Interstitial Lung Disease during ANCA-Associated Vasculitis: A Poor-Prognosis Factor

IF 7.873; International audience

Should mild hypogammaglobulinemia be managed as severe hypogammaglobulinemia? A study of 389 patients with secondary hypogammaglobulinemia.

Although secondary hypogammaglobulinemia is more frequent than primary hypogammaglobulinemia, its etiology and management are poorly described, particularly for mild hypogammaglobulinemia.This retrospective observational study included all adult patients with a gammaglobulin level6.4g/L on serum electrophoresis identified at Dijon teaching hospital between April and September 2012. Clinico-biological features, etiologies and infectious complications were collected at inclusion and compared between group 1 (gammaglobulin5g/L, severe hypogammaglobulinemia), and group 2 (gammaglobulin6.4 and ≥5g/L, mild hypogammaglobulinemia).Among the 4011 serum electrophoreses, 570 samples from 389 patients …

Performances diagnostiques de l’IRM des sacro-iliaques et du rachis pour le diagnostic de spondyloarthrite axiale non radiographique chez des patients avec rachialgies inflammatoires chroniques

Resume Objectif Le manque de specificite des criteres IRM de l’ASAS pour la spondylarthrite axiale non radiographique (SpA ax NR) justifie d’evaluer la capacite discriminante d’autres anomalies IRM au niveau des sacro-iliaques (SI) et du rachis. Methodes Chez des patients hospitalises pour lombalgies inflammatoires, les performances diagnostiques (sensibilite, specificite, rapport de vraisemblance positif (RVP)) des anomalies IRM ont ete calculees en prenant l’avis d’experts rhumatologues comme reference : (i) sacro-iliaques : œdeme (nombre et localisation), œdeme etendu > 1 cm (deep lesion), metaplasie graisseuse (nombre), erosion (nombre et localisation), backfill ; (ii) rachis dorso-lomb…

The concept of a surrogate is ill adapted to intensive care: Criteria for recognizing a reference person

IF 2.445; International audience; Purpose: In the intensive care unit (ICU), caregivers may find it difficult to identify a suitable person in the patient's entourage to serve as a reference when there is no official surrogate.Methods: We developed a 12-item questionnaire to identify factors potentially important for caregivers when identifying a reference person. Each criterion was evaluated as regards its importance for the role of reference. Responses were on a scale of 0 (not important) to 10 (extremely important). We recorded respondent's age, job title, and number of years' ICU experience. The questionnaire was distributed to all health care professionals in 2 French ICUs.Results: Amo…

Recurrent Encephalopathy Induced by Metformin in an Elderly Man

Cardiovascular outcomes after cardiac resynchronization therapy in cardiac amyloidosis

Abstract Aims Cardiac resynchronization therapy (CRT) is highly effective in dilated cardiomyopathy (DCM) patients with impaired left ventricular ejection fraction (LVEF) and left bundle block branch. In cardiac amyloidosis (CA) patients, left ventricular dysfunction and conduction defects are common, but the potential of CRT to improve cardiac remodelling and survival in this particular setting remains undefined. We investigated cardiovascular outcomes in CA patients after CRT implantation in terms of CRT echocardiographic response and major cardiovascular events (MACEs). Methods and results Our retrospective study included 47 CA patients implanted with CRT devices from January 2012 to Feb…

Étude qualitative par entretiens individuels des conséquences des myopathies inflammatoires sur la qualité de vie

Introduction La survenue d’une myopathie inflammatoire engendre un bouleversement majeur de la vie quotidienne des patients, notamment du fait de la diminution des capacites fonctionnelles liees a l’atteinte musculaire. Les consequences psychologiques et socioprofessionnelles des myopathies inflammatoires sont importantes mais restent actuellement sous-evaluees. Les outils d’evaluation de la qualite de vie utilisables au cours des myopathies inflammatoires sont rares, generiques mais non specifiques et ne permettent pas d’approcher exhaustivement les problematiques des patients. Cette etude qualitative a donc ete menee dans le but d’identifier les determinants du retentissement des myopathi…

Construction of quality of life change patterns: example in oncology in a phase III therapeutic trial (FFCD 0307)

Objective Quality of life data in cancerology are often difficult to summarize due to missing data and difficulty to analyze the pattern of evolution in different groups of patients. The aim of this work was to apply a new methodology to construct Quality of Life (QoL) change patterns within patients included in a clinical trial comparing to regimen of treatment in locally advanced eosogastric cancer. Materials and methods In this trial, QoL was assessed every 2 months by self-reported EORTC QLQ-C30 questionnaire. Physical dimension scores were analyzed. After multiple imputation of missing data, 27 statistical measures aiming to describe the variation of QoL measures among follow-up were c…

Identification of resources and skills developed by partners of patients with advanced colon cancer: a qualitative study

National audience; Les aidants familiaux jouent un rôle central auprès des patients présentant un cancer de stade avancé. Parmi les proches susceptibles d’apporter une aide aux personnes malades, les conjoints, en raison des liens qui les unissent et parce qu’ils partagent leur vie quotidienne, sont sans doute les plus confrontés à la maladie. Ils sont également majoritairement désignés comme étant l’aidant principal. L’irruption de la maladie et le besoin d’accompagnement qu’elle nécessite, viennent bouleverser en profondeur les différents équilibres structurant leur quotidien et leur organisation. Ils viennent aussi questionner la nature des relations qu’ils entretiennent, dans une divers…

Stroke associated with giant cell arteritis: a population-based study

Background Giant cell arteritis (GCA) is the most common vasculitis in people ≥50 years and can be associated with stroke. We aimed to evaluate the epidemiology and characteristics of stroke in patients with GCA. Methods All patients with a biopsy-proven diagnosis of GCA were identified among residents of the city of Dijon, France (152 000 inhabitants), between 2001 and 2012 using a prospective database. Among these, patients who suffered from stroke were retrieved by crossing data from the population-based Dijon Stroke Registry. Demographics and clinical features were recorded. We considered that the stroke was GCA-related if the stroke revealed GCA or occurred between the onset of symptom…

Giant cell arteritis (Horton's disease) in very elderly patients aged 80 years and older: A study of 25 cases

Aim Analysis of the characteristics of very elderly patients with giant cell arteritis (GCA). Methods Patients aged 80 years and older diagnosed with GCA in our department between 1 January 2002 and 31 July 2008 were retrospectively included. For each patient, we recorded general characteristics, reason(s) for hospitalization, specialty of the physician or department that referred the patient to us, medical history, treatment at admission, GCA clinical features, time to diagnosis of GCA, biological screening and GCA treatment. Results We analyzed 25 clinical records, 18 women and seven men with a mean age of 83.9 years. General weakness, visual loss and inflammatory syndrome were the princi…

Tocilizumab en association à la prednisone au cours des 3 premiers mois de traitement de l’artérite à cellules géantes : résultats d’une étude prospective, multicentrique de phase II (PHRC National HORTOCI)

Introduction L’arterite a cellules geantes (ACG) est une vascularite des gros vaisseaux habituellement traitee par corticoides. Ce traitement est remarquablement efficace mais doit etre donne a forte dose pendant 12 a 24 mois, ce qui est responsable d’une importante morbi-mortalite dans cette population âgee. Le tocilizumab (TCZ) est un anticorps monoclonal humanise dirige contre les recepteurs (soluble et membranaire) de l’interleukine-6 (IL-6). Son efficacite a recemment ete montree au cours du traitement de l’ACG [1] . Cependant, les donnees concernant l’evolution apres l’arret du TCZ manquaient dans cet essai therapeutique. De plus, la duree optimale de ce traitement couteux n’est pas c…

L’échographie des ongles dans le rhumatisme psoriasique : étude pilote sur la faisabilité, la reproductibilité et la validité de mesure

Resume Objectif Etude de la faisabilite, de la reproductibilite et de la validite externe versus criteres de reference des parametres echographiques de l’ongle dans le rhumatisme psoriasique. Methodes Etude pilote prospective monocentrique sur huit parametres echographiques en mode B et doppler puissance portant sur l’interphalangienne distale (IPD), la matrice, le lit et la tablette ungueale. La reproductibilite intra-observateur et inter-observateur a ete evaluee pour les sept parametres quantitatifs (ICC et kappa). La recherche de correlations entre les variables echographiques et cliniques a permis d’estimer la validite externe. La faisabilite a ete appreciee par le temps d’examen et le…

French validation of the Stroke Specific Quality of Life Scale (SS-QoL).

To adapt the SS-QoL into French and test its psychometric properties.Seventy-seven patients from a population-based registry were enrolled 3 months after their stroke. SS-QoL, NIHSS score, Barthel index, HAD, FSS, SF-36 scales, and MMSE were administered at enrolment. SS-QoL was re-administered at 15 days and 2 months. Internal consistency was assessed by Cronbach's α coefficients, factorial validity by an exploratory factor analysis and external validity by Mann-Whitney test and Spearman's correlations (ρ), comparing SS-QoL scores with those obtained from established scales. Reliability was assessed by intra-class correlation coefficients (ICC) and responsiveness by standardized effect siz…

What are the characteristics that lead physicians to perceive an ICU stay as non-beneficial for the patient?

Purpose We sought to describe the characteristics that lead physicians to perceive a stay in the intensive care unit (ICU) as being non-beneficial for the patient. Materials and methods In the first step, we used a multidisciplinary focus group to define the characteristics that lead physicians to consider a stay in the ICU as non-beneficial for the patient. In the second step, we assessed the proportion of admissions that would be perceived by the ICU physicians as non-beneficial for the patient according to our focus group’s definition, in a large population of ICU admissions in 4 French ICUs over a period of 4 months. Results Among 1075 patients admitted to participating ICUs during the …

Factors Associated with Specific Quality of Life Evolution in SLE Patients: A French Prospective Longitudinal Multicenter Study

IF 7.879; International audience

Criteria deemed important by the relatives for designating a reference person for patients hospitalized in ICU

Abstract Purpose We investigated the criteria that patients' relatives deem important for choosing, among themselves, the person best qualified to interact with the caregiving staff. Methods Exploratory, observational, prospective, multicentre study between 1st March and 31st October 2018 in 2 intensive care units (ICUs). A 12-item questionnaire was completed anonymously by family members of patients hospitalized in the ICU 3 and 5 days after the patient's admission. Relatives were eligible if they understood French and if no surrogate had been appointed by the patient prior to ICU admission. More than one relative per patient could participate. Results In total, 87 relatives of 73 patients…

Reliability, validity and feasibility of nail ultrasonography in psoriatic arthritis

International audience; Objective: To determine the feasibility, reliability and validity of nails ultrasonography in psoriatic arthritis as an outcome measure.Methods: Pilot prospective single-centre study of eight ultrasonography parameters in B mode and power Doppler concerning the distal interphalangeal (DIP) joint, the matrix, the bed and nail plate. Intraobserver and inter-observer reliability was evaluated for the seven quantitative parameters (ICC and kappa). Correlations between ultrasonography and clinical variables were searched to assess external validity. Feasibility was assessed by the time to carry out the examination and the percentage of missing data.Results: Twenty-seven p…

Tocilizumab induces corticosteroid sparing in rheumatoid arthritis patients in clinical practice

International audience; Objective. The aim of this study was to evaluate the impact of introducing tocilizumab (TCZ) as co-therapy with CS in patients with RA.Methods. This study was an open, observational, retrospective multicentre study. RA patients treated with oral CS for >3 months who started treatment with TCZ between December 2009 and June 2011 in five centres were included. Variables included demographic data, disease history, co-treatments, disease activity and dose of CS at inclusion and at weeks 4, 8, 12 and 24. The evolution of disease activity and of the dose of CS (analysis of variance with repeated measures) were analysed, searching for factors correlated with changes in the …

The usefulness of NEWS2 at day 7 of hospitalization in predicting COVID-19 evolution and as an early endpoint in therapeutic trials

Highlights • There is a need for reliable tools to predict the evolution of hospitalized patients suffering from COVID-19 • The likelihood of unfavourable evolution for patients hospitalized for COVID-19 with a National • Early Warning Score 2 (NEWS2) below 7 at Day 7 of hospitalization is nearly non-existent • Such a score could thus be used to allow earlier discharge of the patients and as a judgement criterion in therapeutic trials

The caregiver/patient relationship at the heart of health : A qualitative study

National audience

Is there a need to widely prescribe antibiotics in patients hospitalized with COVID-19?

Highlights • Antibiotics were a main part of COVID-19 treatments during the first epidemic peak. • Bacterial coinfections seem to be rare, especially if no ICU transfer needed. • We studied the place of antibiotics and the impact on prognosis of patients. • Antibiotics were prescribed if more severe infection and has no impact on prognosis. • We think that antibiotic therapy must be not widely prescribed.