Publications by authors named "Georges Kaltenbach"

58 Publications

Gait Disorder among Elderly People, Psychomotor Disadaptation Syndrome: Post-Fall Syndrome, Risk Factors and Follow-Up - A Cohort Study of 70 Patients.

Gerontology 2021 30;67(1):17-24. Epub 2020 Nov 30.

Geriatric Department, CHU Strasbourg, Strasbourg, France.

Introduction: Falls among older people are a major health issue and the first cause of accidental death after 75 years of age. Post-fall syndrome (PFS) is commonly known and yet poorly studied.

Objective: Identify risk factors for PFS and do a follow-up 1 year later.

Methods: We included all patients over 70 years of age hospitalized after suffering a fall in a case-control study, and then followed them in a cohort study. PFS was retained in case of functional mobility decline (transferring, walking) occurring following a fall in the absence of an acute neurological, orthopedic or rheumatic pathology directly responsible for the decline. The data initially collected were: clinical (anamnestic, emergency and departmental/ward evolution, medical history, lifestyle, treatments, clinical examination items); and imaging if the patient had been subjected to brain imaging in the last 3 years prior to inclusion. Regarding the follow-up at 1 year, we collected from the general physician the occurrence and the characteristics of new falls, functional mobility assessment, hospitalization and death.

Results: Inclusion took place from March 29, 2016 to June 7, 2016 and follow-up until June 30, 2017. We included 70 patients. A total of 29 patients exhibited a PFS (41.4 %). Risk factors for PFS included age, walking disorder prior to the fall, the use of a walking aid prior to the fall, no unaccompanied outdoor walk in the week before the fall, visual impairment making close reading impossible, stiffness in ankle dorsiflexion, grip strength and the fear of falling. Among patients with PFS, 52.9% could still perform a transfer at 1 year and 64.7% could still walk against 80.7% and 85.2%, respectively, for patients without PFS.

Conclusion: The study showed the existence of body functions/structure impairments and activity limitations prior to the fall among patients exhibiting a PFS. This suggests the existence of a pre-fall syndrome, i.e., a psychomotor disadaptation syndrome existing prior to the fall. Among the 8 risk factors, fear of falling, vision impairment and muscle strength could be targeted for improvement. The diagnosis of PFS could be a marker of loss of functional mobility at 1 year.
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http://dx.doi.org/10.1159/000511356DOI Listing
November 2020

Management of thyroid dysfunctions in the elderly. French Endocrine Society consensus 2019 guidelines. Short version.

Ann Endocrinol (Paris) 2020 10 21;81(5):511-515. Epub 2020 May 21.

Service d'endocrinologie et maladies métaboliques, CHU de Larrey, 31059 Toulouse, France. Electronic address:

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http://dx.doi.org/10.1016/j.ando.2020.05.002DOI Listing
October 2020

Effects of a short-term interval aerobic training program with recovery bouts on vascular function in sedentary aged 70 or over: A randomized controlled trial.

Arch Gerontol Geriatr 2019 May - Jun;82:217-225. Epub 2019 Feb 26.

Geriatric Department, University Hospitals of Strasbourg, Strasbourg, France; Department of Physiology and EA-3072, Faculty of Medicine, Strasbourg University, Strasbourg, France.

Background: Interval aerobic training programs with active recovery bouts (IATP-R) are reported as being more adapted to seniors while improving cardiorespiratory and endurance parameters. Report of benefits on vascular function is still limited.

Purpose: To measure the impact of IATP-R on vascular function among seniors.

Methods: Sedentary volunteers (≥70 years of age) were randomly assigned to either IATP-R (n = 30) or control group (n = 30). The IATP-R consisted of 2 weekly sessions of 30-min (6 × 4-min at first ventilatory threshold (VT) intensity + 1-min at 40% of VT) cycling exercise over 9.5-week. Controls remained their sedentary life over the same period. In all participants, the endothelial function was measured by flow-mediated dilation (FMD) in brachial artery and arterial stiffness through the carotid/radial and carotid/femoral pulse wave velocity (PWV). Systolic (SBP) and diastolic blood pressure (DBP) were measured at baseline and 9.5 weeks later.

Results: Resulting from a planned interim analysis, IATP-R improved SBP (IATP-R: from 133.7 ± 9.8 to 122.6 ± 9.4 mmHg vs. Controls: from 128.9 ± 12.5 to 132.6 ± 14.7 mmHg), DBP (IATP-R: from 80.2 ± 7.0 to 74.1 ± 6.7 mmHg vs. Controls: from 77.1 ± 6.8 to 80.3 ± 7.5 mmHg), and FMD (IATP-R: from 6.7 ± 2.0 to 7.5 ± 2.7% vs. Controls: from 7.9 ± 2.7 to 7.5 ± 2.5%). No significant impact on PWV was measured.

Conclusion: Although these findings resulted from an interim analysis, IATP-R might be effective in regulating BP and improving endothelial function among sedentary seniors.
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http://dx.doi.org/10.1016/j.archger.2019.02.017DOI Listing
February 2020

Systematic Review and Pragmatic Clinical Approach to Oral and Nasal Vitamin B12 (Cobalamin) Treatment in Patients with Vitamin B12 Deficiency Related to Gastrointestinal Disorders.

J Clin Med 2018 Sep 26;7(10). Epub 2018 Sep 26.

Department of Geriatrics and Internal Medicine, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France.

The objective of this review is to provide an update on the effectiveness of oral and nasal vitamin B12 (cobalamin) treatment in gastrointestinal (GI) disorders. Relevant articles were identified by PubMed and Google Scholar systematic search, from January 2010 and June 2018, and through hand search of relevant reference articles. Additional studies were obtained from references of identified studies, the Cochrane Library and the ISI Web of Knowledge. Data gleaned from reference textbooks and international meetings were also used, as was information gleaned from commercial sites on the web and data from CARE B12 research group. For oral vitamin B12 treatment, 4 randomized controlled trials (vs. intramuscular), 4 narrative and 4 systematic reviews, and 13 prospective studies fulfilled our inclusion criteria. These studies concerned patients with vitamin B12 deficiency related to: food-cobalamin malabsorption ( = 6), Biermer's disease ( = 3), veganism or vegetarianism ( = 1), total gastrectomy after Roux-en-Y gastric bypass ( = 2) and Crohn's disease ( = 1). Four prospective studies include patients with vitamin B12 deficiency related to the aforementioned etiologies, except veganism or vegetarianism. The systematic present review documents that oral vitamin B12 replacement, at a daily dose of 1000 μg (1 mg), was adequate to normalize serum vitamin B12 levels and cure main clinical manifestations related to vitamin B12 deficiency, in GI disorders, and thus, with safety profile. For nasal vitamin B12 treatment, only one preliminary study was available. We conclude that oral vitamin B12 is an effective alternative to intramuscular vitamin B12 (except in patients presenting with severe neurological manifestations). Oral vitamin B12 treatment avoids the discomfort, contraindication (in patients with anticoagulation), and cost of monthly injections.
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http://dx.doi.org/10.3390/jcm7100304DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6210286PMC
September 2018

Effects of Interval Aerobic Training Program with Recovery bouts on cardiorespiratory and endurance fitness in seniors.

Scand J Med Sci Sports 2018 Nov 22;28(11):2284-2292. Epub 2018 Jul 22.

Health and Wellbeing Academy, Anglia Ruskin University, Cambridge, UK.

Interval aerobic training programs (IATP) improve cardiorespiratory and endurance parameters. They are, however, unsuitable to seniors as frequently associated with occurrence of exhaustion and muscle pain. The purpose of this study was to measure the benefits of an IATP designed with recovery bouts (IATP-R) in terms of cardiorespiratory and endurance parameters and its acceptability among seniors (≥70 years). Sedentary healthy volunteers were randomly assigned either to IATP-R or sedentary lifestyle. All participants performed an incremental cycle exercise and 6-minute walk test (6-MWT) at baseline and 9.5 weeks later. The first ventilatory threshold (VT ); maximal tolerated power (MTP); peak of oxygen uptake (VO ); maximal heart rate (HR ); and distance walked at 6-MWT were thus measured. IATP-R consisted of 19 sessions of 30-minute (6 × 4-min at VT  + 1-minute at 40% of VT ) cycling exercise over 9.5 weeks. With an adherence rate of 94.7% without any significant adverse events, 9.5 weeks of IATP-R, compared to controls, enhanced endurance (VT : +18.3 vs -4.6%; HR at baseline VT : -5.9 vs +0.2%) and cardiorespiratory parameters (VO : +14.1 vs -2.7%; HR : +1.6 vs -1.7%; MTP: +19.2 vs -2.3%). The walk distance at the 6-MWT was also significantly lengthened (+11.6 vs. -3.1%). While these findings resulted from an interim analysis planned when 30 volunteers were enrolled in both groups, IATP-R appeared as effective, safe, and applicable among sedentary healthy seniors. These characteristics are decisive for exercise training prescription and adherence.
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http://dx.doi.org/10.1111/sms.13257DOI Listing
November 2018

Effects of a short-term Interval Aerobic Training Programme with active Recovery bouts (IATP-R) on cognitive and mental health, functional performance and quality of life: A randomised controlled trial in sedentary seniors.

Int J Clin Pract 2019 Jan 2;73(1):e13219. Epub 2018 Jul 2.

Health and Wellbeing Academy, Anglia Ruskin University, Cambridge, UK.

Background: Interval aerobic training programme with active recovery bouts (IATP-R) has shown to improve tolerance to IATP among seniors. However, data concerning its benefits for seniors' health are still limited.

Purpose: The purpose of this study was to examine the effects of IATP-R on seniors' health status.

Methods: Sedentary volunteers (n = 60, aged ≥70 years) were randomly assigned to either IATP-R or maintained sedentary lifestyle for 9.5 weeks. IATP-R consisted of 30-minute cycling (6 × 4 minutes at first ventilatory threshold (VT ) intensity + 1 minute at 40% of VT ) twice a week. Cognitive and functional performances were assessed with the Trail Making Test (TMT-A; TMT-B); Paced Auditory Serial Addition Test (PASAT); Timed Up and Go (TUG) test; 6-Minute Walk Test (6-MWT); one-leg balance test; and the Short Physical Performance Battery (SPPB) tests, respectively. QoL and anxiety/depression status were measured by the Short Form-12 and the Goldberg's Scale, respectively. All participants were assessed at baseline and 9.5 weeks later.

Results: Compared to controls, IATP-R improved cognitive functions (TMT-A: +1.5% vs -21.5%; TMT-B: +0.9% vs -13.3%; PASAT: +1.4% vs -14.6%; semantic fluency: -1.1% vs +11.7%), functional performance (TUG: +5.4% vs -16.5%; 6-MWT: -3.2% vs +11.5%; SPPB: -3.2% vs +14.6%; One-leg balance: -16.3% vs +25.0%); QoL (physical health: -13.3% vs +23.1%; mental health: -7.1% vs +8.2%); and depressive symptoms (+26.3% vs -42.8%). Significant impacts were measured neither on letter modality of fluency tasks nor on anxiety score.

Conclusion: These data showed that IATP-R is an effective training programme to improve functional and cognitive performances, mental health and well-being in sedentary seniors. Trial registration ClinicalTrials.gov NCT02263573. Registered October 1, 2014.
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http://dx.doi.org/10.1111/ijcp.13219DOI Listing
January 2019

Critically ill elderly patients (≥ 90 years): Clinical characteristics, outcome and financial implications.

PLoS One 2018 1;13(6):e0198360. Epub 2018 Jun 1.

Medical Intensive Care Unit and UMR 1121, Hautepierre Hospital, University Hospital of Strasbourg, Strasbourg, France.

Background: Patients aged over 90 are being admitted to intensive care units (ICUs) with increasing frequency. The appropriateness of such decisions still remains controversial due to questionable outcome, limited resources and costs. Our objective was to determine the clinical characteristics and outcome in elderly patients (≥ 90 years) admitted in a medical ICU, with an additional focus on medico-economic implications.

Methods: We reviewed the charts of all patients (≥ 90 years) admitted to our ICU. We compared them with all other ICU patients (< 90 years), sought to identify ICU mortality predictors and also performed a long-term survival follow-up.

Results: In the study group of 317 stays: median age was 92 years (IQR: 91-94 years); most patients were female (71.3%.). Acute respiratory failure (52.4%) was the main admission diagnosis; mean SAPS II was 55.6±21.3; half the stays (49.2%) required mechanical ventilation (duration: 7.2±8.8 days); withholding and withdrawing decisions were made for 33.4% of all stays. ICU and hospital mortality rates were 35.7% and 42.6% respectively. Mechanical ventilation (OR = 4.83, CI95%: 1.59-15.82) was an independent predictor of ICU mortality whereas age was not (OR = 0.88, CI95%: 0.72-1.08). Social security reimbursement was significantly lower in the study group compared with all other ICU stays, both per stay (13,160 vs 22,092 Euros, p< 0.01) and per day of stay (p = 0.03).

Conclusion: Among critically ill elderly patients (≥ 90 years), chronological age was not an independent factor of ICU mortality. ICU care-related costs in this population should not be considered as a limiting factor for ICU admission.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198360PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5983531PMC
January 2019

Effect of Aerobic Training on Peak Oxygen Uptake Among Seniors Aged 70 or Older: A Meta-Analysis of Randomized Controlled Trials.

Rejuvenation Res 2018 Aug 2;21(4):341-349. Epub 2018 Jan 2.

7 Health and Wellbeing Academy, Anglia Ruskin University , Cambridge, United Kingdom .

Older adults undergo a progressive decline in cardiorespiratory fitness and functional capacity. This lower peak oxygen uptake (VO) level is associated with increased risk of frailty, dependency, loss of autonomy, and mortality from all causes. Regular physical activity and particularly aerobic training (AT) have been shown to contribute to better and healthy aging. We conducted a meta-analysis to measure the exact benefit of AT on VO in seniors aged 70 years or older. A comprehensive, systematic database search for articles was performed in Embase, Medline, PubMed Central, Science Direct, Scopus, and Web of Science using key words. Two reviewers independently assessed interventional studies for potential inclusion. Ten randomized controlled trials (RCTs) were included totaling 348 seniors aged 70 years or older. Across the trials, no high risk of bias was measured and all considered open-label arms for controls. With significant heterogeneity between the RCTs (all p < 0.001), pooled analyses were computed for VO. Not only was VO found significantly higher in the training group compared to controls (mean difference [MD] = 1.56; 95% confidence interval [CI]: 0.90-2.23) in pooled analysis of the 10 RCTs but also when the analysis was adjusted on the participants' health statuses. MD among healthy and unhealthy seniors were, respectively, 1.72 (95% CI: 0.34-3.10) and 1.47 (95% CI: 0.60-2.34). This meta-analysis confirms the AT-associated benefits on VO in healthy and unhealthy seniors.
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http://dx.doi.org/10.1089/rej.2017.1988DOI Listing
August 2018

History and Outcome of Febrile Neutropenia Outside the Oncology Setting: A Retrospective Study of 76 Cases Related to Non-Chemotherapy Drugs.

J Clin Med 2017 Sep 26;6(10). Epub 2017 Sep 26.

Departments of Onco-hematology, Strasbourg University Hospitals, Strasbourg 67000, France.

Background: Despite major advances in its prevention and treatment, febrile neutropenia remains a most concerning complication of cancer chemotherapy. Outside the oncology setting, however, only few data are currently available on febrile neutropenia related to non-chemotherapy drugs. We report here data on 76 patients with febrile neutropenia related to non-chemotherapy drugs, followed up in a referral center within a university hospital.

Patients And Methods: Data from 76 patients with idiosyncratic drug-induced febrile neutropenia were retrospectively reviewed. All cases were extracted from a cohort study on agranulocytosis conducted at the Strasbourg University Hospital (Strasbourg, France).

Results: Mean patient age was 52.2 years old (range: 18-93) and gender ratio (F/M) 1.6, with several comorbidities present in 86.8% of patients. The most common causative drugs were: antibiotics (37.4%), antithyroid drugs (17.2%), neuroleptic and anti-epileptic agents (13.1%), non-steroidal anti-inflammatory agents and analgesics (8%), and platelet aggregation inhibitors (8%). Main clinical presentations upon hospitalization included isolated fever (30%), sore throat, acute tonsillitis and sinusitis (18.4%), documented pneumonia (18.4%), septicemia (14.5%), and septic shock (6.6%). Mean neutrophil count at nadir was 0.13 × 10(9)/L (range: 0-0.48). While in hospital, 22 patients (28.9%) worsened clinically and required intensive care unit placement. All patients were promptly treated with broad-spectrum antibiotics, and 45 (59.2%) with hematopoietic growth factors. Mean duration of hematological recovery (neutrophil count ≥1.5 × 10(9)/L) was 7.5 days (range: 2-21), which was reduced to 0.7 days (range: 2-16) ( = 0.089) with hematopoietic growth factors. Outcome was favorable in 89.5% of patients, whereas eight died.

Conclusions: Like in oncology and myelosuppressive chemotherapy settings, idiosyncratic febrile neutropenia is typically serious, about 40% of patients exhibiting severe pneumonia, septicemia, and septic shock, with a mortality rate of 10%. Like in febrile, chemotherapy-related neutropenia, modern and timely management (immediate broad spectrum antibiotherapy, hematopoietic growth factors) may reduce infection-related mortality. All practitioners should be aware of this potential side-effect that may even occur in the event of "daily medication" exposure.
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http://dx.doi.org/10.3390/jcm6100092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664007PMC
September 2017

[Health benefits of aerobic training programs in adults aged 70 or over: A systematic review].

Presse Med 2017 Sep 28;46(9):794-807. Epub 2017 Jun 28.

Service de gériatrie et de réadaptation gériatrique, centre hospitalier universitaire Vaudois (CHUV), 1011 Lausanne, Suisse; Health and wellbeing academy, Anglia Ruskin university, CB1 1PT Cambridge, Royaume-Uni.

Context: Seniors represent the population where sedentary is the highest.

Objective: To evaluate of the exact health benefits of regular aerobic training (AT) in seniors aged 70 years or older.

Documentary Source: Systematic review in CINAHL Plus, Embase, Medline, PubMed Central, ScienceDirect, Scopus, Sport Discus and Web of Science with a keyword search.

Selection Of Studies: Two independent readers have selected randomized controlled and quasi-controlled studies and observational cohort studies published in English.

Results: Of 3515 articles identified, 87 studies were included in the systematic review and categorized according to the analysed outcomes. The benefits of AT are clearly demonstrated on total mortality, coronary and neurovascular disease, glucose metabolism and type 2 diabetes, blood lipid profile, body composition, blood pressure, cardiorespiratory performances, muscle strength and functional capacity, and quality of life among senior aged 70 years or more. More recently, it has shown benefits for primary and tertiary prevention of cancer and primary and secondary prevention of cognitive decline. The benefits on bone health and the risk of falling are yet to confirm.

Limitation Of The Work: The data of benefits result from studies published in English only.

Conclusion: The AT is an important determinant of health and quality of life in seniors. Its promotion in this population should be part of the continuity of efforts undertaken among younger population. Thus, seniors should be more actively encouraged to engage in training programs.
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http://dx.doi.org/10.1016/j.lpm.2017.05.028DOI Listing
September 2017

Long-term cognitive outcome of Alzheimer's disease and dementia with Lewy bodies: dual disease is worse.

Alzheimers Res Ther 2017 Jun 27;9(1):47. Epub 2017 Jun 27.

University of Strasbourg, Laboratory of Biostatistics and French National Centre for Scientific Research (CNRS), ICube Laboratory, Team Modèles, Images et Vision (MIV), Strasbourg, France.

Background: Longitudinal studies of dementia with Lewy bodies (DLB) are rare. Clinically, DLB is usually considered to worsen into Alzheimer's disease (AD). The aim of our study was to compare the rate of the cognitive decline in DLB, AD, and the association of the two diseases (AD + DLB).

Methods: Using the Regional Network for Diagnostic Aid and Management of Patients with Cognitive Impairment database, which includes all the patients seen at all memory clinics (medical consultation and day hospitals) in four French regions, and beta regression, we compared the longitudinal the Mini-Mental State Examination scores of 1159 patients with AD (n = 1000), DLB (n = 131) and AD + DLB (association of the two) (n = 28) during follow-up of at least 4 years.

Results: The mean follow-up of the patients was 5.88 years. Using beta regression without propensity scores, the comparison of the decline of patients with AD and patients with DLB did not show a significant difference, but the decline of patients with AD + DLB was worse than that of either patients with DLB (P = 0.006) or patients with AD (P < 0.001). Using beta regression weighted by a propensity score, comparison of patients with AD and patients with DLB showed a faster decline for patients with DLB (P < 0.001). The comparison of the decline of patients with AD + DLB with that of patients with DLB (P < 0.001) and patients with AD (P < 0.001) showed that the decline was clearly worse in the patients with dual disease.

Conclusions: Whatever the analysis, the rate of decline is faster in patients with AD + DLB dual disease. The identification of such patients is important to enable clinicians to optimise treatment and care and to better inform and help patients and caregivers.
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http://dx.doi.org/10.1186/s13195-017-0272-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5488368PMC
June 2017

Idiosyncratic drug-induced neutropenia & agranulocytosis.

QJM 2017 05 9;110(5):299-305. Epub 2017 Jan 9.

Onco-hematology.

Backgroud: Few data is currently available on neutropenia and agranulocytosis related to drug intake. We report here data on 203 patients with established idiosyncratic drug-induced agranulocytosis, followed up in a referral centre within a university hospital.

Patients And Methods: Data from 203 patients with idiosyncratic drug-induced agranulocytosis were retrospectively reviewed. All cases were extracted from a cohort study on agranulocytosis in the Strasbourg University Hospital (Strasbourg, France) RESULTS: : The mean age was 61.6 years old (range: 18-95), the gender ratio (F/M) was 1.3. Several comorbidities were present in 63.5%. The most frequent causative drugs were: antibiotics (49.3%), especially ß-lactams and cotrimoxazole; antithyroid drugs (16.7%); neuroleptic and anti-epileptic agents (11.8%); antiviral agents (7.9%); and platelet aggregation inhibitors as ticlopidine and acid acetylsalicylic (6.9%). The main primary clinical manifestations during hospitalization included: isolated fever (26.3%); septicaemia (13.9%); documented pneumonia (13.4%); sore throat and acute tonsillitis (9.3%); and septic shock (6.7%). The mean neutrophil count at nadir was 0.148 x 10/L (range: 0-0.48). All febrile patients were treated with broad-spectrum antibiotics and 107 (52.7%) with hematopoietic growth factors. The mean duration of haematological recovery (neutrophil count ≥1.5 x 10/L) was 7.8 (range: 2-20). This mean duration was reduced to 2.1 days (range: 2-16) (p = 0.057) with hematopoietic growth factors. Outcome was favourable in 91.6% of patients; seventeen died. Thirty-seven patients (18.2%) required intensive care.

Conclusions: The present study demonstrated that idiosyncratic drug-induced agranulocytosis is a relative rare events; that antibiotics, antithyroid, neuroleptic and anti-epileptic agents, and platelet aggregation inhibitors are the main incriminated drug classes; that agranulocytosis typically serious, with at least 50% exhibiting severe sepsis and a mortality rate <10%; and that modern management of such disorder may reduce the infection-related mortality.
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http://dx.doi.org/10.1093/qjmed/hcw220DOI Listing
May 2017

Health benefits of aerobic training programs in adults aged 70 and over: a systematic review.

Arch Gerontol Geriatr 2017 Mar - Apr;69:110-127. Epub 2016 Oct 31.

Health and Wellbeing Academy, Anglia Ruskin University, Cambridge, United Kingdom; Geriatric and Rehabilitation Geriatric Division, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.

Aging is intrinsically associated with a progressive decline in muscle strength and mass, and aerobic capacity. This contributes to reduced mobility and impaired quality of life (QoL) among seniors. Regular physical activity, and more particularly aerobic training (AT), has demonstrated benefits on adults' health. The aim of this review was to assess the current level of evidence regarding the health benefits of AT in the population aged 70 years and over. A comprehensive, systematic database search for manuscripts was performed. Two reviewers independently assessed interventional studies for potential inclusion. Cardiovascular, metabolic, functional, cognitive, and QoL outcomes were targeted. Fifty-three studies were included totalling 2051 seniors aged 70 years and over. Studies selected were divided into 5 categories according to their main outcomes: cardiovascular function (34 studies), metabolic outcomes (26 studies), functional fitness (19 studies), cognitive functions (8 studies), and QoL (3 studies). With a good level of evidence but a wide heterogeneity between study designs, a significant and beneficial effect of AT was measured on the 5 outcomes. For QoL results showed a significant but slighter improvement. This systematic review highlights the benefits of AT on seniors' health outcome such as cardiovascular, functional, metabolic, cognitive, and QoL outcomes although the optimal program remains unclear. When more studies regarding this specific population are needed to determine the most favourable exercise program, clinicians should nevertheless encourage older adults over 70 to participate in AT programs to favour active and healthy ageing.
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http://dx.doi.org/10.1016/j.archger.2016.10.012DOI Listing
July 2017

Outcome of endoscopy-negative iron deficiency anemia in patients above 65: A longitudinal multicenter cohort.

Medicine (Baltimore) 2016 Nov;95(47):e5339

Internal Medicine, Endocrinology and Nutrition Department, Hautepierre Hospital Medical Information and Statistics Department, Civil Hospital, University Hospital of Strasbourg, Strasbourg Internal Medicine Department, Saint-Louis Hospital Internal Medicine Department, Lariboisière Hospital, APHP, University Hospital of Paris, Paris Geriatric Department, Robertsau Hospital, University Hospital of Strasbourg, Strasbourg Acute Gerontology Department, Tenon Hospital, APHP, University Hospital of Paris, Paris Internal Medicine Department, New Civil Hospital Internal Medicine Department, Civil Hospital, University Hospital of Strasbourg, Strasbourg, France.

After the age of 65 years, iron deficiency anemia (IDA) requires the elimination of digestive neoplasia and is explored with upper and lower gastrointestinal (GI) endoscopy. However, such explorations are negative in 14% to 37% of patients. To further evaluate this issue, we evaluated the outcomes of patients aged over 65 years with endoscopy-negative IDA.We retrospectively analyzed the outcomes of in-patients over the age of 65 years with IDA (hemoglobin <12 g/dL and ferritin <70 μg/L) who had negative complete upper and lower GI endoscopies in 7 tertiary medical hospitals. Death, the persistence of anemia, further investigations, and the final diagnosis for IDA were analyzed after at least 12 months by calling the patients' general practitioners and using hospital records.Between 2004 and 2011, 69 patients (74% women) with a median age of 78 (interquartile range (IQR) 75-82) years and hemoglobin and ferritin levels of 8.4 (IQR 6.8-9.9) g/dL and 14 (IQR 8-27) μg/L, respectively, had endoscopy-negative IDA, and 73% of these patients received daily antithrombotics. After a follow-up of 41 ± 22 months, 23 (33%) of the patients were dead; 5 deaths were linked with the IDA, and 45 (65%) patients had persistent anemia, which was significantly associated with death (P = 0.007). Further investigations were performed in 45 patients; 64% of the second-look GI endoscopies led to significant changes in treatment compared with 25% for the capsule endoscopies. Conventional diagnoses of IDA were ultimately established for 19 (27%) patients and included 3 cancer patients. Among the 50 other patients, 40 (58%) had antithrombotics.In endoscopy-negative IDA over the age of 65 years, further investigations should be reserved for patients with persistent anemia, and second-look GI endoscopy should be favored. If the results of these investigations are negative, the role of antithrombotics should be considered.
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http://dx.doi.org/10.1097/MD.0000000000005339DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5134861PMC
November 2016

Idiosyncratic Drug-Induced Severe Neutropenia and Agranulocytosis in Elderly Patients (≥75 years): A Monocentric Cohort Study of 61 Cases.

Drugs Real World Outcomes 2016 Dec;3(4):393-399

Department of Internal Medicine, Strasbourg University Hospitals, Strasbourg, France.

Background: Little data is currently available in the literature on neutropenia and agranulocytosis in the elderly, and, to our knowledge, idiosyncratic drug-induced agranulocytosis is particularly poorly covered, or not at all.

Objective: We herein describe the clinical picture and outcome of patients aged ≥75 years with established idiosyncratic drug-induced agranulocytosis.

Patients And Methods: Data from 61 patients over 75 years old with idiosyncratic drug-induced agranulocytosis were retrospectively reviewed. All cases were extracted from a cohort study on agranulocytosis (n = 203) in the Strasbourg University Hospitals (Strasbourg, France), a referral center.

Results: The mean age was 84.9 years (range 75-95), the gender ratio (F/M) was 2.4. Underlying diseases were present in 74 %. The most frequent causative drugs were antibiotics (43.8 %), antithyroid drugs (15.8 %), neuroleptic and anti-epileptic agents (12.3 %), and antiaggregant platelet agents (10.5 %). The primary clinical features during hospitalization included isolated fever (27.6 %), septicemia or septic shock (24.1 %), and pneumonia (20.7 %). The mean neutrophil count at nadir was 0.15 × 10/L (range 0-0.4). All febrile patients were treated with broad-spectrum antibiotics and 36 with hematopoietic growth factors. Outcome was favorable in 85.3 % of patients; nine patients died. Two elderly patients (3.3 %) died of uncontrolled septic shock relating to the depth of the neutropenia. Comparison of mortality between <75- and ≥75-year-old patients revealed a statistical difference: 4.2 % versus 14.8 % (p = 0.023).

Conclusions: Our study demonstrates that 30 % of idiosyncratic drug-induced agranulocytosis concerned elderly patients. Antibiotic, antithyroid, neuroleptic, anti-epileptic, and antiaggregant platelet agents are the primary causative drug classes. Idiosyncratic drug-induced agranulocytosis is typically serious in this frail population of elderly patients, with at least 50 % suffering from severe sepsis and with a mortality rate of approximately 15 %. Modern management of agranulocytosis may reduce the infection-related mortality (3.3 %).
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http://dx.doi.org/10.1007/s40801-016-0091-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5127888PMC
December 2016

[The 'physical aptitude for health consultation' in a geriatric unit].

Soins Gerontol 2016 Jul-Aug;21(120):20-3

Pôle de Gériatrie, Hôpitaux Universitaires de Strasbourg.Hôpitaux universitaires de Strasbourg, 83 rue Himmerich, 67091 Strasbourg cedex, France.

The aim of the 'physical aptitude for health consultation' is to offer a validated physical reconditioning programme to adults with a stabilised chronic condition. It notably enables the absence of any contraindications to be established. A first of its kind in France, the programme has been implemented at Strasbourg university hospital.
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http://dx.doi.org/10.1016/j.sger.2016.05.005DOI Listing
January 2017

Health benefits of cycle ergometer training for older adults over 70: a review.

Eur Rev Aging Phys Act 2015 2;12. Epub 2015 Nov 2.

Geriatric Department, University Hospital, Strasbourg, France ; Department of Physiology and EA-3072, Faculty of Medicine, Strasbourg University, Strasbourg, France.

As the number of older adults continues to increase worldwide, more attention is being paid to geriatric health care needs, and successful ageing is becoming an important topic in the medical literature. A preventive approach to the care of older adults is thus a priority in our aging societies. The purpose of this study was to update evidence for the health benefits of cycle ergometer training for older adults over 70. We searched online electronic databases up to September 2014 for original observational and intervention studies on the relationship between cycle ergometer training and health among older patients over 70. Twenty-five studies examined interventions aimed specifically at promoting cycling for older adults over 70. These studies reported a positive effect on the prevention of cardiovascular disease, and a significant improvement in metabolic responses. Improving functional status, muscle strength and cognitive performance are also well established. Overall, this review demonstrates a positive effect of cycle ergometer training with functional benefits and positive health outcomes for older adults over 70. Based on this evidence, clinicians can now encourage older adults to profit from the health benefits of cycle ergometer training to be able to pursue their daily activities independently.
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http://dx.doi.org/10.1186/s11556-015-0152-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748329PMC
February 2016

Sarcoidosis presenting as late-onset dementia: are cerebrospinal fluid biomarkers analyses helpful?

J Am Geriatr Soc 2015 Jan;63(1):198-200

Department of Geriatrics, Hôpital de la Robertsau, University Hospitals of Strasbourg, Strasbourg, France.

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http://dx.doi.org/10.1111/jgs.13214DOI Listing
January 2015

The Movement Disorders Society criteria for the diagnosis of Parkinson's disease dementia: their usefulness and limitations in elderly patients.

J Neurol 2013 Oct 9;260(10):2569-79. Epub 2013 Jul 9.

Department of Geriatrics, Robertsau Hospital, Strasbourg University Hospitals, 83 rue Himmerich, Strasbourg, 67091, France,

The aim of this study was to assess the performance of the Movement Disorders Society (MDS) criteria for the diagnosis of Parkinson's disease dementia (PDD) in the elderly, and also to evaluate the relevance of applying other tests in this patient population. The MDS criteria include a first short part in checklist form, and a second part which is used as a basis for reference and consists of an in-depth neuropsychological examination. Forty consecutive PD patients presenting with cognitive complaints were enrolled. An assessment was made of the performances of the MDS checklist compared with the MDS exhaustive cognitive examination which was used as a basis for reference, and with other cognitive tests including the Mattis Dementia Rating Scale (MDRS), the French version of the Grober and Buschke test, the verbal fluency test, the Rey-Osterreith complex figure and the paced auditory serial addition test. Out of a total of 40 PD subjects (mean age: 80.5 ± 4.9 years), 20 were diagnosed with PDD according to the checklist and 31 on the basis of the exhaustive examination, i.e. with 11 more patients diagnosed via the latter. The sensitivity of the checklist for the diagnosis of PDD was 0.64, with a specificity of 1.00. The use of the MDRS for PDD diagnosis with a cut-off at ≤ 120 showed a sensitivity of 0.80 and a specificity of 1.00, while at ≤ 132 it displayed a sensitivity of 1.00 and a specificity of 0.444. The specificity of the checklist for the diagnosis of PDD in the elderly was confirmed, but it was lacking in sensitivity. It was also found that the MDRS could be helpful in the diagnosis and screening of PDD.
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http://dx.doi.org/10.1007/s00415-013-7018-8DOI Listing
October 2013

Bed bugs reproductive life cycle in the clothes of a patient suffering from Alzheimer's disease results in iron deficiency anemia.

Parasite 2013 15;20:16. Epub 2013 May 15.

Laboratoire de Parasitologie et de Mycologie Médicale, Hôpitaux Universitaires de Strasbourg, 1-3 rue Koeberlé, 67000 Strasbourg, France.

We report the case of an 82-year-old patient, hospitalized for malaise. Her clothes were infested by numerous insects and the entomological analysis identified them as being Cimex lectularius (bed bugs). The history of the patient highlighted severe cognitive impairment. The biological assessment initially showed a profound microcytic, aregenerative, iron deficiency anemia. A vitamin B12 deficiency due to pernicious anemia (positive intrinsic factor antibodies) was also highlighted, but this was not enough to explain the anemia without macrocytosis. Laboratory tests, endoscopy and a CT scan eliminated a tumor etiology responsible for occult bleeding. The patient had a mild itchy rash which was linked to the massive colonization by the bed bugs. The C. lectularius bite is most often considered benign because it is not a vector of infectious agents. Far from trivial, a massive human colonization by bed bugs may cause such a hematic depletion that severe microcytic anemia may result.
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http://dx.doi.org/10.1051/parasite/2013018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3718524PMC
June 2015

Anemia in elderly patients: new insight into an old disorder.

Geriatr Gerontol Int 2013 Jul 17;13(3):519-27. Epub 2012 Dec 17.

Department of Internal Medicine, Diabetes and Metabolic Disorders, University Hospital of Strasbourg, Strasbourg, France.

Anemia is an important healthcare concern among the elderly. In these patients, the anemia is often mild, with a hemoglobin level >10 g/dL. It is usually well tolerated, but might be responsible for several proteiform and/or atypical presenting complaints. In the elderly, anemia is usually of multifactorial origin, including chronic inflammation, chronic kidney disease, nutrient deficiencies and iron deficiency (approximately two-thirds of all cases). The remaining cases are unexplained (unknown etiology). In the elderly, the classic diagnosis of anemia, which is based on the mean corpuscular volume associated with a low hemoglobin level, might not be accurate. A predefined standardized diagnostic procedure should be followed. In the common case of frail elderly patients, all investigations should be carefully considered and invasive examinations undertaken where justified (risk-benefit balance). Nevertheless, most cases of anemia require further investigation and the underlying cause should be identified and treated whenever possible.
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http://dx.doi.org/10.1111/ggi.12017DOI Listing
July 2013

[Effectiveness of "contact" precautions to prevent the spread of vancomycin resistant enterococci in a long-term care facility].

Presse Med 2011 Jul-Aug;40(7-8):e325-32. Epub 2011 Mar 31.

Hôpitaux universitaires, hôpital de la Robertsau, pôle de gériatrie, 67091 Strasbourg, France.

Introduction: Vancomycin-resistant enterococci (VRE) are major nosocomial pathogens in many countries. VRE can spread rapidly, mostly by cross-transmission through hands of healthcare workers, leading to outbreaks. Moreover, VRE have the possibility to transfer vancomycin resistance genes to other Gram-positive organisms.

Objectives: We conducted a 9-month prospective study to demonstrate the effectiveness of "contact" precautions to prevent the spread of VRE in a long-term care facility.

Methods: Six patients with VRE colonisation were admitted in an 80-bed long-term care facility. The following interventions were implemented to prevent the spread of VRE: gathering patients with VRE colonisation in the same unit, reinforcement of hand hygiene practices, "contact" precautions, reduction of some antibiotics and extensive screening of VRE carriers and contact patients by rectal swabs.

Results: There was no secondary case of VRE colonisation. Screening tests converted from positive to negative in four of the six patients.

Conclusion: Compliance with hand hygiene recommendations and "contact" precautions can prevent the spread of VRE in a long-term care facility.
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http://dx.doi.org/10.1016/j.lpm.2011.01.027DOI Listing
September 2011

TDP43-positive intraneuronal inclusions in a patient with motor neuron disease and Parkinson's disease.

Neurodegener Dis 2010 27;7(4):260-4. Epub 2010 Feb 27.

Department of Neurology, Strasbourg University Hospital, Strasbourg, France.

Background: The role of the 43-kDa transactivation-responsive DNA-binding protein (TDP43) in neurodegenerative diseases is not yet clearly established.

Objective: To assess for the first time the presence of TDP43 in a patient with motor neuron disease (MND) and Parkinson's disease (PD).

Methods: A 78-year-old woman developed poorly dopa-responsive parkinsonism without cognitive alteration. Three years later, MND appeared and led to death in less than a year. Neuropathologic examination was performed.

Results: We observed the presence of PD and MND lesions with TDP43-positive cytoplasmic inclusions in the spinal cord and bulbar nuclei but not in the dentate gyrus and neocortex. The MND was characterized by a severe degeneration of bulbar and cervical lower motor neurons. Numerous senile plaques and topographically limited neurofibrillary tangles were also observed.

Conclusion: The mechanisms underlying the rare co-occurrence of PD and MND are still unclear. The assessment of an abnormal reactivity for TDP43 in our case might gain more insight into the pathophysiology of this association of two diseases. Further studies are needed to confirm these findings and to understand the role of TDP43 in neurodegenerative diseases.
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http://dx.doi.org/10.1159/000273591DOI Listing
January 2011

[Analysis of fourteen French national programmes on physical activity and sports as determinants of health from 2001 to 2006].

Sante Publique 2009 Jan-Feb;21(1):101-18

Service de santé publique et économie de la santé, groupe hospitalier Lariboisière Fernand-Widal, assistance publique des hôpitaux de Paris (AP-HP), 2 rue Ambroise Paré, 75475 Paris cedex 10, France.

Physical activity and sports are considered as one of the determinants of health. The aim of this study is to review the rationale for the formulation of this public health issue and its integration in national action plans. The study shows that fourteen national programmes were drafted and implemented between 2001 and 2006 by seven institutions. The research methodology was based on crossing data obtained from semi-directed interviews and documents regarding the design, implementation and follow-up of these programmes. For the conditions of the success, the fourteen actions scored an average of 175.0 +/- 66.9 out of 300%. Public health actors and professionals must be given more opportunities to involve themselves and engage in developing stronger relationships and linkages, in particular with the institutional and community settings. In general, the most invested parts of a programme are the structural and operational aspects of activities. Six significant points surfaced from the study: consideration of drug use as an addictive behaviour; recognition of the psychological stress of professional athletes; acknowledgment of youth as being at high risk for doping behaviour; integration of the concept that physical activity and sports must take the benefit/risk perspective into account; and the necessity to promote health. Through the exchange of numerous local and regional experiences, an optimisation of their synergistic connections was made possible on a continuum extending from "health promotion through physical activity and sports" to "prevention of drug-use and doping behaviours". Professionals have been able to develop actions in the above-mentioned domains across this continuum that have, to date, remained isolated. Proposals are made to strengthen these dynamics. Other health determinants and public health priorities could be investigated with the same methodology.
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http://dx.doi.org/10.3917/spub.091.0101DOI Listing
July 2009

[What prevention programmes and which organizations are needed to support healthy ageing?].

Sante Publique 2008 Sep-Oct;20(5):475-87

Service de santé publique et économie de la santé, groupe hospitalier Lariboisière Fernand-Widal, assistance publique des hôpitaux de Paris (AP-HP), 2 rue Ambroise Paré, 75475 Paris cedex 10, France.

Physical activity and exercise are recognized as one of the determinants of health. This study aims to produce a review of the logical foundations at work that support the identification of a public health problem for this determinant and how to address it through national action. The research is based on cross-analysis of data from semi-directed interviews and data extracted from documents on the development, implementation and follow-up of such actions and programmes. The study shows that fourteen national programmes were created and implemented by seven different agencies. These fourteen activities scored an average of 175 +/- 66.9 out of 300%. Actors and professionals in the field must be given more capacity to be implicated and involved while simultaneously encouraging the strengthening of relationships with their environment, in particular the institutional and organizational settings as well as the community components. In general, the structural and operational aspects of action are those which receive the most investment in such activities. Six main points arose as important: doping considered as a addictive mechanism, acknowledgement of the psychological suffering of professional athletes, youth at high risk of doping, and that the concepts of physical activity and sports should take into account a risk/ benefit analysis and the necessity to first and foremost promote health. The act of sharing and exchanging a number of experiences, at the local and regional level, resulted in the identification of synergies between these experiences on a continuum from "health promotion through physical activity and sports" to "prevention of doping". Within this framework, professionals were able to develop activities in the aforementioned domains, which until now had remained isolated and marginal. Recommendations were made to reinforce and strengthen this dynamic. Other determinants of health and public health priorities could be explored using the same methodology.
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http://dx.doi.org/10.3917/spub.085.0475DOI Listing
March 2009

Update of nutrient-deficiency anemia in elderly patients.

Eur J Intern Med 2008 Nov 14;19(7):488-93. Epub 2008 Mar 14.

Department of Internal Medicine, University Hospital of Strasbourg, Strasbourg, France.

Anemia, defined as a hemoglobin level < 13 g/dL in men and < 12 g/dL in women, is an important healthcare concern among the elderly. Nutrient-deficiency anemia represents one third of all anemias in elderly patients. About two thirds of nutrient-deficiency anemia is associated with iron deficiency and most of those cases are the result of chronic blood loss from gastrointestinal lesions. The remaining cases of nutrient-deficiency anemia are usually associated with vitamin B12, most frequently related to food-cobalamin malabsorption, and/or folate deficiency and are easily treated (nutrient-deficiency replacement).
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http://dx.doi.org/10.1016/j.ejim.2008.01.016DOI Listing
November 2008

[Food-cobalamin syndrome].

Presse Med 2009 Jan 5;38(1):55-62. Epub 2008 Nov 5.

Service de médecine interne, diabète et maladies métaboliques, Clinique médicale B, Hôpitaux universitaires de Strasbourg, F-67091 Strasbourg, France.

Food-cobalamin malabsorption is a new well-characterized syndrome. In association with pernicious anemia, it is the leading etiology of cobalamin deficiency in adult, especially in elderly patient. Currently, it is an exclusion diagnosis that requires a well-codified clinical strategy for diagnosis. There are several causes of food-cobalamin malabsorption, mainly gastric disorders and drugs (metformin and anti-acid drugs). Current treatment modality includes oral cobalamin administration with lower doses than in pernicious anemia. Studies are in the way to better characterize the food-cobalamin malabsorption in a clinical practice perspective and to validate the usefulness of oral cobalamin therapy.
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http://dx.doi.org/10.1016/j.lpm.2008.09.017DOI Listing
January 2009