Cyril Ferdynus | La Reunion (original) (raw)

Papers by Cyril Ferdynus

Cahiers de géographie du Québec, 2000

... Jennifer.Zeitlin@inserm.fr. Résumé. ... 29 SA), des études montrent que les chances de survie... more ... Jennifer.Zeitlin@inserm.fr. Résumé. ... 29 SA), des études montrent que les chances de survie de l'enfant augmentent lorsque l'accouchement a lieu dans un établissement équipé d'un service de soins intensifs néonatals (Phibbs et al., 2007), des recherches menées en Finlande ...

Administrative health databases such as the French National Heath Insurance Database - SNIIRAM - ... more Administrative health databases such as the French National Heath Insurance Database - SNIIRAM - are a major tool to answer numerous public health research questions. However the use of such data requires complex and time-consuming data management. Our objective was to develop and make available a tool to optimize cohort constitution within administrative health databases.

We developed a process to extract, transform and load (ETL) data from various heterogeneous sources in a standardized data warehouse. This data warehouse is architected as a star schema corresponding to an i2b2 star schema model. We then evaluated the performance of this ETL using data from a pharmacoepidemiology research project conducted in the SNIIRAM database.

The ETL we developed comprises a set of functionalities for creating SAS scripts. Data can be integrated into a standardized data warehouse. As part of the performance assessment of this ETL, we achieved integration of a dataset from the SNIIRAM comprising more than 900 million lines in less than three hours using a desktop computer. This enables patient selection from the standardized data warehouse within seconds of the request.

The ETL described in this paper provides a tool which is effective and compatible with all administrative health databases, without requiring complex database servers. This tool should simplify cohort constitution in health databases; the standardization of warehouse data facilitates collaborative work between research teams.

Les pays en développement sont confrontés à des ressources financières et humaines limitées malgr... more Les pays en développement sont confrontés à des ressources financières et humaines limitées malgré les besoins importants et les défis de santé multiples. Plus de 75 % des personnes atteintes de diabète dans le monde vivent dans des pays en développement. En Afrique, le nombre de personnes atteintes de diabète devrait doubler dans les 30 prochaines années. Les défis à relever pour offrir une éducation visant à permettre aux personnes souffrant d’une condition chronique de la gérer eux-mêmes se situent à trois niveaux : les patients, les prestataires de soins et les systèmes de santé. Au Mali, après le développement de capacités de prise en charge des patients diabétiques en centres de santé à partir de 2001 à Bamako et dans les capitales régionales, la question du soutien éducatif dans un contexte de ressources limitées s’est donc posée. Pour tenir compte de ce cadre complexe, l’appui à un réseau de pairs éducateurs formés à des cycles d’éducation de groupe structurés, en lien avec le suivi médical, a été mis en place à partir de 2009. Nous rapportons ici les résultats encourageants de ces actions en termes de faisabilité, d’efficacité en terme clinico-biologique.

Abstract : In developing countries, financial and human resources are limited despite serious needs and multiple health challenges. More than three-quarters of the people with diabetes worldwide live in developing countries. The number of people with diabetes in Africa is expected to double in the next 30 years. The challenges involved in providing education to enable people to self-manage their chronic condition exist at three levels: patients, healthcare providers, healthcare systems. In Mali, actions have been taken from 2001 in order to strengthen diabetes management in primary health structures in Bamako and main regional towns. To take into account the question of patient education and support in this complex context, a peer educators’ network was initiated and developed from 2009. We report here the results of this encouraging experience in terms of feasibility and efficacy.
Médecine des Maladies Métaboliques 10(2):167-171 · March 2016

Mycoses, 2016

Onychomycosis is a common nail disorder mainly due to dermatophytes for which the conventional di... more Onychomycosis is a common nail disorder mainly due to dermatophytes for which the conventional diagnosis requires direct microscopic observation and culture of a biological sample. Nevertheless, antifungal treatments are commonly prescribed without a mycological examination having been performed, partly because of the slow growth of dermatophytes. Therefore, molecular biology has been applied to this pathology, to support a quick and accurate distinction between onychomycosis and other nail damage. Commercial kits are now available from several companies for improving traditional microbiological diagnosis. In this paper, we present the first evaluation of the real-time PCR kit marketed by Bio Evolution for the diagnosis of dermatophytosis. Secondly, we compare the efficacy of the kit on optimal and non-optimal samples. This study was conducted on 180 nails samples, processed by conventional methods and retrospectively analysed using this kit. According to our results, this molecular kit has shown high specificity and sensitivity in detecting dermatophytes, regardless of sample quality. On the other hand, and as expected, optimal samples allowed the identification of a higher number of dermatophytes by conventional mycological diagnosis, compared to non-optimal samples. Finally, we have suggested several strategies for the practical use of such a kit in a medical laboratory for quick pathogen detection.

Revue d'Épidémiologie et de Santé Publique, 2014

Journal of Pediatric Urology, 2015

One of the main challenges in proximal hypospadias repair is correcting curvature. The best techn... more One of the main challenges in proximal hypospadias repair is correcting curvature. The best technique to achieve this remains the object of debate. Indeed, some authors believe the urethral plate should be kept and used as often as possible. In some cases, however, even after extensive mobilization and dorsal plication, significant curvature remains and it is necessary to transect the urethral plate. Having a reliable pre-dissection marker of the need for urethral transection would be useful in choosing a technique.We wanted to determine if presence of marked separation of the scrotal sac (SSS), also referred to as bifid scrotum, could reliably predict the need for urethral plate transection. We prospectively enrolled a series of boys with proximal hypospadias. We noted age, degree of hypospadias, meatal position, presence of cryptorchidism, and presence or absence of SSS. During surgery we fully degloved the penile shaft, freeing all ventral tissues, and radically dissected the more proximal bulbar urethra. We then performed an erection test. If there was residual curvature <30° we performed a dorsal plication, if it was >30° we transected the urethral plate. Twenty-nine patients were included, of whom 18 presented SSS. The average age was comparable in both groups, as was type of hypospadias and meatal position. We estimated transection of the urethral plate to be necessary in 15 out of the 18 children with SSS, and 2 out of the 11 children without SSS. The relative risk for requiring urethral plate transection in case of SSS in this series was 4.58. Techniques that commit to urethral plate transection are criticized because they preclude using the urethral plate. In our study presence of SSS was predictive for the need to transect the plate. Obviously one can decide to keep the urethral plate at all cost, and mobilize it more than we did, or accept more residual curvature, but in reality our aim was to determine a preoperative marker allowing us to define a patient category. We believe presence of SSS is a marker of severity, and that this "severity" translates into "a less usable urethra". As recent studies caution us about the evolution of the reconstructed native urethra and the possibility that it may not grow as well as the other penile tissues, we believe this extra information could influence the surgeon's decision as to the most appropriate technique for each patient.

Annals of Intensive Care, 2015

High-frequency oscillatory ventilation (HFOV) does not improve the prognosis of ARDS patients des... more High-frequency oscillatory ventilation (HFOV) does not improve the prognosis of ARDS patients despite an improvement in oxygenation. This paradox may partly be explained by HFOV hemodynamic side-effects on right ventricular function. Our goal was to study the link between HFOV and hemodynamic effects and to test if the pre-HFOV right over left ventricular end-diastolic area (RVEDA/LVEDA) ratio, as a simple parameter of afterload-related RV dysfunction, could be used to predict HFOV hemodynamic intolerance in patients with severe ARDS. Twenty-four patients were studied just before and within 3 h of HFOV using transthoracic echocardiography and transpulmonary thermodilution. Before HFOV, the mean PaO2/FiO2 ratio was 89 ± 23. The number of patients with a RVEDA/LVEDA ratio &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.6 significantly increased after HFOV [11 (46 %) vs. 17 (71 %)]. Although HFOV did not significantly decrease the arterial pressure (systolic, diastolic, mean and pulse pressure), it significantly decreased the cardiac index (CI) by 13 ± 18 % and significantly increased the RVEDA/LVEDA ratio by 14 ± 11 %. A significant correlation was observed between pre-HFOV RVEDA/LVEDA ratio and CI diminution after HFOV (r = 0.78; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). A RVEDA/LVEDA ratio superior to 0.6 resulted in a CI decrease &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;15 % during HFOV with a sensitivity of 80 % (95 % confidence interval 44-98 %) and a specificity of 79 % (confidence interval 49-95 %). The RVEDA/LVEDA ratio measured just before HFOV predicts the hemodynamic intolerance of this technique in patients with severe ARDS. A high ratio under CMV raises questions about the use of HFOV in such patients. ClinicalTrials.gov: NCT01167621.

Critical Care Medicine, 2015

Although stress cardiomyopathy has been described in association with epilepsy, its frequency in ... more Although stress cardiomyopathy has been described in association with epilepsy, its frequency in patients with convulsive status epilepticus remains unknown. Accordingly, we sought to determine the prevalence and risk factors of stress cardiomyopathy in patients admitted to the ICU for convulsive status epilepticus. Prospective, descriptive, single-center study. Medical-surgical ICU of a teaching hospital. Thirty-two consecutive ventilated patients (21 men; age, 50 ± 18 yr; Simplified Acute Physiology Score II, 53 ± 15; Sequential Organ Failure Assessment, 6 ± 2) hospitalized in the ICU for convulsive status epilepticus. None. Hemodynamic parameters, transthoracic echocardiography, biological data, and electrocardiogram were obtained serially on ICU admission (H0), and after 6, 12, 24, and 48 hours of hospitalization (H6, H12, H24, and H48). Stress cardiomyopathy was defined as a 20% decrease in left ventricular ejection fraction between H0 or H6 and H48. Stress cardiomyopathy was diagnosed in 18 patients (56%; 95% CI, 38-74%). Mean left ventricular ejection fraction, left ventricular stroke index and cardiac index were initially (at H0 or H6 according to lowest individual values) significantly reduced in stress cardiomyopathy patients (45 ± 14% vs 61 ± 6%, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001; 24 ± 8 vs 28 ± 8 mL/m, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05; 2.3 ± 0.7 vs 3.0 ± 0.8 L/min/m, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05, respectively) and increased secondarily to reach similar mean values than those observed in patients without transient left ventricular dysfunction at H24. Dobutamine was more frequently used in patients with stress cardiomyopathy. Mean lactate level was increased and significantly higher in stress cardiomyopathy patients at H0 and H6, whereas mean central venous oxygen saturation was preserved but significantly lower in this group. Only three patients with stress cardiomyopathy had left ventricular regional wall motion abnormalities but normal coronary angiography. Risk factors of stress cardiomyopathy were age and Simplified Acute Physiology Score II. These results suggest that stress cardiomyopathy is common in patients admitted to the ICU for convulsive status epilepticus. Accordingly, these patients should be screened for stress cardiomyopathy and monitored if they present with hemodynamic compromise.

Journal of Clinical Pharmacy and Therapeutics

What is known and objectiveThe risk of dosage Prescription Medication Error (PME) among manually ... more What is known and objectiveThe risk of dosage Prescription Medication Error (PME) among manually written prescriptions within ‘mixed’ prescribing system (computerized physician order entry (CPOE) + manual prescriptions) has not been previously assessed in neonatology. This study aimed to evaluate the rate of dosage PME related to manual prescriptions in the high-risk population of very preterm infants (GA < 33 weeks) in a mixed prescription system.Methods The study was based on a retrospective review of a random sample of manual daily prescriptions in two neonatal intensive care units (NICU) A and B, located in different French University hospitals (Dijon and La Reunion island). Daily prescription was defined as the set of all drugs manually prescribed on a single day for one patient. Dosage error was defined as a deviation of at least ±10% from the weight-appropriate recommended dose.Results and discussionThe analyses were based on the assessment of 676 manually prescribed drugs...

Journal of pediatric urology

INTRODUCTION: Postnatal management of prenatally detected hydronephrosis remains controversial. I... more INTRODUCTION: Postnatal management of prenatally detected hydronephrosis remains controversial. It has been suggested that cortical transit time (CTT) could successfully predict deterioration in children with pelvi-ureteric junction (PUJ) obstruction. We decided to conduct a retrospective study in our hydronephrosis population to evaluate whether initial CTT was significantly correlated with the need for surgery. PATIENTS AND METHOD: We reviewed the charts of all our patients managed for significant PUJ obstruction (>12 mm) between 2007 and 2010 and determined CTT retrospectively, on the first diuretic scan of each of these patients. We then determined the relationship between initial CTT and the need for surgery. RESULTS: We identified 37 patients with hydronephrosis (pelvic size >12 mm) of which 26 were diagnosed prenatally. Out of 22 patients with an initial abnormal CTT, 20 underwent surgery. Out of 15 children with a normal initial CTT, 4 underwent surgery (OR 27.5 (IC95%...

Anesthésie & Réanimation, 2015

BMC Infectious Diseases

Aim of this study was to provide a detailed description of a Methicillin-resistant Staphylococcus... more Aim of this study was to provide a detailed description of a Methicillin-resistant Staphylococcus aureus (MRSA) outbreak management strategy in the neonatal intensive care unit of a university hospital. This was a retrospective, "before-after" study, over two consecutive 18-month periods. The outbreak management strategy was performed by a multidisciplinary team and included: extensive healthcare workers (HCW) involvement, education, continuous hand-hygiene training and active MRSA colonization surveillance. The actions implemented were identified based on an anonymous, voluntary, reporting system, carried out among all the HCW, and regular audit and feedback were provided to the nursing staff.The main measured outcome was the rate of MRSA infections before and after the implementation of the outbreak management strategy. Piecewise linear Poisson regression was performed and the model adjusted for confounding variables. The secondary outcome was the rate of laboratory-conf...

Archives of Disease in Childhood - Fetal and Neonatal Edition

BACKGROUND: We observed two preterm infants who developed severe hypokalaemia following doxapram.... more BACKGROUND: We observed two preterm infants who developed severe hypokalaemia following doxapram. We therefore wished to review the possible association between doxapram and severe hypokalaemia. STUDY DESIGN: A retrospective study of preterm infants born before 32 weeks of gestation and hospitalised in our intensive care unit in 2004. For each infant, treatment with doxapram or with any drug known to interfere with potassium metabolism, potassium intakes and episodes of hypokalaemia have been recorded. RESULTS: Out of 105 infants, 54 received doxapram. Doxapram-treated infants were significantly younger and had a lower birth weight. Doxapram treated infants were more likely to receive caffeine, furosemide, insulin and mechanical ventilation. There was no difference between the two groups for the other parameters. Hypokalaemia was frequently encountered in our population since it occurred in 76% of enrolled patients and severe hypokalaemia (potassium plasma level below 3 mmol/l) was ...

Breast Cancer Research and Treatment

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Archives de Pédiatrie

Intrauterine growth restriction indicates that a fetus is unable to achieve its growth potential.... more Intrauterine growth restriction indicates that a fetus is unable to achieve its growth potential. The individual growth potential is approximated by customization of growth charts. Neonatal growth charts rely on body weight measures at birth while fetal growth charts rely on body weight estimated from biometric measurements of the fetus. The neonatal and fetal growth charts are not equivalent and have different meanings for epidemiologists and clinicians. Fetal growth charts also assess fetal growth velocity, but individual assessment of fetal weight may be flawed by lack of precision. Neonatal charts are constructed based on data obtained in the whole population or in a subgroup without gestational diseases. The two types of neonatal charts markedly differ at low gestational ages as 30% of preterm infants present intrauterine growth restriction, usually due to maternal diseases. Even if intrauterine growth restriction is a risk factor of fetal mortality, neonatal mortality, and sho...

Health & Place

Maternity unit closures in France have increased travel time for pregnant women in rural areas. W... more Maternity unit closures in France have increased travel time for pregnant women in rural areas. We assessed the impact of travel time to the closest unit on perinatal outcomes and care in Burgundy using multilevel analyses of data on deliveries from 2000 to 2009. A travel time of 30min or more increased risks of fetal heart rate anomalies, meconium-stained amniotic fluid, out-of-hospital births, and pregnancy hospitalizations; a positive but non-significant gradient existed between travel time and perinatal mortality. The effects of long travel distances on perinatal outcomes and care should be factored into closure decisions.

Pharmacoepidemiology and Drug Safety

PurposeSeveral studies have been conducted to estimate persistence to hormonal therapy among wome... more PurposeSeveral studies have been conducted to estimate persistence to hormonal therapy among women with breast cancer (BC). Most studies focus on first treatment discontinuation. Patients, however, can have numerous periods of treatment discontinuation or treatment exposure.Our objective is to estimate persistence to tamoxifen in patients with BC while accounting for temporary treatment discontinuations and this by using multi-state (MS) models.MethodsA cohort of 10,806 women with BC having received at least one prescription of tamoxifen between 1998 and 2008 was constituted from the UK General Practice Research Database. We fitted a semi-Markov model with three states to estimate the probability of being off treatment over a 5-year period while accounting for temporary treatment discontinuations (transition between on treatment and off treatment) and competing risks (recurrence of BC or death).ResultsNon-persistence, as estimated from the MS model, ranged from 12.1% (95% confidence...