 5‐8 residents vs. 0‐2 residents) were associated with early mortality. Resident duty hour reform was not associated with hospital mortality (aOR, 0.73; 95% CI, 0.50‐1.07; after vs. before resident duty hour reform). Conclusion Resident duty hour restrictions were associated with a reduction in the number of yearly hours worked by residents in the NICU as well as a significant decrease in adjusted odds of early mortality but not of hospital mortality in admitted neonates.