Background: Diagnosing stroke in dizzy patients remains a challenge in emergency medicine. The accuracy of the neuroophthalmologic examination HINTS performed by emergency physicians (EPs) is unknown. Our objective was to determine the accuracy of the HINTS examination performed by trained EPs for diagnosing central cause of acute vertigo and unsteadiness and to compare it with another bedside clinical tool, STANDING, and with the history-based score ABCD2. Methods: This was a prospective diagnostic cohort study among patients with isolated vertigo and unsteadiness seen in a single emergency department (ED). Trained EPs performed HINTS and STANDING tests blinded to attending physicians. ABCD2 ≥ 4 was used as the threshold and was calculated retrospectively. The criterion standard was diffusion-weighted brain magnetic resonance imaging (MRI). Peripheral diagnoses were established by a normal MRI, and etiologies were further refined by an otologic examination. Results:We included 300 patients of whom 62 had a central lesion on neuroimaging including 49 strokes (79%). Of the 238 peripheral diagnoses, 159 were vestibulopathies, mainly benign paroxysmal positional vertigo (40%). HINTS and STANDING tests reached high sensitivities at 97% and 94% and NPVs at 99% and 98%, respectively.The ABCD2 score failed to predict half of central vertigo cases and had a sensitivity of 55% and a NPV of 87%. The STANDING test was more specific and had a better positive predictive value (PPV; 75% and 49%, respectively; positive likelihood ratio [LR+] = 3.71, negative likelihood ratio [LR-] = 0.09) than the HINTS test (67% and 44%, respectively; LR+ = 2.96, LR-= 0.04). The ABCD2 score was specific (82%, LR+ = 3.04, LR-= 0.56) but had a very low PPV (44%). Conclusions: In the hands of EPs, HINTS and STANDING tests outperformed ABCD2 in identifying central causes of vertigo. For diagnosing peripheral disorders, the | 1369 GERLIER Et aL.

BackgroundCOVID-19-related Acute Respiratory Distress Syndrome (CARDS) is the severe evolution of the Sars-Cov-2 infection leading to an intensive care unit (ICU) stay. Its onset is associated with “long-covid” including persisting respiratory disorders up to one year. Rehabilitation is suggested by most guidelines in the treatment of “long-covid”. As no randomised controlled trial did support its use in “long-covid” we aimed to evaluate the effects of endurance training rehabilitation (ETR) on dyspnoea in “long-covid” following CARDS.MethodsIn this multicentre, two-arm, parallel, open, assessor-blinded, randomised, controlled trial performed in three French ICU, we enrolled adults previously admitted for CARDS, discharged for at least three months and presenting an mMRC dyspnea scale score > 1. Eligible patients were randomly allocated (1:1) to receive either ETR or standard physiotherapy (SP), both for three months. Outcomes assessors were masked to treatment assignment. Primary outcome was dyspnoea’s evolution, measured by Multidimensional Dyspnea Profile (MDP) at inclusion and after 90 days.ResultsBetween August 7, 2020 and January 26, 2022, 871 COVID-19 patients were screened, of whom 60 were randomly assigned to ETR (n=27) or SP (n=33). Mean MDP score after treatment was significantly lower in the ETR group than in the SP group (26.15 [SD 15.48] vs. 44.76 [SD 19.25]; mean difference -18.61 [95% CI -27.78 to -9.44]; p<0.0001).ConclusionCARDS patients suffering from breathlessness three months after discharge improved their dyspnoea significantly more when treated with ETR for three months rather than with SP.

Background Intradialytic hypotension (IDH), a common complication in hemodialysis (HD) patients, is associated with multiple risk factors including cardiac dysfunction and alterations of the peripheral autonomic nervous system. To what extent dysautonomia may contribute to the occurrence of IHD remains elusive. We sought to investigate the clinical utility of Sudocan®, a device that quantifies dysautonomia, in the prediction of IDH. Methods We conducted a prospective monocentric study in adult HD patients from July 2019 to February 2020. Dysautonomia was assessed by the measurements of hand and foot Electrochemical Skin Conductance (ESC) using Sudocan®, before HD. The primary end point was the incidence of IDH (NKF/K-DOQI definition), according to the presence of a pathological hand and/or foot ESC value, during the 3-month study period. Results A total of 176 HD patients (64 ± 14 years old) were enrolled. Mean pre-dialysis hand and foot ESC were 45 ± 20 µS and 54 ± 22 µS, respectively. Thirty-five and 40% of patients had a pathological ESC at the hand and foot, respectively. IDH occurred in 46 patients. Logistic regression showed that pathologic pre-HD hand ESC was associated with an increased risk of IDH [OR = 2.56, IC95% (1.04-6.67), p = 0.04]. The cumulative risk incidence of IHD during the study was 5.65 [IC95% (2.04-15.71), p = 0.001] and 3.71 [IC95% (1.41-9.76), p = 0.008], with a pathological hand and foot ESC, respectively. Conclusions A pathological hand ESC, as assessed by a non-invasive Sudoscan® test is associated with an increased risk of IDH.

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Précis: The nonpenetrating deep sclerectomy (NPDS) procedure resulted in significantly more surgical success than the standalone XEN gel stent procedure without differences in safety profile. Purpose:The purpose of this study was to compare surgical success and safety profile of NPDS and XEN gel stent.Methods: A retrospective chart review of 328 eyes of 282 patients who were scheduled for standalone XEN gel stent surgery (n = 140) or NPDS (n = 188) at Groupe Hospitalier Paris Saint-Joseph between January 2017 and December 2018 was conducted. Primary outcome measure was the proportion of surgical success 12 months after surgery. Complete and qualified surgical successes were defined by intraocular pressure (IOP) ≤ 18 mm Hg and a reduction of IOP ≥ 20% without or with hypotensive medication, respectively.Results: In total, 82 eyes were included in the XEN group and 124 eyes in the NPDS group. In the 1-eye analysis, rates of "complete success" and "qualified success" were, respectively, at the end of follow-up, 28.57% and 20.00% in the XEN group, and 42.72% and 16.50% in the NPDS group (P = 0.17). Success probability plots based on the Kaplan-Meier estimate for overall surgical success demonstrated a median success probability time of 3.73 years for the NPDS group and 2.38 years for the XEN group (P < 0.0001). After adjustment for confounding variables using Cox regression, the NPDS procedure was significantly more associated with surgical success than the XEN gel stent implantation (P < 0.001). No difference was demonstrated in terms of reduction of antiglaucoma medications, needling procedures, or reoperations. Conclusions:The NPDS procedure may be more effective than the XEN gel stent in reducing IOP in patients with open angle glaucoma and may result in longer surgical success. However, a well-conducted prospective randomized study is required to confirm these results.