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Thizy G, Flahault A, Scemla A, Roux O, Jarraud S, Lebeaux D, Pouchot J, Gautier-Vargas G, Malvezzi P, Murris M, Vuotto F, Girerd S, Pansu N, Antonini T, Elkrief L, Barrou B, Besch C, Blot M, Boignard A, Brenier H, Coilly A, Gouezel C, Hannah K, Housssel-Debry P, Jouan J, Lecuyer H, Limelette A, Luyt CE, Melloni B, Pison C, Rafat C, Rebibou JM, Savier E, Schvartz B, Scatton O, Toure F, Varnous S, Vidal P, Savoye E, Ader F, Lortholary O, Lanternier F, Lafont E. Legionnaires Disease in Solid Organ Transplant Recipients: A Decade-Long Nationwide Study in France. Chest 2024; 165:507-520. [PMID: 37839586 DOI: 10.1016/j.chest.2023.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/05/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Legionnaires disease (LD) is a rare, life-threatening opportunistic bacterial infection that poses a significant risk to patients with impaired cell-mediated immunity such as solid organ transplant recipients. However, the epidemiologic features, clinical presentation, and outcomes of LD in this population are poorly described. RESEARCH QUESTION What are the clinical manifestations, radiologic presentation, risk factors for severity, treatment, and outcome of LD in solid organ transplant recipients? STUDY DESIGN AND METHODS In this 10-year multicenter retrospective cohort study in France, where LD notification is mandatory, patients were identified by hospital discharge databases. Diagnosis of LD relied on positive culture findings from any respiratory sample, positive urinary antigen test (UAT) results, positive specific serologic findings, or a combination thereof. Severe LD was defined as admission to the ICU. RESULTS One hundred one patients from 51 transplantation centers were eligible; 64 patients (63.4%) were kidney transplant recipients. Median time between transplantation and LD was 5.6 years (interquartile range, 1.5-12 years). UAT results were positive in 92% of patients (89/97). Among 31 patients with positive culture findings in respiratory samples, Legionella pneumophila serogroup 1 was identified in 90%. Chest CT imaging showed alveolar consolidation in 98% of patients (54 of 57), ground-glass opacity in 63% of patients (36 of 57), macronodules in 21% of patients (12 of 57), and cavitation in 8.8% of patients (5 of 57). Fifty-seven patients (56%) were hospitalized in the ICU. In multivariate analysis, severe LD was associated with negative UAT findings at presentation (P = .047), lymphopenia (P = .014), respiratory symptoms (P = .010), and pleural effusion (P = .039). The 30-day and 12-month mortality rates were 8% (8 of 101) and 20% (19 of 97), respectively. In multivariate analysis, diabetes mellitus was the only factor associated with 12-month mortality (hazard ratio, 3.2; 95% OR, 1.19-8.64; P = .022). INTERPRETATION LD is a late and severe complication occurring in solid organ transplant recipients that may present as pulmonary nodules on which diabetes impacts its long-term prognosis.
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Affiliation(s)
- Guillaume Thizy
- Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Adrien Flahault
- Service de Néphrologie et Transplantation Rénale, CHRU Nancy-Brabois, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Anne Scemla
- Service de Transplantation Rénale, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Olivier Roux
- Service d'Hépatologie, Hôpital Beaujon, Université Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Clichy, France
| | - Sophie Jarraud
- Centre National de Référence des Légionelles, Institut des Agents Infectieux, Hospices Civils de Lyon, France; Centre International de Recherche en Infectiologie, Inserm 1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Université de Lyon, France
| | - David Lebeaux
- Unité Mobile d'Infectiologie, Service de Microbiologie, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jacques Pouchot
- Service de Médecine Interne, Hôpital Européen Georges Pompidou, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Gabriela Gautier-Vargas
- Service de Néphrologie et Transplantation, Hôpital Civil, CHRU Hautepierre, Université de Strasbourg, Strasbourg, France
| | - Paolo Malvezzi
- Service de Néphrologie, Dialyse, Aphérèses et Transplantation, CHU Grenoble Alpes, Université de Grenoble, la Tronche, France
| | - Marlene Murris
- Service de Pneumologie-Consultation Mucoviscidose, Pôle Voies Respiratoires, CHU de Toulouse-Hôpital Larrey, Université de Toulouse, Toulouse, France
| | - Fanny Vuotto
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Lille, Université de Lille, Lille, France
| | - Sophie Girerd
- Service de Néphrologie et Transplantation Rénale, CHRU Nancy-Brabois, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Nathalie Pansu
- Service de Maladies Infectieuses et Tropicales, CHU Gui de Chauliac, Université de Montpellier, Montpellier, France
| | - Teresa Antonini
- Service d'Hépatologie, Hôpital Universitaire Croix-Rousse, Lyon, France; Cancer Research Center of Lyon, INSERM U1052, Lyon, France
| | - Laure Elkrief
- Service d'Hépatologie, CHRU de Tours, Hôpital Trousseau, Université de Tours, Chambray-lès-Tours, France
| | - Benoit Barrou
- Département d'Urologie, Néphrologie et Transplantation, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Camille Besch
- Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, CHRU Hautepierre, Université de Strasbourg, Strasbourg, France
| | - Mathieu Blot
- Département de Maladies Infectieuses, Centre Hospitalo-Universitaire de Dijon-Bourgogne, Université de Bourgogne, France
| | - Aude Boignard
- Service de Cardiologie, CHU de Grenoble, CHU Grenoble Alpes, Université de Grenoble, Grenoble, France
| | - Henri Brenier
- Service de Néphrologie, Centre Hospitalier Universitaire Pontchaillou, Hôpital Universitaire de Pontchaillou, Université de Rennes, Rennes, France
| | - Audrey Coilly
- Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Université Paris-Saclay, Villejuif, France
| | - Corentin Gouezel
- Service d'Anesthésie et Réanimation de Chirurgie Cardiaque, Hôpital Bichat, Université Paris Cité, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Kaminski Hannah
- Service de Néphrologie, Transplantation Dialyse, Aphérèses, CHU de Bordeaux, Hôpital Pellegrin, Université de Bordeaux, Bordeaux, France
| | - Pauline Housssel-Debry
- Service d'Hépatologie et Transplantation Hépatique, Hôpital Universitaire de Pontchaillou, Université de Rennes, Rennes, France
| | - Jerome Jouan
- Service de Chirurgie Cardiaque, CHU Limoges, Centre Hospitalier et Universitaire de Limoges, Université de Limoges, Limoges, France
| | - Hervé Lecuyer
- Service de Microbiologie Clinique, Hôpital Necker Enfants-Malades, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Anne Limelette
- Laboratoire de Microbiologie, Hôpital Robert Debré, CHU de Reims, Université de Reims, Reims, France
| | - Charles Edouard Luyt
- Médecine Intensive Réanimation, Hôpital Pitié-Salpêtrière, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Boris Melloni
- Service de Pathologie Respiratoire, CHU Limoges, Centre Hospitalier et Universitaire de Limoges, Université de Limoges, Limoges, France
| | - Christophe Pison
- Service de Pneumologie Physiologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, Université de Grenoble, Grenoble, France
| | - Cédric Rafat
- Service de Soins Intensifs Néphrologique et Rein Aigu, Hôpital Tenon, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jean-Michel Rebibou
- Service de Néphrologie, Transplantation Hémodialyse, CHU, Université de Dijon, Dijon, France
| | - Eric Savier
- Service de Chirurgie Digestive et Hépato-Bilio-Pancréatique, Transplantation Hépatique, CHU Pitié-Salpêtriere, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Betoul Schvartz
- Service de Néphrologie, Hémodialyse, Transplantation Rénale, CHU de Reims, Université de Reims, Reims, France
| | - Olivier Scatton
- Service de Chirurgie Digestive Hépato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Fatouma Toure
- Service Néphrologie, CHU Limoges, Centre Hospitalier et Universitaire de Limoges, Université de Limoges, Limoges, France
| | - Shaida Varnous
- Service de Chirurgie Cardiaque et Thoracique, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Pauline Vidal
- Laboratoire de Bactériologie-Hygiène, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Emilie Savoye
- Organ and Tissue Procurement and Transplantation Department, French Biomedicine Agency, Saint Denis La Plaine, France
| | - Florence Ader
- Centre National de Référence des Légionelles, Institut des Agents Infectieux, Hospices Civils de Lyon, France; Centre International de Recherche en Infectiologie, Inserm 1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Université de Lyon, France; Service de Maladies Infectieuses et Tropicales, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Hôpital Universitaire Croix-Rousse, Lyon, France
| | - Olivier Lortholary
- Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Fanny Lanternier
- Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Emmanuel Lafont
- Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
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Senot N, Pouchot J. [A swollen thumb]. Rev Med Interne 2024; 45:114-115. [PMID: 37634973 DOI: 10.1016/j.revmed.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023]
Affiliation(s)
- N Senot
- Service de médecine interne, université Paris-Cité, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
| | - J Pouchot
- Service de médecine interne, université Paris-Cité, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
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Lafont E, Blez D, Bildan MA, Veyer D, Péré H, Puech J, Kably B, Cheminet G, Pouchot J, Thervet E, Peytavin G, Lazareth H. Nirmatrelvir and Ritonavir combination in COVID-19 patients with advanced chronic kidney disease. Clin Infect Dis 2023:ciad785. [PMID: 38159041 DOI: 10.1093/cid/ciad785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- Emmanuel Lafont
- Department of Internal Medicine, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Damien Blez
- Bacteriology Laboratory, Microbiology Department, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc-Antoine Bildan
- Pharmacology Department, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - David Veyer
- Virology Laboratory, Microbiology Department, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- UMR 1137, IAME, Université Paris Cité, Paris, France
- Université Paris Cité, Paris, France
| | - Hélène Péré
- Virology Laboratory, Microbiology Department, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- UMR 1137, IAME, Université Paris Cité, Paris, France
- Université Paris Cité, Paris, France
| | - Julien Puech
- Virology Laboratory, Microbiology Department, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benjamin Kably
- Pharmacology Unit and DMU BIOPHYGEN, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, France; INSERM PARCC UMRS970, Paris, France
| | - Geoffrey Cheminet
- Department of Internal Medicine, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jacques Pouchot
- Department of Internal Medicine, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, Paris, France
| | - Eric Thervet
- Université Paris Cité, Paris, France
- Nephrology Department, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gilles Peytavin
- Université Paris Cité, Paris, France
- Pharmacology Department, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Helene Lazareth
- Université Paris Cité, Paris, France
- Nephrology Department, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
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Espitia O, Bruneval P, Assaraf M, Pouchot J, Liozon E, de Boysson H, Gaudric J, Chiche L, Achouh P, Roussel JC, Miranda S, Mirault T, Boussouar S, Redheuil A, Serfaty JM, Bénichou A, Agard C, Guédon AF, Cacoub P, Paraf F, Fouret PJ, Toquet C, Biard L, Saadoun D. Long-Term Outcome and Prognosis of Noninfectious Thoracic Aortitis. J Am Coll Cardiol 2023; 82:1053-1064. [PMID: 37673506 DOI: 10.1016/j.jacc.2023.06.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/22/2023] [Accepted: 06/12/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Aortitis is a group of disorders characterized by the inflammation of the aorta. The large-vessel vasculitides are the most common causes of aortitis. Aortitis long-term outcomes are not well known. OBJECTIVES The purpose of this study was to assess the long-term outcome and prognosis of noninfectious surgical thoracic aortitis. METHODS This was a retrospective multicenter study of 5,666 patients with thoracic aorta surgery including 217 (3.8%) with noninfectious thoracic aortitis (118 clinically isolated aortitis, 57 giant cells arteritis, 21 Takayasu arteritis, and 21 with various systemic autoimmune disorders). Factors associated with vascular complications and a second vascular procedure were assessed by multivariable analysis. RESULTS Indications for aortic surgery were asymptomatic aneurysm with a critical size (n = 152 [70%]), aortic dissection (n = 28 [13%]), and symptomatic aortic aneurysm (n = 30 [14%]). The 10-year cumulative incidence of vascular complication and second vascular procedure was 82.1% (95% CI: 67.6%-90.6%), and 42.6% (95% CI: 28.4%-56.1%), respectively. Aortic arch aortitis (HR: 2.08; 95% CI: 1.26-3.44; P = 0.005) was independently associated with vascular complications. Descending thoracic aortitis (HR: 2.35; 95% CI: 1.11-4.96; P = 0.031) and aortic dissection (HR: 3.08; 95% CI: 1.61-5.90; P = 0.002) were independently associated with a second vascular procedure, while treatment with statins after aortitis diagnosis (HR: 0.47; 95% CI: 0.24-0.90; P = 0.028) decreased it. After a median follow-up of 3.9 years, 19 (16.1%) clinically isolated aortitis patients developed features of a systemic inflammatory disease and 35 (16%) patients had died. CONCLUSIONS This multicenter study shows that 82% of noninfectious surgical thoracic aortitis patients will experience a vascular complication within 10 years. We pointed out specific characteristics that identified those at highest risk for subsequent vascular complications and second vascular procedures.
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Affiliation(s)
- Olivier Espitia
- Nantes Université, CHU Nantes, Department of Vascular Medicine, Nantes, France; l'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary diseases, Nantes, France.
| | - Patrick Bruneval
- Department of cardiology, Hôpital Européen Georges Pompidou, Paris, France
| | - Morgane Assaraf
- Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire (CEREMAIA), Paris, France; INSERM, UMR_S 959, Paris, France; DMU 3ID, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Jacques Pouchot
- Department of Internal Medicine, Hôpital Européen Georges Pompidou, Paris, France
| | - Eric Liozon
- Department of Internal Medicine, CHU Limoges, France
| | | | - Julien Gaudric
- Department of Vascular Surgery, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Laurent Chiche
- Department of Vascular Surgery, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Paul Achouh
- Department of Cardiothoracic Surgery, Hôpital Européen Georges Pompidou, Paris, France
| | - Jean-Christian Roussel
- Department of Cardiothoracic Surgery, Nantes Université, CHU Nantes, Department of Internal and Vascular Medicine, Nantes, France
| | | | - Tristan Mirault
- Université Paris Cité, Department of Vascular Medicine, Hôpital Européen Georges Pompidou, APHP, INSERM U970 PARCC, Paris, France
| | - Samia Boussouar
- Sorbonne Universités, Pitié-Salpêtrière University Hospital, Department of Cardiovascular Imaging, Paris, France
| | - Alban Redheuil
- Sorbonne Universités, Pitié-Salpêtrière University Hospital, Department of Cardiovascular Imaging, Paris, France
| | - Jean-Michel Serfaty
- Nantes Université, CHU Nantes, Department of Cardiovascular Imaging, Nantes, France
| | - Antoine Bénichou
- Nantes Université, CHU Nantes, Department of Vascular Medicine, Nantes, France; l'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary diseases, Nantes, France
| | - Christian Agard
- Nantes Université, CHU Nantes, Department of Vascular Medicine, Nantes, France; l'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary diseases, Nantes, France
| | - Alexis F Guédon
- Nantes Université, CHU Nantes, Department of Vascular Medicine, Nantes, France; l'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary diseases, Nantes, France
| | - Patrice Cacoub
- Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire (CEREMAIA), Paris, France; INSERM, UMR_S 959, Paris, France; DMU 3ID, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | | | - Pierre-Jean Fouret
- Sorbonne Universités, Pitié-Salpêtrière University Hospital, Service d'anatomopathologie, UPMC-Paris VI, Paris, France
| | - Claire Toquet
- Nantes Université, CHU Nantes, Department of Pathology, Nantes, France
| | - Lucie Biard
- APHP Department of Biostatistics and Medical Information, Saint-Louis Hospital, Paris, France; ECSTRRA Team, CRESS UMR 1153, INSERM, Paris Cité University, Paris, France
| | - David Saadoun
- Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire (CEREMAIA), Paris, France; INSERM, UMR_S 959, Paris, France; DMU 3ID, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
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Derdevet J, Ranque B, Khimoud D, Joseph L, Michon A, Flamarion E, Lafont E, Corbasson A, Pouchot J, Arlet JB, Cheminet G. Efficacy of COVID-19 vaccination in adult patients with sickle cell disease during the Omicron wave in France. Eur J Haematol 2023; 111:509-512. [PMID: 37380177 DOI: 10.1111/ejh.14034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Julien Derdevet
- Internal Medicine Department, French National Sickle Cell Referral Center, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Brigitte Ranque
- Internal Medicine Department, French National Sickle Cell Referral Center, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- Faculty of Medicine, Université Paris Cité, Paris, France
- Université Paris Cité, Inserm UMR-S970, Paris, France
| | - Djamal Khimoud
- Internal Medicine Department, French National Sickle Cell Referral Center, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laure Joseph
- Department of Biotherapy, French National Sickle Cell Disease Referral Center, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Adrien Michon
- Internal Medicine Department, French National Sickle Cell Referral Center, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Edouard Flamarion
- Internal Medicine Department, French National Sickle Cell Referral Center, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuel Lafont
- Internal Medicine Department, French National Sickle Cell Referral Center, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne Corbasson
- Internal Medicine Department, French National Sickle Cell Referral Center, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jacques Pouchot
- Internal Medicine Department, French National Sickle Cell Referral Center, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- Faculty of Medicine, Université Paris Cité, Paris, France
| | - Jean-Benoît Arlet
- Internal Medicine Department, French National Sickle Cell Referral Center, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- Faculty of Medicine, Université Paris Cité, Paris, France
- Laboratoire d'excellence sur le globule rouge GR-ex, Paris, France
- INSERM U1163, CNRS 8254, Institut IMAGINE, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Geoffrey Cheminet
- Internal Medicine Department, French National Sickle Cell Referral Center, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- Faculty of Medicine, Université Paris Cité, Paris, France
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Torres MJ, Coste J, Canouï-Poitrine F, Pouchot J, Rachas A, Carcaillon-Bentata L. Impact of the First COVID-19 Pandemic Wave on Hospitalizations and Deaths Caused by Geriatric Syndromes in France: A Nationwide Study. J Gerontol A Biol Sci Med Sci 2023; 78:1612-1626. [PMID: 36702778 DOI: 10.1093/gerona/glad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The fear of contracting coronavirus disease 2019 (COVID-19) and the preventive measures taken during the health crisis affected both people's lifestyles and the health system. This nationwide study aimed to investigate the impact of the first wave of the COVID-19 pandemic on hospitalizations and mortality related to geriatric syndromes (GS) in older adults in France. METHODS The French National Health Data System was used to compare hospital admissions (excluding the main diagnosis of COVID-19) and mortality rates (using multiple-cause and initial-cause analyses, and both including or excluding confirmed/probable COVID-19) related to 10 different GS (dementia, other cognitive disorders and symptoms, delirium/disorientation, depression, undernutrition/malnutrition, dehydration, pressure ulcer, incontinence, fall/injury and femoral neck fracture) from January to September 2020 to rates observed in previous years. Analyses were stratified by age, sex, place of residence or place of death, and region. RESULTS Hospitalization rates for all GS decreased during the first lockdown compared to the same periods in 2017-19 (from -59% for incontinence to -13% for femoral neck fractures). A dose-response relationship was observed between reduced hospitalizations and COVID-19-related mortality rates. Conversely, for almost all GS studied, excess mortality without COVID-19 was observed during this lockdown compared to 2015-17 (from +74% for delirium/disorientation to +8% for fall/injury), especially in nursing homes and at home. CONCLUSIONS In France, during the first lockdown, a substantial decrease in hospitalizations for GS was accompanied by excess mortality. This decline in the use of services, which persisted beyond lockdown, may have a mid- and long-term impact on older adults' health.
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Affiliation(s)
- Marion J Torres
- Santé Publique France (French Public Health Agency), Saint-Maurice, France
| | - Joël Coste
- Santé Publique France (French Public Health Agency), Saint-Maurice, France
| | - Florence Canouï-Poitrine
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France
- APHP, Hôpital Henri-Mondor, Service de Santé Publique, Creteil, France
| | - Jacques Pouchot
- Service de Médecine Interne, Hôpital Européen Georges Pompidou, AP-HP, Université de Paris, Paris, France
| | - Antoine Rachas
- Department of Strategy, Studies and Statistics, French National Health Insurance (Cnam), Paris, France
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Daban A, Gonnin C, Phan L, Saldmann A, Granier C, Lillo-Lelouet A, Le Beller C, Pouchot J, Weiss L, Tartour E, Fabre E, Medioni J, Oudard S, Vano YA, Dragon-Durey MA, Simonaggio A. Preexisting autoantibodies as predictor of immune related adverse events (irAEs) for advanced solid tumors treated with immune checkpoint inhibitors (ICIs). Oncoimmunology 2023; 12:2204754. [PMID: 37187974 PMCID: PMC10177742 DOI: 10.1080/2162402x.2023.2204754] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/15/2023] [Accepted: 04/16/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Immune checkpoint inhibitors (ICIs) are now standard of care in many cancers. They can generate immune-related adverse events (irAEs), but no biomarkers are available to identify patients who are more likely to develop irAEs. We assess the association between pre-existing autoantibodies and occurrence of irAEs. PATIENTS AND METHODS We prospectively collected data from consecutive patients receiving ICIs for advanced cancers, in a single center between May 2015 and July 2021. Autoantibodies testing was performed before ICIs initiation including AntiNeutrophil Cytoplasmic Antibodies, Antinuclear Antibodies, Rheumatoid Factor anti-Thyroid Peroxidase and anti-Thyroglobulin. We analyzed the associations of pre-existing autoantibodies with onset, severity, time to irAEs and with survival outcomes. RESULTS Of the 221 patients included, most had renal cell carcinoma (n = 99; 45%) or lung carcinoma (n = 90; 41%). Grade ≥2 irAEs were more frequent among patients with pre-existing autoantibodies: 64 (50%) vs. 20 (22%) patients (Odds-Ratio= 3.5 [95% CI=1.8-6.8]; p < 0.001) in the positive vs negative group, respectively. irAEs occurred earlier in the positive group with a median time interval between ICI initiation and irAE of 13 weeks (IQR = 8.8-21.6) vs. 28.5 weeks (IQR=10.6-55.1) in the negative group (p = 0.01). Twelve patients (9.4%) experienced multiple (≥2) irAEs in the positive group vs. 2 (2%) in the negative group (OR = 4.5 [95% CI: 0.98-36], p = 0.04). After a median follow-up of 25 months, median PFS and OS were significantly longer among patients experiencing irAE (p = 0.00034 and p = 0.016, respectively). CONCLUSION The presence of pre-existing autoantibodies is significantly associated with the occurrence of grade ≥2 irAEs, with earlier and multiple irAEs in patients treated with ICIs.
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Affiliation(s)
- A Daban
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, AP-HP.Centre – Université Paris Cité, Paris, France
| | - C Gonnin
- Department of Immunology, Hôpital Européen Georges Pompidou, AP-HP.Centre – Université Paris Cité, Paris, France
| | - L Phan
- ARTIC - Association pour la Recherche de Thérapeutiques Innovantes en Cancérologie; Hǒpital Européen Georges Pompidou, AP-HP. Centre – Université Paris Cité, Paris, France
| | - A Saldmann
- Department of Immunology, Hôpital Européen Georges Pompidou, AP-HP.Centre – Université Paris Cité, Paris, France
| | - C Granier
- Department of Immunology, Hôpital Européen Georges Pompidou, AP-HP.Centre – Université Paris Cité, Paris, France
- INSERM U970, PARCC, Université Paris-Cité, Paris, France
| | - A Lillo-Lelouet
- Department of Pharmacovigilance, Hôpital Européen Georges Pompidou, AP-HP.Centre – Université Paris Cité, Paris, France
| | - C Le Beller
- Department of Pharmacovigilance, Hôpital Européen Georges Pompidou, AP-HP.Centre – Université Paris Cité, Paris, France
| | - J Pouchot
- Department of Internal Medicine, Hôpital Européen Georges Pompidou, AP-HP.Centre – Université Paris Cité, Paris, France
| | - l Weiss
- Department of Clinical Immunology, Hôpital Hôtel-Dieu, AP-HP.Centre – Université Paris Cité, Paris, France
| | - E Tartour
- Department of Immunology, Hôpital Européen Georges Pompidou, AP-HP.Centre – Université Paris Cité, Paris, France
- INSERM U970, PARCC, Université Paris-Cité, Paris, France
| | - E Fabre
- INSERM U970, PARCC, Université Paris-Cité, Paris, France
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, Paris, France
| | - J Medioni
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, AP-HP.Centre – Université Paris Cité, Paris, France
| | - S Oudard
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, AP-HP.Centre – Université Paris Cité, Paris, France
- INSERM U970, PARCC, Université Paris-Cité, Paris, France
| | - YA Vano
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, AP-HP.Centre – Université Paris Cité, Paris, France
- Centre de Recherche des Cordeliers, INSERM, Université Paris Cité, Sorbonne Université, Paris, France
| | - MA Dragon-Durey
- Department of Immunology, Hôpital Européen Georges Pompidou, AP-HP.Centre – Université Paris Cité, Paris, France
- Centre de Recherche des Cordeliers, INSERM, Université Paris Cité, Sorbonne Université, Paris, France
| | - A. Simonaggio
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, AP-HP.Centre – Université Paris Cité, Paris, France
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Cheminet G, Brunetti A, Khimoud D, Ranque B, Michon A, Flamarion E, Pouchot J, Jannot AS, Arlet JB. Acute chest syndrome in adult patients with sickle cell disease: The relationship with the time to onset after hospital admission. Br J Haematol 2023. [PMID: 36965115 DOI: 10.1111/bjh.18777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/23/2023] [Accepted: 03/15/2023] [Indexed: 03/27/2023]
Abstract
Data on acute chest syndrome (ACS) in adult sickle cell disease patients are scarce. In this study, we describe 105 consecutive ACS episodes in 81 adult patients during a 32-month period and compare the characteristics as a function of the time to onset after hospital admission for a vaso-occlusive crisis (VOC), that is early-onset episodes (time to onset ≤24 h, 42%) versus secondary episodes (>24 h, 58%; median [interquartile range] time to onset: 2 [2-3] days). The median age was 27 [22-34] years, 89% of the patients had an S/S or S/β0 -thalassaemia genotype; 81% of the patients had a history of ACS (median: 3 [2-5] per patient), only 61% were taking a disease-modifying treatment at the time of the ACS. Fever and chest pain were noted in respectively 54% and 73% of the episodes. Crackles (64%) and bronchial breathing (32%) were the main abnormal auscultatory findings. A positive microbiological test was found for 20% of episodes. Fifty percent of the episodes required a blood transfusion; ICU transfer and mortality rates were respectively 29% and 1%. Secondary and early-onset forms of ACS did not differ significantly. Disease-modifying treatments should be revaluated after each ACS episode because the recurrence rate is high.
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Affiliation(s)
- Geoffrey Cheminet
- Université Paris Cité, Paris, France
- AP-HP, Hôpital Européen Georges Pompidou, DMU ENDROMED, Service de Médecine Interne, Centre National de Référence de la drépanocytose et autres maladies rares des globules rouges, Paris, France
| | - Antoine Brunetti
- Service d'Informatique, de biostatistique et santé publique, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Djamal Khimoud
- AP-HP, Hôpital Européen Georges Pompidou, DMU ENDROMED, Service de Médecine Interne, Centre National de Référence de la drépanocytose et autres maladies rares des globules rouges, Paris, France
| | - Brigitte Ranque
- Université Paris Cité, Paris, France
- AP-HP, Hôpital Européen Georges Pompidou, DMU ENDROMED, Service de Médecine Interne, Centre National de Référence de la drépanocytose et autres maladies rares des globules rouges, Paris, France
- Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité, INSERM U970 Equipe 4 "Epidémiologie cardiovasculaire et mort subite", Paris Centre de Recherche Cardiovasculaire, Paris, France
| | - Adrien Michon
- AP-HP, Hôpital Européen Georges Pompidou, DMU ENDROMED, Service de Médecine Interne, Centre National de Référence de la drépanocytose et autres maladies rares des globules rouges, Paris, France
| | - Edouard Flamarion
- AP-HP, Hôpital Européen Georges Pompidou, DMU ENDROMED, Service de Médecine Interne, Centre National de Référence de la drépanocytose et autres maladies rares des globules rouges, Paris, France
| | - Jacques Pouchot
- Université Paris Cité, Paris, France
- AP-HP, Hôpital Européen Georges Pompidou, DMU ENDROMED, Service de Médecine Interne, Centre National de Référence de la drépanocytose et autres maladies rares des globules rouges, Paris, France
| | - Anne-Sophie Jannot
- Université Paris Cité, Paris, France
- Service d'Informatique, de biostatistique et santé publique, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
- HEKA, Centre de Recherche des Cordeliers, INSERM, INRIA, Paris, France
| | - Jean-Benoît Arlet
- Université Paris Cité, Paris, France
- AP-HP, Hôpital Européen Georges Pompidou, DMU ENDROMED, Service de Médecine Interne, Centre National de Référence de la drépanocytose et autres maladies rares des globules rouges, Paris, France
- Laboratoire d'excellence GR-Ex, Hôpital Necker, AP-HP, Université Paris Cité, INSERM U1163, CNRS 8254, institut IMAGINE, Paris, France
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Tennenbaum J, Volle G, Pouchot J, Joseph L, Khimoud D, Ranque B, Arlet JB. Increased risk of venous thromboembolism in splenectomized patients with sickle cell disease. Br J Haematol 2023; 201:793-796. [PMID: 36916494 DOI: 10.1111/bjh.18743] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/12/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Affiliation(s)
- Juliette Tennenbaum
- French National Reference Center for sickle cell disease, thalassaemia and other red blood cell and erythropoiesis disorders, Department of Internal Medicine, European Georges Pompidou Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris-Cité University Paris, Paris, France
| | - Geoffroy Volle
- Department of Internal Medicine, Henri-Mondor Hospital, AP-HP, Paris Est University, Créteil, France
| | - Jacques Pouchot
- French National Reference Center for sickle cell disease, thalassaemia and other red blood cell and erythropoiesis disorders, Department of Internal Medicine, European Georges Pompidou Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris-Cité University Paris, Paris, France
| | - Laure Joseph
- Reference Center for sickle cell disease, thalassemia and other red blood cell and erythropoiesis disorders, Biotherapy department, Necker Hospital, AP-HP, Paris-Cité University, Paris, France.,Laboratory of Excellence GR-Ex, Paris-Cité University, Paris, France
| | - Djamal Khimoud
- French National Reference Center for sickle cell disease, thalassaemia and other red blood cell and erythropoiesis disorders, Department of Internal Medicine, European Georges Pompidou Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris-Cité University Paris, Paris, France
| | - Brigitte Ranque
- French National Reference Center for sickle cell disease, thalassaemia and other red blood cell and erythropoiesis disorders, Department of Internal Medicine, European Georges Pompidou Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris-Cité University Paris, Paris, France.,Laboratory of Excellence GR-Ex, Paris-Cité University, Paris, France
| | - Jean-Benoît Arlet
- French National Reference Center for sickle cell disease, thalassaemia and other red blood cell and erythropoiesis disorders, Department of Internal Medicine, European Georges Pompidou Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris-Cité University Paris, Paris, France.,Laboratory of Excellence GR-Ex, Paris-Cité University, Paris, France.,INSERM U1163, CNRS 8254, IMAGINE Institute, Paris-Cité University, Paris, France
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10
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Tennenbaum J, Volle G, Buffet P, Ranque B, Pouchot J, Arlet JB. [Splenic dysfunction in sickle cell disease: An update]. Rev Med Interne 2023:S0248-8663(23)00005-X. [PMID: 36710088 DOI: 10.1016/j.revmed.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/01/2023] [Accepted: 01/08/2023] [Indexed: 01/30/2023]
Abstract
The spleen filters blood cells and contributes to the immune defense. The red pulp clears the blood from altered red blood cells via its unique microcirculatory network ; while the white pulp is a secondary lymphoid organ, directly connected to the bloodstream, whose specificity is the defense against encapsulated bacteria through the production of "natural" IgM in the marginal zone. Various health conditions can cause acquired impairment of the splenic function (or hyposplenism) directly and/or through therapeutic splenectomy. Hypo/asplenia is complicated by an increased susceptibility to encapsulated germ infections, but an increased risk of thrombosis and pulmonary hypertension has also been reported after surgical splenectomy. Homozygous sickle cell disease is the most common disease associated with functional asplenia. The latter appears early in childhood likely through repeated ischemic alterations caused by the sickling of red blood cells. In addition, specific complications such as hypersplenism and acute splenic sequestration can occur and may be life-threatening. We provide here an update on the role and physiology of the spleen, which will allow a better understanding of the pathophysiology of spleen damage and its consequences in sickle cell disease.
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Affiliation(s)
- J Tennenbaum
- Service de médecine interne, Centre de référence national de la drépanocytose de l'adulte, Hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, Paris, France.
| | - G Volle
- Service de médecine interne, Hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, Créteil, France
| | - P Buffet
- Laboratoire d'Excellence GR-Ex, Biologie intégrée du globule rouge (BIGR), Université Paris Cité, Inserm, Paris, France
| | - B Ranque
- Service de médecine interne, Centre de référence national de la drépanocytose de l'adulte, Hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, Paris, France; Laboratoire d'Excellence GR-Ex, Biologie intégrée du globule rouge (BIGR), Université Paris Cité, Inserm, Paris, France; Faculté de médecine Paris Cité, Paris, France
| | - J Pouchot
- Service de médecine interne, Centre de référence national de la drépanocytose de l'adulte, Hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, Paris, France; Faculté de médecine Paris Cité, Paris, France
| | - J-B Arlet
- Service de médecine interne, Centre de référence national de la drépanocytose de l'adulte, Hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, Paris, France; Laboratoire d'Excellence GR-Ex, Biologie intégrée du globule rouge (BIGR), Université Paris Cité, Inserm, Paris, France; Faculté de médecine Paris Cité, Paris, France; Inserm U1163, CNRS 8254, Institut IMAGINE, Hôpital Necker, Assistance publique-Hôpitaux de Paris, Paris, France
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11
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Volle G, Alexandre C, Rotenberg L, Derobertmasure A, Michon A, Flamarion E, Ranque B, Arlet JB, Pouchot J, Martis N. [Visual and auditory hallucinations in a 80 year-old man]. Rev Med Interne 2023; 44:42-44. [PMID: 36335046 DOI: 10.1016/j.revmed.2022.10.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 01/02/2023]
Affiliation(s)
- G Volle
- Service de médecine interne, hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015 Paris, France.
| | - C Alexandre
- Service de psychiatrie, hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - L Rotenberg
- Service de psychiatrie, hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - A Derobertmasure
- Service de pharmaco-toxicologie, hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - A Michon
- Service de médecine interne, hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - E Flamarion
- Service de médecine interne, hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - B Ranque
- Service de médecine interne, hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - J-B Arlet
- Service de médecine interne, hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - J Pouchot
- Service de médecine interne, hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - N Martis
- Service de médecine interne, CHU de Nice, 151, route Saint-Antoine de Ginestière, 06200 Nice, France
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Tennenbaum J, Volle G, Ranque B, Pouchot J, Arlet J. Caractéristiques des patients drépanocytaires SS et Sβ0 splénectomisés : étude comparative sur 360 patients adultes. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Régent A, Arlet JB, Cheminet G, Pouchot J, Mouthon L, Le Jeunne C. [Contribution and limits of "OSCE", "long-case" and "global end-of-placement marking" as end-of-rotation assessment methods. Experience from two internal medicine wards]. Rev Med Interne 2022; 43:581-588. [PMID: 36089428 DOI: 10.1016/j.revmed.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/11/2022] [Accepted: 07/27/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION During placements, there is an opportunity to learn clinical skills and to assess their application. However, it represents two different goals. The validity of an end-of-placement assessment is questionable, as the medical competency is contextual. We decided to evaluate the contribution and limits of different assessment modalities as an end-of-placement assessment. MATERIAL AND METHODS Internal medicine clerks were assessed using the Mini-Cex grid by a structured objective clinical examination (OSCE), a long-case clinical examination (LCE) and a global end-of-placement marking (GEPM). Following these evaluations, students and teachers fulfilled an open questionnaire. RESULTS In 2021, 41 students and 16 teachers participated in the study. Physical examination was evaluated in 0%, 97% et 76% of cases during OSCE, LCE and GEPM, respectively; teaching skills were assessed for 100, 42 et 49% of students in OSCE, LCE and GEPM, respectively. As compared to OSCE, there was a perceived superiority of LCE regarding its formative value (P=0.07 and P=0.03) and its summative value (P=0.0007 and P=0.02), for students and teachers, respectively. Qualitative analysis highlights the breadth of clinical skills that could be assessed during OSCE stations. Integration into a team was an additional skill that could specifically be assessed during GEPM. GEPM could also take into account the progress made during placement. CONCLUSION Despite its subjectivity, LCE seemed to be the preferred modality for an end-of-rotation assessment.
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Affiliation(s)
- A Régent
- Université de Paris, 15, rue de l'école de médecine, 75006 Paris, France; Service de médecine interne, centre de référence maladies auto-immunes et systémiques rares d'ile de France, hôpital Cochin, AP-HP-CUP, 75014 Paris, France.
| | - J-B Arlet
- Université de Paris, 15, rue de l'école de médecine, 75006 Paris, France; Service de médecine interne, centre de référence des syndromes drépanocytaires majeurs, hôpital européen Georges-Pompidou, AP-HP-CUP, 75015 Paris, France
| | - G Cheminet
- Université de Paris, 15, rue de l'école de médecine, 75006 Paris, France; Service de médecine interne, centre de référence des syndromes drépanocytaires majeurs, hôpital européen Georges-Pompidou, AP-HP-CUP, 75015 Paris, France
| | - J Pouchot
- Université de Paris, 15, rue de l'école de médecine, 75006 Paris, France; Service de médecine interne, centre de référence des syndromes drépanocytaires majeurs, hôpital européen Georges-Pompidou, AP-HP-CUP, 75015 Paris, France
| | - L Mouthon
- Université de Paris, 15, rue de l'école de médecine, 75006 Paris, France; Service de médecine interne, centre de référence maladies auto-immunes et systémiques rares d'ile de France, hôpital Cochin, AP-HP-CUP, 75014 Paris, France
| | - C Le Jeunne
- Université de Paris, 15, rue de l'école de médecine, 75006 Paris, France; Service de médecine interne, centre de référence maladies auto-immunes et systémiques rares d'ile de France, hôpital Cochin, AP-HP-CUP, 75014 Paris, France
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Gillard L, Pouchot J, Cohen-Aubart F, Koné-Paut I, Mouterde G, Michaud M, Reumaux H, Savey L, Belot A, Fautrel B, Mitrovic S. JAK inhibitors in difficult-to-treat adult-onset Still's disease and systemic-onset juvenile idiopathic arthritis. Rheumatology (Oxford) 2022; 62:1594-1604. [PMID: 35920788 DOI: 10.1093/rheumatology/keac440] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/22/2022] [Accepted: 07/22/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Excessive and inappropriate production of pro-inflammatory cytokines plays a key role in Still's disease. JAK inhibitor (JAKi) agents mainly block pro-inflammatory cytokine pathways, notably IL-6 and IFN. The objective was to assess the efficacy and safety of JAKi agents in difficult-to-treat systemic juvenile idiopathic arthritis (SJIA) or adult-onset Still's disease (AOSD). METHODS This retrospective study was based on a national survey conducted in the departments of rheumatology, paediatric rheumatology and internal medicine of French hospitals regarding SJIA and AOSD patients who received JAKi agents. The data were collected with a standardised questionnaire and analysed at different times (treatment initiation, months 1, 3, and 6 and the end of follow-up). RESULTS Nine patients (7 adults) were included. All patients showed inadequate response to corticosteroids or conventional synthetic or biologic disease-modifying anti-rheumatic drugs. Baricitinib was used in 5 patients, ruxolitinib in 2, tofacitinib in 2, and upadacitinib in 1. A JAKi was used combined with corticosteroids in all but 2 patients. A JAKi was associated with anakinra and corticosteroids in one patient, and with methotrexate, anakinra and corticosteroids in another. The median follow-up was 16 [1-33] months. Two cases out 9 showed complete remission, 3/9 partial response and 4/9 treatment failure. At the last visit, corticosteroids could be decreased but not stopped. Tolerance of the JAKi was acceptable (no severe adverse events). CONCLUSION JAKi agents may be a therapeutic option for some patients with difficult-to-treat Still's disease, especially those with partial response to medium- or high-dose corticosteroids or biologics.
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Affiliation(s)
- Louise Gillard
- Service de Rhumatologie, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, AP-HP, France
| | - Jacques Pouchot
- Service de Médecine Interne, Hôpital Européen Georges Pompidou, Université Paris Cité, AP-HP, Paris, France
| | - Fleur Cohen-Aubart
- Service de Médecine Interne 2, Hôpital Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Isabelle Koné-Paut
- Service de Rhumatologie Pédiatrique, Hôpital de Bicêtre, Université de Paris Saclay, AP-HP, Le Kremlin-Bicêtre, France.,Centre de Référence des Maladies Autoinflammatoires et des Amyloses (CéRéMAIA), Paris, France
| | - Gaël Mouterde
- Service de Rhumatologie, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Martin Michaud
- Service de Médecine Interne, Clinique Ambroise Paré, Toulouse, France
| | - Héloïse Reumaux
- Service de Rhumatologie Pédiatrique, Hôpital Jeanne de Flandres, Université de Lille, CHU de Lille, Lille, France
| | - Lea Savey
- Service de Médecine Interne, Hôpital Tenon, Sorbonne Université, AP-HP, Paris, France
| | - Alexandre Belot
- Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard, Lyon 1, Centre National de la Recherche Scientifique, UMR5308, ENS de Lyon, Lyon, France.,Centre de référence pour les maladies rhumatologiques et inflammatoires pédiatriques (RAISE), Hopital Femme Mère Enfant, Lyon, France.,Service de Néphrologie, Rhumatologie et Néphrologie Pédiatriques, Unité de rhumatologie, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Bruno Fautrel
- Service de Rhumatologie, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, AP-HP, France.,Centre de Référence des Maladies Autoinflammatoires et des Amyloses (CéRéMAIA), Paris, France.,Institut d'Epidémiologie et de Santé Publique Pierre Louis, UMR S1136, Equipe PEPITES, Paris, France
| | - Stéphane Mitrovic
- Service de Rhumatologie, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, AP-HP, France.,Centre de Référence des Maladies Autoinflammatoires et des Amyloses (CéRéMAIA), Paris, France.,Département de Médecine Interne, Unité de Rhumatologie, Institut Mutualiste Montsouris, Paris, France
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15
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Cheminet G, Mekontso-Dessap A, Pouchot J, Arlet JB. [Acute chest syndrome in adult sickle cell patients]. Rev Med Interne 2022; 43:470-478. [PMID: 35810055 DOI: 10.1016/j.revmed.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/26/2022] [Accepted: 04/09/2022] [Indexed: 11/17/2022]
Abstract
Sickle cell disease is a frequent genetic condition, due to a mutation of the β-globin gene, leading to the production of an abnormal S hemoglobin and characterized by multiple vaso-occlusive events. The acute chest syndrome is a severe complication associated with a significant disability and mortality. It is defined by the association of one or more clinical respiratory manifestations and a new infiltrate on lung imaging. Its pathophysiology is complex and implies vaso-occlusive phenomena (pulmonary vascular thrombosis, fat embolism), infection, and alveolar hypoventilation. S/S or S/β0-thalassemia genotype, a history of vaso-occlusive crisis or acute chest syndrome, a low F hemoglobin level (<5%), a high steady-state hemoglobin level (> 10 g/dL), or a high steady-state leukocytosis (>10 G/L) are the main risk factors. Febrile chest pain, dyspnea, sometimes cough with expectorations are its main clinical manifestations, and bi-basal crackles are found at auscultation. Inferior alveolar opacities with or without pleural effusions are identified on chest X-ray or CT-scan. Management of the acute chest syndrome should be prompt and implies, besides the recognition of severity signs, a multimodal analgesia, oxygen supplementation, sometimes a parenteral antibiotic treatment and the frequent use of blood transfusions especially in the most severe cases. Prevention is important and includes a regular monitoring of hospitalized patients and the use of incentive spirometry.
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Affiliation(s)
- G Cheminet
- Service de médecine interne, Centre de référence national des syndromes drépanocytaires majeurs de l'adulte, hôpital européen Georges Pompidou, Assistance-Publique hôpitaux de Paris, 75015 Paris, France; Faculté de médecine Paris Centre, université de Paris, 75006 Paris, France.
| | - A Mekontso-Dessap
- Service de médecine intensive-réanimation, hôpitaux Universitaires Henri-Mondor, Assistance-Publique hôpitaux de Paris, 94010 Créteil, France; Université Paris Est Créteil, INSERM, IMRB, CARMAS, Créteil, 94010, France
| | - J Pouchot
- Service de médecine interne, Centre de référence national des syndromes drépanocytaires majeurs de l'adulte, hôpital européen Georges Pompidou, Assistance-Publique hôpitaux de Paris, 75015 Paris, France; Faculté de médecine Paris Centre, université de Paris, 75006 Paris, France
| | - J-B Arlet
- Service de médecine interne, Centre de référence national des syndromes drépanocytaires majeurs de l'adulte, hôpital européen Georges Pompidou, Assistance-Publique hôpitaux de Paris, 75015 Paris, France; Faculté de médecine Paris Centre, université de Paris, 75006 Paris, France; Laboratoire d'excellence sur le globule rouge GR-ex, 75015 Paris, France; Inserm U1163, CNRS 8254, institut IMAGINE, hôpital Necker, Assistance-Publique hôpitaux de Paris, 75015 Paris, France
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16
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Rambaud E, Ranque B, Tsiakyroudi S, Joseph L, Bouly N, Douard R, François A, Pouchot J, Arlet JB. Risks and Benefits of Prophylactic Transfusion before Cholecystectomy in Sickle Cell Disease. J Clin Med 2022; 11:jcm11143986. [PMID: 35887750 PMCID: PMC9319142 DOI: 10.3390/jcm11143986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/04/2022] [Accepted: 07/07/2022] [Indexed: 11/20/2022] Open
Abstract
Preoperative transfusion (PT) reduces acute postoperative vaso-occlusive events (VOE) in sickle cell disease (SCD), but exposes patients to alloimmunization, encouraging a recent trend towards transfusion sparing. The aim of this study was to investigate the benefit–risk ratio of PT before cholecystectomy on the occurrence of postoperative VOE. Adult SCD patients who underwent cholecystectomy between 2008 and 2019 in our center were included. Patients’ characteristics, collected retrospectively, were compared according to PT. A total of 79 patients were included, 66% of whom received PT. Gallbladder histopathology found chronic cholecystitis (97%) and gallstones (66%). Transfused patients underwent more urgent surgeries and had experienced more painful vaso-occlusive crises (VOC) in the month before surgery (p = 0.05). Four (8.5%) post-transfusion alloimmunizations occurred, and two of them caused a delayed hemolytic transfusion reaction (DHTR) (4.3%). The occurrence of postoperative VOE was similar between the groups (19.2% vs. 29.6%, p = 0.45). Though not statistically significant, a history of hospitalized VOC within 6 months prior to surgery seemed to be associated to postoperative VOE among non-transfused patients (75% vs. 31.6%, p = 0.10). PT before cholecystectomy exposes to risks of alloimmunization and DHTR that could be avoided in some patients. Recent VOCs appear to be associated with a higher risk of postoperative VOE and prompt the preemptive transfusion of these patients.
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Affiliation(s)
- Elise Rambaud
- Reference Center for Sickle Cell Disease, Thalassemia and Other Red Blood Cell and Erythropoiesis Diseases, Department of Internal Medicine, European Georges Pompidou University Hospital (AP-HP), European Georges Pompidou Hospital (AP-HP), Paris Cité University, F-75015 Paris, France; (B.R.); (J.P.); (J.-B.A.)
- Correspondence:
| | - Brigitte Ranque
- Reference Center for Sickle Cell Disease, Thalassemia and Other Red Blood Cell and Erythropoiesis Diseases, Department of Internal Medicine, European Georges Pompidou University Hospital (AP-HP), European Georges Pompidou Hospital (AP-HP), Paris Cité University, F-75015 Paris, France; (B.R.); (J.P.); (J.-B.A.)
| | - Sofia Tsiakyroudi
- Digestive Surgery Department, European Georges Pompidou University Hospital (AP-HP), F-75015 Paris, France; (S.T.); (R.D.)
| | - Laure Joseph
- Reference Center for Sickle Cell Disease, Thalassemia and Other Red Blood Cell and Erythropoiesis Diseases, Biotherapy Service, Necker Hospital (AP-HP), F-75015 Paris, France;
| | - Nathalie Bouly
- French Blood Establishment, F-75015 Paris, France; (N.B.); (A.F.)
| | - Richard Douard
- Digestive Surgery Department, European Georges Pompidou University Hospital (AP-HP), F-75015 Paris, France; (S.T.); (R.D.)
| | - Anne François
- French Blood Establishment, F-75015 Paris, France; (N.B.); (A.F.)
| | - Jacques Pouchot
- Reference Center for Sickle Cell Disease, Thalassemia and Other Red Blood Cell and Erythropoiesis Diseases, Department of Internal Medicine, European Georges Pompidou University Hospital (AP-HP), European Georges Pompidou Hospital (AP-HP), Paris Cité University, F-75015 Paris, France; (B.R.); (J.P.); (J.-B.A.)
| | - Jean-Benoît Arlet
- Reference Center for Sickle Cell Disease, Thalassemia and Other Red Blood Cell and Erythropoiesis Diseases, Department of Internal Medicine, European Georges Pompidou University Hospital (AP-HP), European Georges Pompidou Hospital (AP-HP), Paris Cité University, F-75015 Paris, France; (B.R.); (J.P.); (J.-B.A.)
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17
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Sabatier P, Wack M, Pouchot J, Danchin N, Jannot AS. A data-driven pipeline to extract potential adverse drug reactions through prescription, procedures and medical diagnoses analysis: application to a cohort study of 2,010 patients taking hydroxychloroquine with an 11-year follow-up. BMC Med Res Methodol 2022; 22:166. [PMID: 35676635 PMCID: PMC9175346 DOI: 10.1186/s12874-022-01628-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/06/2022] [Indexed: 12/05/2022] Open
Abstract
Context Real-life data consist of exhaustive data which are not subject to selection bias. These data enable to study drug-safety profiles but are underused because of their temporality, necessitating complex models (i.e., safety depends on the dose, timing, and duration of treatment). We aimed to create a data-driven pipeline strategy that manages the complex temporality of real-life data to highlight the safety profile of a given drug. Methods We proposed to apply the weighted cumulative exposure (WCE) statistical model to all health events occurring after a drug introduction (in this paper HCQ) and performed bootstrap to select relevant diagnoses, drugs and interventions which could reflect an adverse drug reactions (ADRs). We applied this data-driven pipeline on a French national medico-administrative database to extract the safety profile of hydroxychloroquine (HCQ) from a cohort of 2,010 patients. Results The proposed method selected eight drugs (metopimazine, anethole trithione, tropicamide, alendronic acid & colecalciferol, hydrocortisone, chlormadinone, valsartan and tixocortol), twelve procedures (six ophthalmic procedures, two dental procedures, two skin lesions procedures and osteodensitometry procedure) and two medical diagnoses (systemic lupus erythematous, unspecified and discoid lupus erythematous) to be significantly associated with HCQ exposure. Conclusion We provide a method extracting the broad spectrum of diagnoses, drugs and interventions associated to any given drug, potentially highlighting ADRs. Applied to hydroxychloroquine, this method extracted among others already known ADRs. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01628-3. • The challenge of drug-safety signal detection methods is to handle four types of difficulties: ○ The data source, the study of long-term adverse drug reactions or effects not suspected by healthcare professionals, requires the use of a real-life data source. ○ The consideration of a broad spectrum of potential adverse drug reactions (ADRs), and not only candidate ADRs. ○ The temporal impact (meaning that safety depends on the dose, date and duration of treatment). ○ The difference between true ADRs and disease natural course. • We aimed to create a data-driven pipeline strategy, without any assumption of any ADRs, which take into account the complex temporality of real-life data to provide the safety profile of a given drug. • Our pipeline used three sources of real-life data to establish a safety profile of a given drug: drug prescriptions, procedures and medical diagnoses. • We successfully applied our data-driven pipeline strategy to hydroxychloroquine (HCQ). Our pipeline enabled us to find diagnoses, drugs and interventions related to HCQ and which could reflect an ADR due to HCQ or the disease itself. • This data-driven pipeline strategy may be of interest to other experts involved in the pharmacovigilance discipline.
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Affiliation(s)
- P Sabatier
- Inria, HeKA, PariSantéCampus, 10 Rue d'Oradour-sur-Glane, 75015, Paris, France. .,Inserm, Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris Cité, 75006, Paris, France. .,AP-HP: Medical Informatics Department, Georges Pompidou European Hospital, 20 Rue Leblanc, 75015, Paris, France.
| | - M Wack
- Inria, HeKA, PariSantéCampus, 10 Rue d'Oradour-sur-Glane, 75015, Paris, France.,Inserm, Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris Cité, 75006, Paris, France.,AP-HP: Medical Informatics Department, Georges Pompidou European Hospital, 20 Rue Leblanc, 75015, Paris, France
| | - J Pouchot
- AP-HP: Department of Cardiology, Georges Pompidou European Hospital, 75015, Paris, France
| | - N Danchin
- AP-HP: Department of Internal Medicine, Georges Pompidou European Hospital, 75015, Paris, France
| | - A S Jannot
- Inria, HeKA, PariSantéCampus, 10 Rue d'Oradour-sur-Glane, 75015, Paris, France.,Inserm, Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris Cité, 75006, Paris, France.,AP-HP: Medical Informatics Department, Georges Pompidou European Hospital, 20 Rue Leblanc, 75015, Paris, France
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18
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Daban A, Gonnin C, Vano YA, Phan L, lillo-Lelouet A, le Beller C, Pouchot J, Fabre E, Weiss L, Tartour E, Oudard S, Dragon Durey MA, Simonaggio A. Preexisting autoantibodies as predictor of immune-related adverse events for advanced solid tumors treated with immune checkpoint inhibitors. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.2523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2523 Background: Immune checkpoint inhibitors (ICIs), used alone or as a combination are standard of care in many cancers. Generally well tolerated, they can generate immune-related adverse events (irAEs). No biomarkers are available to identify patients who are more likely to develop irAEs. The aim of this study was to assess the association between preexisting autoantibodies, occurrence of irAEs and survival outcomes. Methods: We performed a prospective study including 221 patients receiving ICIs for advanced solid tumors between May 2015 and July 2021. Autoantibodies testing (anti-neutrophil cytoplasmic, anti-nuclear, thyroid peroxidase and thyroglobulin) was performed before ICIs initiation. The associations among preexisting autoantibodies, the occurrence, the severity, the delay of irAEs and the survival outcomes, including progression-free survival (PFS) and overall survival (OS) were analyzed. Statistical analyses were performed with T-test, Cox regression models, univariate and multivariate analyses and Kaplan-Meier’s method. Results: Of the 221 patients, 151 (68%) were men, the median age was 66,5 (range 21-90) years and 103 (81%) had an ECOG-PS of 0 or 1. Seventy-three percent (n=162) received an anti-PD-(L)1 in monotherapy, 27% (n=59) an anti-PD-(L)1 in combination, for a renal cell carcinoma in 45% (n=99) and a lung carcinoma in 41% (n=90). In total, 129 (58%) patients had preexisting antibodies. IrAEs were significantly more frequent in patients with preexisting autoantibodies: 64 patients (50%) in the positive group vs. 20 patients (22%) in the negative group, OR = 3.5 (95%CI=1.8 - 6.8), p=0.00002. Median time interval between ICI initiation and irAE was shorter in the positive group vs. the negative group, 13 weeks (IQR=43weeks) vs. 28.5 weeks (IQR=12weeks) respectively (p=0.01). Twelve patients (9.4%) experienced multi toxicities in the positive group vs. two (2%) in the negative group, OR=4.5 (95%CI0.98-36), p=0.04. ICIs exposure was identical in preexisting and non-preexisting autoantibodies groups. After a median follow-up of 25 months (95%CI=19-31), median PFS and OS were significantly longer among patients experiencing irAE: 12.6 months (95%CI=11-22.7) vs 5 months (95%CI=4.2-7.0), p= 0.0003 and 30 months (95%CI= 22.7-NR) vs 21 months (95%CI=15-34.6), p= 0.016. In multivariate analyses irAEs remain statistically associated with survival outcomes. Preexisting autoantibodies were not associated with survival outcomes. Conclusions: The presence of preexisting autoantibodies is significantly associated with the occurrence of irAE in patients treated with ICIs. Earlier and multiple irAEs were observed in the presence of preexisting autoantibodies. Thus, these biomarkers could help to identify patients at risk of irAEs and would prompt us to closely monitor them.
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Affiliation(s)
| | | | - Yann-Alexandre Vano
- Department of Medical Oncology, Georges Pompidou Hospital, University Paris Descartes, Paris, France
| | | | | | | | | | | | | | - Eric Tartour
- Immunology Department, European Georges Pompidou Hospital, Paris, France
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Rambaud E, Ranque B, Pouchot J, Arlet JB. Complications lithiasiques chez les patients drépanocytaires. Rev Med Interne 2022; 43:479-486. [DOI: 10.1016/j.revmed.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022]
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20
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Lenfant T, L'Honneur A, Ranque B, Pilmis B, Charlier C, Zuber M, Pouchot J, Rozenberg F, Michon A. Neurological complications of varicella zoster virus reactivation: Prognosis, diagnosis, and treatment of 72 patients with positive PCR in the cerebrospinal fluid. Brain Behav 2022; 12:e2455. [PMID: 35040287 PMCID: PMC8865153 DOI: 10.1002/brb3.2455] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 11/05/2021] [Accepted: 11/11/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND VZV infection can involve every level of the neurologic system: from the central nervous system (CNS) to the peripheral nervous system (PNS), including aseptic meningitis. Prognosis seems to differ between these neurological involvements. Prognostic factors remain unknown. METHODS This is a retrospective multicenter study including all patients with a positive VZV polymerase chain reaction (PCR) in the cerebrospinal fluid (CSF) from eight centers in Paris (France) between 2011 and 2018. Unfavorable outcome was defined as mortality linked to VZV or incomplete recovery. Modified Rankin Scale (mRS) evaluated disability before and after the infection, with the difference designated as Rankin Delta. RESULTS Seventy-two patients were included (53% male, median age 51 years, median mRS 0). Immunosuppression was reported in 42%. The clinical spectrum included 26 cases of meningitis, 27 instances of CNS involvement, 16 of PNS involvement, and 3 isolated replications (positive PCR but no criteria for neurological complications from VZV). Antiviral treatment was administered to 69 patients (96%). Sixty-two patients completed follow-up. Death linked to VZV occurred in eight cases. Unfavorable outcome (UO) occurred in 60% and was significantly associated with a higher prior mRS (Odd-ratio (OR) 3.1 [1.4-8.8] p = .012) and the presence of PNS or CNS manifestations (OR 22 [4-181] p = .001, OR 6.2 [1.3-33] p = .03, respectively, compared to meningitis). In the CSF, higher protein level (p < .0001) was also significantly associated with a higher Rankin Delta. CONCLUSIONS Neurological complications of VZV with evidence of CSF viral replication are heterogeneous: aseptic meningitis has a good prognosis, whereas presence of CNS and PNS involvement is associated with a higher risk of mortality and of sequelae, respectively.
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Affiliation(s)
- Tiphaine Lenfant
- Université de Paris, Service de Médecine InterneHôpital Européen Georges Pompidou, AP‐HPParisFrance
| | | | - Brigitte Ranque
- Université de Paris, Service de Médecine InterneHôpital Européen Georges Pompidou, AP‐HPParisFrance
| | - Benoit Pilmis
- Équipe Mobile de Microbiologie CliniqueGroupe Hospitalier Paris Saint JosephParisFrance
| | - Caroline Charlier
- Université de Paris, Equipe Mobile InfectiologieHôpital Cochin Port‐Royal, AP‐HPUnité Biologie des Infections, Institut Pasteur, Inserm U1117ParisFrance
| | - Mathieu Zuber
- Service de Neurologie et NeurovasculaireGroupe Hospitalier Paris Saint JosephParisFrance
| | - Jacques Pouchot
- Université de Paris, Service de Médecine InterneHôpital Européen Georges Pompidou, AP‐HPParisFrance
| | - Flore Rozenberg
- Université de Paris, Service de VirologieHôpital Cochin, AP‐HPParisFrance
| | - Adrien Michon
- Université de Paris, Service de Médecine InterneHôpital Européen Georges Pompidou, AP‐HPParisFrance
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Kachaner A, Rives-Lange C, Radu A, Czernichow S, Ranque B, Pouchot J, Lafont E. Ketoacidosis in a non-diabetic lactating woman: A case report and literature review. Eur J Clin Nutr 2021; 76:775-777. [PMID: 34675399 DOI: 10.1038/s41430-021-01013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 09/15/2021] [Indexed: 11/09/2022]
Abstract
We report the case of a 36-year-old woman who developed non-diabetic ketoacidosis following a low carbohydrate diet in order to lose weight while actively breast feeding her newborn. She was admitted in intensive care unit because of severe metabolic acidosis. She rapidly recovered after refeeding process. Lactation ketoacidosis, a special condition that occurs in non-diabetic breastfeeding women, is rare and life-threatening. This report highlights the importance of nutritional education of lactating women in the post-partum period.
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Affiliation(s)
- Alexandra Kachaner
- Université de Paris, Paris, France.,Service de médecine interne, Hôpital Européen Georges-Pompidou, Paris, France
| | - Claire Rives-Lange
- Université de Paris, Paris, France.,Service de nutrition, Hôpital Européen Georges-Pompidou, Paris, France
| | - Alina Radu
- Université de Paris, Paris, France.,Service de nutrition, Hôpital Européen Georges-Pompidou, Paris, France
| | - Sebastien Czernichow
- Université de Paris, Paris, France.,Service de nutrition, Hôpital Européen Georges-Pompidou, Paris, France
| | - Brigitte Ranque
- Université de Paris, Paris, France.,Service de médecine interne, Hôpital Européen Georges-Pompidou, Paris, France
| | - Jacques Pouchot
- Université de Paris, Paris, France.,Service de médecine interne, Hôpital Européen Georges-Pompidou, Paris, France
| | - Emmanuel Lafont
- Université de Paris, Paris, France. .,Service de médecine interne, Hôpital Européen Georges-Pompidou, Paris, France.
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Wahbi A, Tessoulin B, Bretonnière C, Boileau J, Carpentier D, Decaux O, Fardet L, Geri G, Godmer P, Goujard C, Maisonneuve H, Mari A, Pouchot J, Ziza JM, Georgin-Lavialle S, Hamidou M, Néel A. Catastrophic adult-onset Still's disease as a distinct life-threatening clinical subset: case-control study with dimension reduction analysis. Arthritis Res Ther 2021; 23:256. [PMID: 34635157 PMCID: PMC8504015 DOI: 10.1186/s13075-021-02631-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/16/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives Adult-onset Still’s disease (AOSD) is a rare systemic inflammatory disorder. Diagnosing AOSD can be challenging, as disease presentation and clinical course are highly heterogeneous. For unclear reasons, a few patients develop life-threatening complications. Our objective was to determine whether these cases resulted from therapeutic delay or could represent a peculiar AOSD subset. Methods We conducted a multicentre retrospective study of 20 AOSD patients with organ failure requiring intensive care unit admission and 41 control AOSD patients without organ failure. Clinico-biological data at hospital admission were explored using supervised analyses and unsupervised dimension reduction analysis (factor analysis of mixed data, FAMD). Results Disease duration before admission was shorter in patients with life-threatening AOSD (median, 10 vs 20 days, p = 0.007). Disease duration before AOSD therapy initiation also tended to be shorter (median, 24 vs 32 days, p = 0.068). Despite this shorter disease duration, FAMD, hierarchical clustering and univariate analyses showed that these patients exhibited distinctive characteristics at first presentation, including younger age; higher frequency of splenomegaly, liver, cardiac and/or lung involvement; less frequent arthralgia; and higher ferritin level. In multivariate analysis, 3 parameters predicted life-threatening complications: lack of arthralgia, younger age and shorter time between fever onset and hospitalisation. Conclusion This study suggests that life-threatening complications of AOSD occur very early, in a peculiar subset, which we propose to name catastrophic adult-onset Still’s disease (CAOSD). Its exact burden may be underestimated and remains to be clarified through large multicentre cohorts. Further studies are needed to identify red flags and define the optimal therapeutic strategy.
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Affiliation(s)
- Anaïs Wahbi
- Service de Médecine Interne, PHU3, Centre Hospitalier Universitaire de Nantes - Hôtel-Dieu, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Benoît Tessoulin
- Service d'Hématologie, PHU1, CHU Hôtel-Dieu, 44093, Nantes, France
| | - Cédric Bretonnière
- Service de Pneumologie, PHU2, CHU de Nantes, 44093, Nantes, France.,UPRES EA 3826, Faculté de Médecine, Université de Nantes, 44035, Nantes, France
| | - Julien Boileau
- Service de Médecine, CH de Morlaix, 29672, Morlaix, France
| | | | - Olivier Decaux
- Service de Médecine Interne, CHU de Rennes, 35033, Rennes, France
| | - Laurence Fardet
- Service de Dermatologie, Hôpital Henri Mondor, 94000, Créteil, France
| | - Guillaume Geri
- Service de Réanimation Médicale, CHU Cochin, AP-HP, 75012, Paris, France
| | | | - Cécile Goujard
- Service de Médecine Interne, CHU Bicêtre, AP-HP, 94270, Kremlin-Bicêtre, France
| | - Hervé Maisonneuve
- Service de Médecine Interne, CHD Vendée, 85925, La Roche-sur-Yon, France
| | - Arnaud Mari
- Service de Réanimation, Hôpital Yves Le Foll, 22000, St Brieuc, France
| | - Jacques Pouchot
- Service de Médecine Interne, Hôpital Européen Georges Pompidou, AP-HP, 75908, Paris, France
| | - Jean-Marc Ziza
- Service de Médecine Interne-Rhumatologie, Groupe Hospitalier Diaconesses-Croix-Saint-Simon, 75020, Paris, France
| | | | - Mohamed Hamidou
- Service de Médecine Interne, PHU3, Centre Hospitalier Universitaire de Nantes - Hôtel-Dieu, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Antoine Néel
- Service de Médecine Interne, PHU3, Centre Hospitalier Universitaire de Nantes - Hôtel-Dieu, 1 Place Alexis Ricordeau, 44093, Nantes, France.
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Bonnet I, Rousseau A, Duraffour P, Pouchot J, Nguyen CD, Gabison E, Seror R, Marotte H, Mariette X, Nocturne G. Efficacy and safety of rituximab in peripheral ulcerative keratitis associated with rheumatoid arthritis. RMD Open 2021; 7:rmdopen-2020-001472. [PMID: 33510042 PMCID: PMC7845725 DOI: 10.1136/rmdopen-2020-001472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/20/2020] [Accepted: 12/28/2020] [Indexed: 12/23/2022] Open
Abstract
Objective Peripheral ulcerative keratitis (PUK) is a rare but severe ocular complication of rheumatoid arthritis (RA). It can be considered as an ocular manifestation of rheumatoid vasculitis (RV). Our case series aimed to evaluate the efficacy of rituximab (RTX) for PUK occurring in patients with RA. Methods Study population were patients with RA-associated PUK treated with RTX 1000 mg on days 1 and 15 at least once after the diagnosis. We identified patients referred to the rheumatology and ophthalmology departments of our hospital between February 2014 and June 2020. We also included patients referred by their specialist after being contacted through the Club Rhumatismes et Inflammation. Demographic data and clinical and biological features were retrospectively collected. Results We included seven patients (three men and four women, median age 58 years). All but one had a long-standing RA with a median disease duration of 13.9 years (IQR 0–30.2). RA was erosive in six out of seven patients. All patients had rheumatoid factors and anticitrullinated peptides antibodies were positive in six of them. PUK was complicated by corneal perforation in three patients and required surgery. After a median follow-up of 29.8 months (IQR 5–75), corneal inflammation was controlled in all patients. PUK recurred in one patient, 8 months after a single infusion of RTX. 71% of the patients presented a good articular response. No patient developed other manifestations of RV. No serious adverse event related to RTX was observed. Conclusion RTX appears to be an efficient and safe therapeutic option in the treatment of RA-associated PUK.
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Affiliation(s)
- Isabelle Bonnet
- Department of Rheumatology, AP-HP, Paris-Sud University Hospitals, Le Kremlin Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Antoine Rousseau
- Ophtalmology, Hospital Bicetre, Le Kremlin-Bicetre, Île-de-France, France.,Immunology of Viral Infections and Autoimmune, Hematological and Bacterial Diseases, Inserm U1184, Le Kremlin-Bicetre, Île-de-France, France
| | | | - Jacques Pouchot
- Internat Medicine, Hopital Europeen Georges Pompidou, Paris, Île-de-France, France
| | - Chi Duc Nguyen
- Rheumatology, Hospital Centre Bethune, Bethune, Nord-Pas de Calais, France
| | - Eric Gabison
- Ophtalmology, Hôpital Bichat Claude-Bernard, Paris, Île-de-France, France.,Centre de Référence pour les Maladies Ren Ophtalmologie (OPHTARA), Fondation Rothschild, Paris, Île-de-France, France
| | - Raphaele Seror
- Department of Rheumatology, AP-HP, Paris-Sud University Hospitals, Le Kremlin Bicêtre Hospital, Le Kremlin-Bicêtre, France.,Immunology of Viral Infections and Autoimmune, Hematological and Bacterial Diseases, Inserm U1184, Le Kremlin-Bicetre, Île-de-France, France
| | - Hubert Marotte
- Rhumatologie, CHU Saint-Etienne, Saint-Etienne, France.,SAINBIOSE, INSERM U1059, University of Lyon, Saint-Etienne, France, University of Lyon, Saint-Etienne, France
| | - Xavier Mariette
- Department of Rheumatology, AP-HP, Paris-Sud University Hospitals, Le Kremlin Bicêtre Hospital, Le Kremlin-Bicêtre, France.,Immunology of Viral Infections and Autoimmune, Hematological and Bacterial Diseases, Inserm U1184, Le Kremlin-Bicetre, Île-de-France, France
| | - Gaetane Nocturne
- Department of Rheumatology, AP-HP, Paris-Sud University Hospitals, Le Kremlin Bicêtre Hospital, Le Kremlin-Bicêtre, France.,Immunology of Viral Infections and Autoimmune, Hematological and Bacterial Diseases, Inserm U1184, Le Kremlin-Bicetre, Île-de-France, France
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Avouac J, Drumez E, Hachulla E, Seror R, Georgin-Lavialle S, El Mahou S, Pertuiset E, Pham T, Marotte H, Servettaz A, Domont F, Chazerain P, Devaux M, Claudepierre P, Langlois V, Mekinian A, Maria A, Banneville B, Fautrel B, Pouchot J, Thomas T, Flipo RM, Richez C. OP0284 OUTCOME OF COVID-19 IN PATIENTS WITH RHEUMATIC AND INFLAMMATORY DISEASES TREATED WITH RITUXIMAB: DATA FROM DE FRENCH RMD COVID-19 COHORT. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Various observations have suggested that the course of the COVID-19 infection may be less favorable in patients with inflammatory rheumatic and musculoskeletal diseases (iRMD) receiving rituximab (RTX).Objectives:To investigate whether treatment with RTX is associated with severe infection and death.Methods:We performed an observational, multicenter, French national cohort study querying the French RMD COVID-19 cohort, including highly suspected/confirmed iRMD-COVID-19 patients. The primary endpoint was to assess the severity rate of COVID-19. Severe disease was defined by hospitalization in intensive care unit or death. The secondary objectives were to analyze death rate and length of hospital stay. Two control groups were considered for comparison with RTX treated patients: a first group including all non-RTX treated iRMD patients and a second consisting on RTX untreated iRMD patients with diseases for which RTX is a recognized therapeutic option. Adjusting on potential confounding factors was performed by using inverse probability of treatment weighting (IPTW) propensity score method.Results:We collected a total of 1090 records. Patients were mainly females (67.3%, 734/1090) with a mean age of 55.2±16.4 years, and 51.1% (557/1090) were over the age of 55. Almost 70% of the population had at least one comorbidity (756/1090). A total of 63 patients were treated with RTX, mainly for rheumatoid arthritis (RA) (31/63, 49.2%). RTX treated patients were more likely to be males, with older age, higher prevalence of comorbidities and corticosteroid use. The control population consisted on 1027 non-RTX treated iRMD patients, and 495 RTX untreated iRMD patients with diseases for which RTX is a recognized therapeutic option.Of the 1,090 patients, 137 developed severe disease (12.6%). After adjusting on potential confounding factors (age, sex, arterial hypertension, diabetes, smoking status, body mass index, interstitial lung disease, cardiovascular diseases, cancer, corticosteroid use, chronic renal failure and the underlying disease), severe disease was confirmed to be observed more frequently in patients receiving RTX compared to all RTX untreated iRMD patients (effect size, ES 3.26, 95% confidence interval, CI 1.66 to 6.40, p<0.001) and the subgroup of untreated RTX patients with diseases eligible for RTX therapy (ES 2.62, 95% CI 1.34 to 5.09, p=0.005). Patients who developed a severe disease had a more recent rituximab infusion compared to patients with mild or moderate disease. Indeed, the time between the last infusion of rituximab and the first symptoms of COVID-19 was significantly shorter in patients who developed a severe form of COVID-19 (Figure 1).Figure 1.Distribution (Tukey’s box plot) of Lag time between last infusion of Rituximab according to disease severity. P-Values for comparison between disease severity with Kruskal Wallis test are reported; P-Value<0.001 for either post-hoc comparison of severe disease group with moderate or mild disease group (calculated using Dunn’s test).Eighty-nine patients in our cohort died, resulting in an overall death rate of 8.2%. Death rate was numerically higher in RTX treated patients (13/63, 20.6%) compared to all RTX untreated iRMDs patients (76/1027, 7.4%) and the subgroup of untreated RTX patients with diseases eligible for RTX therapy (49/495, 9.9%). After considering the previously described confounding factors, the risk of death was not significantly increased in patients treated with RTX compared to all RTX untreated iRMDs patients (ES 1.32, 95% CI 0.55 to 3.19, p=0.53) (Table 2) and the subgroup of untreated RTX patients with diseases eligible for RTX therapy (ES 1.48, 95% CI 0.68 to 3.20, p=0.32). In line with a more severe COVID-19 disease, the length of hospital stay was markedly longer in patients treated with RTX compared to both untreated RTX patient groups.Conclusion:RTX therapy is associated with a more severe COVID-19 infection. RTX will have to be applied with particular caution in patients with iRMDs.Acknowledgements:Muriel Herasse played a major role in collecting the missing data of the cohort.We thank Julien Labreuche (biostatistician, CHU-Lille) for the help in the statistical analysis.Disclosure of Interests:None declared
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Sabatier P, Wack M, Pouchot J, Danchin N, Jannot A. Nouvelle méthode pour extraire le spectre d’effets secondaires d’un médicament en analysant les co-prescriptions : application à une étude de cohorte de 2010 patients sous hydroxychloroquine avec un suivi de 11 ans. Rev Epidemiol Sante Publique 2021. [DOI: 10.1016/j.respe.2021.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Mitrovic S, Boucly A, Lazaro E, Schleinitz N, Bloch-Queyrat C, Christides C, Pouchot J, Humbert M, Montani D, Savale L, Jaïs X, Sitbon O, Fautrel B. OP0094 PULMONARY ARTERIAL HYPERTENSION IN ADULT-ONSET STILL’S DISEASE: A CASE SERIES OF 13 PATIENTS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Pulmonary Arterial Hypertension (PAH) is a rare but potentially fatal complication of Adult-Onset Still’s Disease (AOSD) (1). To date, only isolated observations have been published.Objectives:To establish the largest case series of AOSD patients with PAH, and to describe their clinical profile, evolution and response to treatments.Methods:Cases were retrospectively identified from the French PAH network database and from an online call of the “Club Rhumatismes et Inflammation” (http://www.cri-net.com). To be included, all patients had to fulfil the Yamaguchi or Fautrel’s criteria for AOSD and PAH had to be confirmed by right heart catheterization. The data were collected using a standardized questionnaire.Results:Thirteen patients were identified. All were female, the mean age at PAH diagnosis was 32± 12 years, 2 (15%) patients were Caucasian, 6 (46%) from Sub-Saharan Africa, 1 (8%) from Asia and 4 (31%) from West Indies. Only 2 (15%) patients were smokers. All patients had a systemic onset of AOSD, 12 had a polycyclic and 1 a chronic articular evolution, and the mean delay between AOSD and PAH diagnosis was 2.9 (range 1.7 -5.4) years. At PAH diagnosis, patients were receiving the following treatments: 13 (100%) corticosteroids (median dose 12 mg [interquartile range (IQR) 9-18]), 3 (23%) methotrexate, 8 (61%) interleukin (IL)-1 inhibitors (exposure median duration 6.7 months [IQR 3.6-8.5]), none IL-6 inhibitors, 2 (15%) TNF inhibitors. Six (46%) patients developed PAH during an AOSD flare. PAH was severe at diagnosis: 2 (15%), 7 (54%) and 4 (31%) patients were in NYHA functional class II, III and IV, respectively, with a median 6-minute walk distance of 289 m [IQR 0-448], a mean pulmonary arterial pressure of 41 ± 12 mmHg, a mean pulmonary arterial occlusion pressure of 6 ± 3 mmHg, a mean cardiac output of 3.9 ± 1.2 L/min, a mean cardiac index of 2.5 ± 0.9 L/min/m2 and a median pulmonary vascular resistance of 7 Wood Units [IQR 6-11]. The treatment prescribed after PAH diagnosis is detailed in the table. The median follow-up was 34 months [IQR 7-42]. Five patients (38.5 %) died. Figure 1 shows the overall survival. The haemodynamic response to PAH treatment seemed to be dissociated from the prognosis since several patients have died while their haemodynamic had improved or almost normalised.Conclusion:PAH is a rare but potentially severe complication of AOSD, leading to death in 38.5% of our cases series. AOSD remission should be physicians’ objective, since PAH seems to occur when the underlying disease is not controlled.References:[1]Feist E, Mitrovic S, Fautrel B. Mechanisms, biomarkers and targets for adult-onset Still’s disease. Nat Rev Rheumatol. 2018;1:603-618.Table 1.Therapeutic managementTreatmentn (%)Inotropic therapy5 (38%)HTAP treatment10 (77%)•0Monotherapy3•oInitial oral dual combination therapy3•nDual combination therapy including intravenous (IV) prostacyclin1•uUpfront triple combination therapy including IV prostacyclin3High-dose corticosteroids9 (69%)Interleukin 1 inhibitors initiation2 (15%)Interleukin 6 inhibitors initiation5 (38%)Acknowledgements:The authors want to thank the Club Rhumatismes et Inflammation for the diffusion of the online call.Disclosure of Interests:None declared
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Gillard L, Mitrovic S, Reumaux H, Michaud M, Cohen F, Pouchot J, Fautrel B. AB0772 JAK INHIBITORS IN REFRACTORY ADULT AND CHILDHOOD ONSET STILL’S DISEASE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Excessive and inappropriate production of pro-inflammatory cytokines such as interleukin (IL)-1, IL-6 or IL-18, is a pathogenic cornerstone in adult and childhood onset Still’s disease. Beyond therapies targeting IL-1 or IL-6, Janus kinases (JAK) inhibitors have been proposed for adult-onset Still’s disease (AOSD) patients refractory to or intolerant of treatment with biologicals. Recently, it has been suggested that JAK inhibitors might be efficient in refractory AOSD patients1.Objectives:To assess the efficacy and safety of JAK inhibitors in the treatment of refractory systemic juvenile idiopathic arthritis (sJIA) or AOSD.Methods:This retrospective study was based on a national survey of the departments of rheumatology, paediatric rheumatology and internal medicine in all French hospitals from an online call of the “Club Rhumatismes et Inflammation” (www.cri-net.com). The data were collected using a standardized questionnaire, and analyzed at different time points (treatment initiation, M1, M3, M6 and end of the follow-up). The response to JAK inhibitors was categorized as: complete remission (resolution of all clinical and biologic signs), partial remission (clinical improvement with persistence of a few symptoms) or failure (lack of clinical or biological improvement).Results:6 patients (5 adults and 1 child) were recruited (Table 1). Mean age at treatment start was 39.6 years for the AOSD patient and 6 years for the sJIA patient, and mean disease duration was 5.3 years. The clinical expression was predominantly systemic in 5 five patients and chronic articular in one. Response to corticosteroids, conventional synthetic or biological Disease Modifying Anti-Rheumatic Drugs had been considered inadequate in all patients. Baricitinib was used in 3 patients, ruxolitinib in 2, and tofacitinib in 1. Steroids were concurrently used in all patients, anakinra in one, methotrexate and anakinra in one. At a mean (SD) follow-up of 9.5 months, partial response was observed in 4 (66.7%) cases (patients with ruxolitinib, tofacitinib or baricitinib) and failure in 2 (33.3%) (patients with baricitinib). No patient achieved complete remission. At the last visit, steroids could be decreased but not stopped in all patients. Patients with partial response had an average decrease of 72,8% (90% for tofacitinib, 70% for baricitinib, 58.5% for ruxolitinib between the start and the follow-up end date) and non-responder patients were yet able to reduce steroids by 60,5% (Table 1). Tolerance of JAK inhibitors was excellent, however patient 4 experienced an episode of infectious pulmonary disease.Conclusion:JAK inhibitors therapy may be helpful for some patients with refractory Still’s disease. However, no complete response was observed in this short series of cases. There might be a difference of response between the molecules, although the number of patients is too low to draw conclusions. Additional information is thus needed to evaluate more precisely the risk-benefit ratio of this treatment, and a possible difference in efficacy among the different groups of JAK inhibitors.References:[1]Hu Q, Wang M, Jia J, et al. Ann Rheum Dis 2020;0:1–3. doi:10.1136/annrheumdis-2019-216Table 1.Characteristics of the AOSD patientNo.SexAge (year)Main symptomsTreatments before JAKi onsetJAK inhibitorsSteroids at onset (mg/day)Concomitant treatmentResponse at last F-USteroids at the end of F-U (mg/day)F-U (months)1F6Fever, polyarthritis, rashAINS, ANAKI, TOCI, CANAKI, ADA, THALI, INFLIXRUXOLITINIB 5mgx2/day30P1232M28Fever, polyarthritis, rashANAKIBARICITINIB 4mg/day800N1013M32Fever, polyarthritis, rashTOCI+MTX, ANAKI+MTX, CANAKI+MTX, ADA, CICLO, IgIVBARICITINIB 4mg/day16MTX 20 mg/week ANAKINRA 100mg/dayP12194F40Fever, polyarthritis, rashMTX, IMUREL, CICLO, ETANERCEPT, ANAKI+MTX, TOCI+MTX, IgIVRUXOLITINIB 15mgx2/day60ANAKI 200mg/dayP3045F48Fever, polyarthritis, rashTOCI, ANAKI, CICLO, CANAKI, IMURELTOFACITINIB 5mgx2/day500P7.596F50Fever, polyarthralgia, rashANAKIBARICITINIB 4mg/day600N401F-U: Follow-upN: No responseP: Partial responseAcknowledgements:I thank all the coauthors, particularly Stéphane Mitrovic and Bruno Fautrel. Also, a special thank to the CRI.Disclosure of Interests:None declared
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Cheminet G, Brunetti A, Khimoud D, Ranque B, Michon A, Flamarion E, Pouchot J, Jannot A, Arlet J. Syndrome thoracique aigu chez les patients drépanocytaires adultes : caractéristiques selon le délai de survenue en hospitalisation. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Desbois AC, Régnier P, Quiniou V, Lejoncour A, Maciejewski-Duval A, Comarmond C, Vallet H, Rosenzwag M, Darrasse-Jèze G, Derian N, Pouchot J, Samson M, Bienvenu B, Fouret P, Koskas F, Garrido M, Sène D, Bruneval P, Cacoub P, Klatzmann D, Saadoun D. Specific Follicular Helper T Cell Signature in Takayasu Arteritis. Arthritis Rheumatol 2021; 73:1233-1243. [PMID: 33538119 DOI: 10.1002/art.41672] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/09/2020] [Accepted: 01/28/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Our aim was to compare transcriptome and phenotype profiles of CD4+ T cells and CD19+ B cells in patients with Takayasu arteritis (TAK), patients with giant cell arteritis (GCA), and healthy donors. METHODS Gene expression analyses, flow cytometry immunophenotyping, T cell receptor (TCR) gene sequencing, and functional assessments of cells from peripheral blood and arterial lesions from TAK patients, GCA patients, and healthy donors were performed. RESULTS Among the most significantly dysregulated genes in CD4+ T cells of TAK patients compared to GCA patients (n = 720 genes) and in CD4+ T cells of TAK patients compared to healthy donors (n = 1,447 genes), we identified a follicular helper T (Tfh) cell signature, which included CXCR5, CCR6, and CCL20 genes, that was transcriptionally up-regulated in TAK patients. Phenotypically, there was an increase in CD4+CXCR5+CCR6+CXCR3- Tfh17 cells in TAK patients that was associated with a significant enrichment of CD19+ B cell activation. Functionally, Tfh cells helped B cells to proliferate, differentiate into memory cells, and secrete IgG antibodies. Maturation of B cells was inhibited by JAK inhibitors. Locally, in areas of arterial inflammation, we found a higher proportion of tertiary lymphoid structures comprised CD4+, CXCR5+, programmed death 1+, and CD20+ cells in TAK patients compared to GCA patients. CD4+CXCR5+ T cells in the aortas of TAK patients had an oligoclonal α/β TCR repertoire. CONCLUSION We established the presence of a specific Tfh cell signature in both circulating and aorta-infiltrating CD4+ T cells from TAK patients. The cooperation of Tfh cells and B cells might be critical in the occurrence of vascular inflammation in patients with TAK.
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Affiliation(s)
- A C Desbois
- Sorbonne Université, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, INSERM UMR 959, Groupe Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - P Régnier
- Sorbonne Université, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, INSERM UMR 959, Groupe Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - V Quiniou
- Sorbonne Université, INSERM UMR 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - A Lejoncour
- Sorbonne Université, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, INSERM UMR 959, Groupe Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - A Maciejewski-Duval
- Sorbonne Université, INSERM UMR 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - C Comarmond
- Sorbonne Université, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, INSERM UMR 959, Groupe Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - H Vallet
- Sorbonne Université, INSERM UMR 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - M Rosenzwag
- Sorbonne Université, INSERM UMR 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - G Darrasse-Jèze
- Sorbonne Université, INSERM UMR 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - N Derian
- Sorbonne Université, INSERM UMR 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - J Pouchot
- Hôpital Européen Georges-Pompidou, AP-HP, Université Paris Descartes, Paris, France
| | - M Samson
- Centre Hospitalier Universitaire Dijon Bourgogne, Université Bourgogne-Franche Comté, INSERM EFS Bourgogne-Franche Comté UMR1098, Dijon, France
| | - B Bienvenu
- Centre Hospitalier Universitaire Caen, Caen, France
| | - P Fouret
- Groupe Hospitalier Pitié-Salpétrière, Paris, France
| | - F Koskas
- Groupe Hospitalier Pitié-Salpétrière, Paris, France
| | - M Garrido
- Sorbonne Université, INSERM UMR 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - D Sène
- Hôpital Lariboisière, Paris, France
| | - P Bruneval
- Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - P Cacoub
- Sorbonne Université, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, INSERM UMR 959, Groupe Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - D Klatzmann
- Sorbonne Université, INSERM UMR 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - D Saadoun
- Sorbonne Université, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, INSERM UMR 959, Groupe Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
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Avouac J, Drumez E, Hachulla E, Seror R, Georgin-Lavialle S, El Mahou S, Pertuiset E, Pham T, Marotte H, Servettaz A, Domont F, Chazerain P, Devaux M, Claudepierre P, Langlois V, Mekinian A, Maria ATJ, Banneville B, Fautrel B, Pouchot J, Thomas T, Flipo RM, Richez C. COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases treated with rituximab: a cohort study. Lancet Rheumatol 2021; 3:e419-e426. [PMID: 33786454 PMCID: PMC7993930 DOI: 10.1016/s2665-9913(21)00059-x] [Citation(s) in RCA: 166] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Various observations have suggested that the course of COVID-19 might be less favourable in patients with inflammatory rheumatic and musculoskeletal diseases receiving rituximab compared with those not receiving rituximab. We aimed to investigate whether treatment with rituximab is associated with severe COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases. Methods In this cohort study, we analysed data from the French RMD COVID-19 cohort, which included patients aged 18 years or older with inflammatory rheumatic and musculoskeletal diseases and highly suspected or confirmed COVID-19. The primary endpoint was the severity of COVID-19 in patients treated with rituximab (rituximab group) compared with patients who did not receive rituximab (no rituximab group). Severe disease was defined as that requiring admission to an intensive care unit or leading to death. Secondary objectives were to analyse deaths and duration of hospital stay. The inverse probability of treatment weighting propensity score method was used to adjust for potential confounding factors (age, sex, arterial hypertension, diabetes, smoking status, body-mass index, interstitial lung disease, cardiovascular diseases, cancer, corticosteroid use, chronic renal failure, and the underlying disease [rheumatoid arthritis vs others]). Odds ratios and hazard ratios and their 95% CIs were calculated as effect size, by dividing the two population mean differences by their SD. This study is registered with ClinicalTrials.gov, NCT04353609. Findings Between April 15, 2020, and Nov 20, 2020, data were collected for 1090 patients (mean age 55·2 years [SD 16·4]); 734 (67%) were female and 356 (33%) were male. Of the 1090 patients, 137 (13%) developed severe COVID-19 and 89 (8%) died. After adjusting for potential confounding factors, severe disease was observed more frequently (effect size 3·26, 95% CI 1·66–6·40, p=0·0006) and the duration of hospital stay was markedly longer (0·62, 0·46–0·85, p=0·0024) in the 63 patients in the rituximab group than in the 1027 patients in the no rituximab group. 13 (21%) of 63 patients in the rituximab group died compared with 76 (7%) of 1027 patients in the no rituximab group, but the adjusted risk of death was not significantly increased in the rituximab group (effect size 1·32, 95% CI 0·55–3·19, p=0·53). Interpretation Rituximab therapy is associated with more severe COVID-19. Rituximab will have to be prescribed with particular caution in patients with inflammatory rheumatic and musculoskeletal diseases. Funding None.
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Affiliation(s)
- Jérôme Avouac
- Université de Paris, Service de Rhumatologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Centre Université de Paris, Paris, France
| | - Elodie Drumez
- ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Université de Lille, CHU Lille, Lille, France
| | - Eric Hachulla
- Université de Lille, INSERM, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Autoimmunes Systémiques Rares Du Nord et Nord-Ouest de France, U1286-INFINITE: Institute for Translational Research in Inflammation, Le Kremlin-Bicêtre, France
| | - Raphaèle Seror
- Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Service de Rhumatologie, Centre de Référence des Maladies Autoimmunes Systémiques Rares, Hôpital Bicêtre, INSERM UMR 1184, Le Kremlin-Bicêtre, France
| | - Sophie Georgin-Lavialle
- Sorbonne Université, Service de Médecine Interne, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Soumaya El Mahou
- Service de Rhumatologie, Centre Hospitalier de Tourcoing, Tourcoing, France
| | - Edouard Pertuiset
- Service de Rhumatologie, Centre Hospitalier René Dubos, Pontoise, France
| | - Thao Pham
- Service de Rhumatologie, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Hubert Marotte
- INSERM 1059, Université de Lyon, Saint-Etienne, France.,Service de Rhumatologie and CIC-1408, CHU de Saint-Etienne, Saint-Etienne, France.,CHU de Saint-Etienne, Saint-Etienne, France
| | - Amélie Servettaz
- Service de Médecine Interne, Maladies Infectieuses et Immunologie Clinique, CHU Reims, Hôpital Robert Debré, Reims, France
| | - Fanny Domont
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Service de Médecine Interne et Immunologie Clinique, Paris, France
| | - Pascal Chazerain
- Service de Rhumatologie et Médecine Interne, Groupe Hospitalier Diaconesses-croix St-Simon, Paris, France
| | - Mathilde Devaux
- Service de Médecine Interne, CHI Poissy Saint Germain, Poissy, France
| | - Pascal Claudepierre
- EpiDermE, Université Paris Est Créteil, Service de Rhumatologie, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Vincent Langlois
- Service de Maladies Infectieuses et Médecine Interne, Groupe Hospitalier du Havre, Le Havre, France
| | - Arsène Mekinian
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Médecine Interne et Inflammation- (DMU i3), Paris, France
| | | | - Béatrice Banneville
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Rhumatologie, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Bruno Fautrel
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Rhumatologie, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Jacques Pouchot
- Hôpital Européen Georges-Pompidou, Médecine Interne, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Thierry Thomas
- Service de Rhumatologie, Hôpital Nord, CHU de Saint-Etienne, INSERM U1059, Université de Lyon-Université Jean Monnet, Saint Etienne, France
| | | | - Christophe Richez
- Service de Rhumatologie, Centre de Référence des Maladies Autoimmunes Systémiques Rares de l'Est et du Sud-Ouest de France, CHU de Bordeaux and UMR-CNRS 5164, Université de Bordeaux, Bordeaux, France
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Flamarion E, Reichert C, Sayegh C, de Saint Gilles D, Bariseel R, Arnoux JB, Schmitt C, Poli A, Karras A, Pouchot J, Cheminet G, Penet MA. [Abnormal urine color assessment: The urine wheel]. Rev Med Interne 2021; 43:31-38. [PMID: 33736891 DOI: 10.1016/j.revmed.2021.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 02/14/2021] [Indexed: 12/17/2022]
Abstract
Looking at the urine for diagnostic purposes, once performed by ancient Egyptians, can still provide some valuable clues in modern medicine. Several diseases have been named after their associated urine color and this underlines the clinical value of visual urine inspection: blue diaper disease, purple urine bag syndrome, black urine disease or porphyria. Abnormal urine color could be challenging for the clinician: it may reveal neoplastic disease (urologic cancer; melanoma), cell lysis (rhabdomyolysis; hemolysis), infection (lymphatic filariasis; malaria), enzyme deficiency (porphyria; alkaptonuria), medication or food intake. In this article, we present the diagnostic approach, the mechanisms involved and the main causes of abnormal urine color.
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Affiliation(s)
- Edouard Flamarion
- Hôpital Européen Georges Pompidou, Service de médecine interne, APHP-Centre, Université de Paris, France.
| | - Constance Reichert
- Hôpital Européen Georges Pompidou, Service de médecine interne, APHP-Centre, Université de Paris, France
| | - Caroline Sayegh
- Hôpital Européen Georges Pompidou, Service de médecine interne, APHP-Centre, Université de Paris, France
| | - David de Saint Gilles
- Hôpital Européen Georges Pompidou, Service de médecine interne, APHP-Centre, Université de Paris, France
| | - Romane Bariseel
- Hôpital Européen Georges Pompidou, Service de médecine interne, APHP-Centre, Université de Paris, France
| | - Jean Baptise Arnoux
- Hôpital Necker Enfants Malades, Centre de Référence des Maladies Héréditaires du Métabolisme, APHP-Centre, Université de Paris, France
| | - Caroline Schmitt
- Hôpital Louis Mourier, Centre Français des Porphyries, APHP-Nord, Centre de recherche sur l'inflammation, INSERM U1149, Université de Paris, France
| | - Antoine Poli
- Hôpital Louis Mourier, Centre Français des Porphyries, APHP-Nord, Centre de recherche sur l'inflammation, INSERM U1149, Université de Paris, France
| | - Alexandre Karras
- Hôpital Européen Georges Pompidou, Service de néphrologie, APHP-Centre, Université de Paris, France
| | - Jacques Pouchot
- Hôpital Européen Georges Pompidou, Service de médecine interne, APHP-Centre, Université de Paris, France
| | - Geoffrey Cheminet
- Hôpital Européen Georges Pompidou, Service de médecine interne, APHP-Centre, Université de Paris, France
| | - Marie Aude Penet
- Hôpital Européen Georges Pompidou, Service de médecine interne, APHP-Centre, Université de Paris, France
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Ducharme O, Pouchot J, Amico S, Milpied B, Seneschal J, Beylot-Barry M, Pham-Ledard A. Omalizumab : une nouvelle option thérapeutique pour la pemphigoïde bulleuse. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Touchard J, Perrin G, Berdot S, Pouchot J, Loustalot MC, Sabatier B. Effects of a multifaceted intervention to promote the use of intravenous iron sucrose complex instead of ferric carboxymaltose in patients admitted for more than 24 h. Eur J Clin Pharmacol 2020; 77:189-195. [PMID: 32926203 DOI: 10.1007/s00228-020-02993-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 09/10/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Although more practical for use, the impact of ferric carboxymaltose (FCM) on the hospital budget is considerable, and intravenous iron sucrose complex (ISC) represents a cost-saving alternative for the management of iron deficiency anemia in patients during hospitalization. The Drug Committee decided to reserve FCM for day hospitalizations and contraindications to ISC, especially allergy. ISC was available for prescription for all other situations. METHODS The impact of a multifaceted intervention promoting a switch from FCM to ISC was evaluated using an interrupted time series model with segmented regression analysis. The standardized rate of the dispensing of FCM, ISC, and oral iron by the hospital pharmacy, as well as the rate of the dispensing of packed red blood cells and the number of biological iron status measurements, was analyzed before and after the intervention. RESULTS There was an immediate decrease in FCM consumption following the intervention, with a reduction of 88% (RR: 0.12 [CI95% 0.10 to 0.15]). Conversely, there was a large increase in ISC use (RR: 5.1 [CI95% 4.4 to 5.9]). We did not observe a prescription shift to packed red blood cells or oral iron after the intervention. The time series analysis showed the frequency of iron status testing to remain stable before and after. The direct savings for intravenous iron for 8 months were 187,417.54 €. CONCLUSION Our intervention to lower the impact of intravenous iron therapy on the hospital budget was effective.
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Affiliation(s)
- Justine Touchard
- Pharmacy Department, Georges-Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, 20 rue Leblanc, 75015, Paris, France.
| | - G Perrin
- Pharmacy Department, Georges-Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, 20 rue Leblanc, 75015, Paris, France.,Inserm UMRS 1138 Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Paris, France
| | - S Berdot
- Pharmacy Department, Georges-Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, 20 rue Leblanc, 75015, Paris, France.,Inserm UMRS 1138 Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Paris, France.,Faculty of pharmacy, Clinical Pharmacy Department, Paris-Sud University, Chatenay-Malabry, France
| | - J Pouchot
- Internal Medicine Department, Georges-Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - M C Loustalot
- Pharmacy Department, Georges-Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, 20 rue Leblanc, 75015, Paris, France
| | - B Sabatier
- Pharmacy Department, Georges-Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, 20 rue Leblanc, 75015, Paris, France.,Inserm UMRS 1138 Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Paris, France
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Thizy G, Lafont E, Scemla A, Roux O, Jarraud S, Lebeaux D, Pouchot J, Ader F, Lanternier F. Légionellose en transplantation d’organe solide : étude rétrospective multicentrique sur 10 ans. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Semenov A, Denoix E, Thiebaut M, Michon A, Pouchot J. [Pituitary apoplexy following coronary bypass surgery: A case report and literature review]. Rev Med Interne 2020; 41:852-857. [PMID: 32800377 DOI: 10.1016/j.revmed.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/11/2020] [Accepted: 07/01/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Pituitary apoplexy is a >rare entity that presents with a sudden onset of headache associated with visual and endocrinological disturbances due to pituitary hemorrhage or infarction. It usually occurs in patients with an unknown pituitary adenoma. Cardiac surgery, and especially coronary artery bypass grafting, can be a precipitating factor in these patients. CASE REPORT We report an 82-year-old male patient who presented with sudden headache and delirium, a right sixth cranial nerve palsy, a right temporal hemianopsia, and a severe loss of left eye visual acuity in the immediate post-operative course of a coronary artery bypass surgery. Pituitary apoplexy was demonstrated on both MRI and CT-scan. Trans-sphenoidal surgical decompression was performed 13 days after coronary artery bypass grafting, with immediate beneficial effect on the delirium and a partial recovery of visual disturbances. CONCLUSION Pituitary apoplexy is a rare and life-threatening complication that may occur after cardiac surgery (coronary artery bypass, cardiac valve surgery), often precipitated by the use of cardiopulmonary bypass. It can occur after other surgical procedures (orthopedic, digestive, thoracic). The diagnosis must be considered during the early postoperative period in the presence of unusual and severe headache associated with visual disturbances.
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Affiliation(s)
- A Semenov
- Service de médecine interne, Hôpital Européen Georges Pompidou, 20-40, rue Leblanc, 75015 Paris, France; AP-HP Centre, Université de Paris, Faculté de médecine Paris Descartes, France
| | - E Denoix
- Service de médecine interne, Hôpital Européen Georges Pompidou, 20-40, rue Leblanc, 75015 Paris, France; AP-HP Centre, Université de Paris, Faculté de médecine Paris Descartes, France
| | - M Thiebaut
- Service de médecine interne, Hôpital Européen Georges Pompidou, 20-40, rue Leblanc, 75015 Paris, France; AP-HP Centre, Université de Paris, Faculté de médecine Paris Descartes, France
| | - A Michon
- Service de médecine interne, Hôpital Européen Georges Pompidou, 20-40, rue Leblanc, 75015 Paris, France; AP-HP Centre, Université de Paris, Faculté de médecine Paris Descartes, France
| | - J Pouchot
- Service de médecine interne, Hôpital Européen Georges Pompidou, 20-40, rue Leblanc, 75015 Paris, France; AP-HP Centre, Université de Paris, Faculté de médecine Paris Descartes, France.
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Abstract
"Typical" Cogan's syndrome is defined as a non-syphilitic interstitial keratitis associated with audio-vestibular resembling Ménière's disease with a 2-year maximum delay between these 2 organ impairment. Cogan syndrome is classified as "atypical" in the absence of interstitial keratitis and the presence of other inflammatory eye manifestations, an audio-vestibular impairment different from typical Menière-like disease, or a delay longer than 2 years between eye and audio-vestibular manifestations. Constitutional signs and large-vessel vasculitis is also possible, mostly affecting the thoracic aorta. The presence of acute-phase reactants is common, but no specific laboratory tests are available. The prognosis is dominated by the audio-vestibular impairment and in particular the risk of deafness, while other complications especially vascular complications being rare. Treatment with glucocorticoids is usually necessary and the combination to other immunosuppressive therapies or biological-targeted drugs needs to be determined.
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Affiliation(s)
- A Mekinian
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, service de médecine interne and Inflammation-Immunopathology-Biotherapy Department (DMU i3), 75012 Paris, France.
| | - J Pouchot
- AP-HP, Université de Paris, Hôpital européen Georges Pompidou, Service de médecine interne, Paris, France
| | - T Zenone
- Service de médecine interne, Hôpital de Valence, Valence, France
| | - O Fain
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, service de médecine interne and Inflammation-Immunopathology-Biotherapy Department (DMU i3), 75012 Paris, France
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Pouchot J, Couprie A. A wandering spleen, splenomegaly, hypersplenism, and iron deficiency anaemia. Lancet 2020; 396:412. [PMID: 32771108 DOI: 10.1016/s0140-6736(20)31552-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/11/2020] [Accepted: 07/01/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Jacques Pouchot
- Hôpital européen Georges-Pompidou, Médecine Interne, Assistance Publique, Hôpitaux de Paris, Paris, France.
| | - Anne Couprie
- Hôpital européen Georges-Pompidou, Médecine Interne, Assistance Publique, Hôpitaux de Paris, Paris, France
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Marcombes C, Lafont E, Jullien V, Flamarion E, Dion J, Costedoat-Chalumeau N, Pouchot J, Arlet JB. [Sickle cell trait complications: A case series of 6 patients]. Rev Med Interne 2020; 41:583-590. [PMID: 32768266 DOI: 10.1016/j.revmed.2020.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/19/2020] [Accepted: 04/23/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Patients with sickle cell trait (SCT) are commonly considered as asymptomatic carriers. However, some clinical manifestations may occur. METHODS Here we present a retrospective descriptive study about SCT subjects with at least one complication diagnosed in a sickle cell disease referral center, in Paris, between 2008 and 2019. We also performed a literature review on the complications of SCT subjects. RESULTS Six patients (between 19 and 65 years old) were included. SCT was already known only for 4 of them at the time of the complication. Four patients presented with a splenic infarct after a stay in high altitude or a plane trip, one of them was associated with papillary necrosis; one patient had isolated papillary necrosis, and the last one had splenic sequestration. These complications happened for most of them after exposure to an unusual situation of hypoxia or deshydratation. Five out of 6 patients had a marked elevated C reactive protein. CONCLUSION SCT may cause acute ischemic complications in a context of prolonged hypoxia or dehydration. The most commonly reported are the splenic infarct and the renal papillary necrosis. A study of hemoglobin should be considered in these clinical situations in patients with compatible ethnic origin.
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Affiliation(s)
- C Marcombes
- Département de médecine interne, Centre de référence des syndromes drépanocytaires majeurs de l'adulte, Hôpital européen Georges Pompidou (AP-HP), 20 rue Leblanc, 75015 Paris, France
| | - E Lafont
- Département de médecine interne, Centre de référence des syndromes drépanocytaires majeurs de l'adulte, Hôpital européen Georges Pompidou (AP-HP), 20 rue Leblanc, 75015 Paris, France; Faculté de médecine Paris Descartes, Université de Paris, 15 Rue de l'École de Médecine, 75006 Paris, France
| | - V Jullien
- Département de médecine interne, Centre de référence des syndromes drépanocytaires majeurs de l'adulte, Hôpital européen Georges Pompidou (AP-HP), 20 rue Leblanc, 75015 Paris, France
| | - E Flamarion
- Département de médecine interne, Centre de référence des syndromes drépanocytaires majeurs de l'adulte, Hôpital européen Georges Pompidou (AP-HP), 20 rue Leblanc, 75015 Paris, France
| | - J Dion
- Faculté de médecine Paris Descartes, Université de Paris, 15 Rue de l'École de Médecine, 75006 Paris, France
| | - N Costedoat-Chalumeau
- Faculté de médecine Paris Descartes, Université de Paris, 15 Rue de l'École de Médecine, 75006 Paris, France; Département de médecine interne, Hôpital Cochin (AP-HP), rue Saint Jacques, 75014 Paris, France
| | - J Pouchot
- Département de médecine interne, Centre de référence des syndromes drépanocytaires majeurs de l'adulte, Hôpital européen Georges Pompidou (AP-HP), 20 rue Leblanc, 75015 Paris, France; Faculté de médecine Paris Descartes, Université de Paris, 15 Rue de l'École de Médecine, 75006 Paris, France
| | - J B Arlet
- Département de médecine interne, Centre de référence des syndromes drépanocytaires majeurs de l'adulte, Hôpital européen Georges Pompidou (AP-HP), 20 rue Leblanc, 75015 Paris, France; Faculté de médecine Paris Descartes, Université de Paris, 15 Rue de l'École de Médecine, 75006 Paris, France.
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Coste J, Tarquinio C, Rouquette A, Montel S, Pouchot J. Cross-cultural adaptation and validation of the French version of the credibility/expectancy questionnaire. Further insights into the measured concepts and their relationships. Psychologie Française 2020. [DOI: 10.1016/j.psfr.2018.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wieczorek M, Rotonda C, Coste J, Pouchot J, Saraux A, Guillemin F, Rat AC. Trajectory analysis combining pain and physical function in individuals with knee and hip osteoarthritis: results from the French KHOALA cohort. Rheumatology (Oxford) 2020; 59:3488-3498. [DOI: 10.1093/rheumatology/keaa148] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 02/13/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
The aims of this study were to identify homogeneous subgroups of knee and/or hip OA patients with distinct trajectories of the combination of pain and physical function (PF) over time and to determine the baseline factors associated with these trajectories.
Methods
We used data from the Knee and Hip Osteoarthritis Long-term Assessment (KHOALA) cohort, a French population-based cohort of 878 patients with symptomatic knee and/or hip OA. Pain and PF were measured annually over 5 years with the Medical Outcomes Study Short Form 36 questionnaire. First, trajectory models were estimated with varying numbers of groups for each of the outcomes separately then fitted into a multi-trajectory model. We used multinomial logistic regression to determine the baseline characteristics associated with each trajectory.
Results
Univariate four-class models were identified as most appropriate for pain and PF. Comparison of separate trajectories showed that 41% of patients included in the severe functional limitations trajectory did not belong to the more severe pain trajectory (Cramér’s V statistic = 0.45). Group-based multi-trajectory modelling revealed four distinct trajectories of pain and PF. On multivariate analyses, female sex, older age, high Kellgren grade, low physical activity intensity, low psychosocial distress score (high distress) and low vitality score were associated with the more severe symptoms trajectory.
Conclusion
Over 5 years, we identified four distinct trajectories combining pain and PF. Management of weight, fatigue and psychosocial distress and the practice of physical activity seem important to maintain function and limit pain in patients with lower-limb OA.
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Affiliation(s)
| | | | - Joël Coste
- Biostatistics and Epidemiology Unit, Assistance Publique-Hôpitaux de Paris, Hôtel Dieu, Paris
| | - Jacques Pouchot
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou Hospital, Paris
| | - Alain Saraux
- Rheumatology Department, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), Cavale Blanche University Hospital, Brest
- UMR 1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, CHU, Brest, LabEx IGO, Brest
| | - Francis Guillemin
- EA4360 Apemac, Université de Lorraine, Nancy
- ICIC-1433 Epidémiologie Clinique, CHRU Nancy, Université de Lorraine, Inserm, Nancy
| | - Anne-Christine Rat
- EA4360 Apemac, Université de Lorraine, Nancy
- Department of Rheumatology, CHU Caen, Caen, France
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Pacot L, Pouchot J, De Prost N, Senant M, Tartour E, Le Pimpec-Barthes F, Israel-Biet D, Dragon-Durey MA. Interstitial Lung Disease-Complicated Anti-MDA5 Antibody in Clinically Amyopathic Dermatomyositis Patients: Report of Two Cases With Distinct Clinical Features. Front Med (Lausanne) 2020; 7:77. [PMID: 32211415 PMCID: PMC7076087 DOI: 10.3389/fmed.2020.00077] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/25/2020] [Indexed: 12/25/2022] Open
Abstract
Two patients presented simultaneously to our hospital with distinct clinical features associated with the presence of anti-MDA5 antibodies: the first one was admitted for a skin rash resembling to a toxic epidermal necrosis (Lyell syndrome) and the second one presented with pulmonary manifestations attributed to a diffuse fibrosing interstitial pneumonitis on chest CT-scan. In addition to the skin lesions involving 40% of the body surface area, the first patient developed a rapid diffuse interstitial pneumonitis with respiratory distress justifying the initiation of a systemic immunosuppressive treatment. However, she died 3 weeks after her admission from mesenteric thrombosis associated with septic shock. The second patient respiratory condition worsened despite an intensive immunosuppressive treatment with high doses of intravenous methylprednisolone and cyclophosphamide and plasmapheresis, and required lung transplantation. Anti-MDA5 antibody titer declined and disappeared on anti-rejection treatment. These two cases underline the diagnostic conundrum and the therapeutic difficulties in patients with anti-MDA5 antibodies and clinically amyopathic dermatomyositis (CADM) or interstitial lung disease (ILD), who may undergo rapidly-progressive and fatal outcome. Presence of anti-MDA5 antibodies should always be suspected when confronted to CADM patients with cutaneous ulcerations or ILD to allow a rapid and adapted treatment initiation.
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Affiliation(s)
- Laurence Pacot
- Service d'Immunologie Biologique, Hôpital Européen Georges Pompidou, Paris, France
| | - Jacques Pouchot
- Service de Médecine Interne, Hôpital Européen Georges Pompidou, Paris, France
| | - Nicolas De Prost
- Service de Réanimation Médicale, Hôpital Henri Mondor, Créteil, France
| | - Marie Senant
- Service d'Immunologie Biologique, Hôpital Européen Georges Pompidou, Paris, France.,Université Paris-Descartes, Paris, France
| | - Eric Tartour
- Service d'Immunologie Biologique, Hôpital Européen Georges Pompidou, Paris, France.,Université Paris-Descartes, Paris, France
| | | | - Dominique Israel-Biet
- Université Paris-Descartes, Paris, France.,Service de Pneumologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Marie-Agnes Dragon-Durey
- Service d'Immunologie Biologique, Hôpital Européen Georges Pompidou, Paris, France.,Université Paris-Descartes, Paris, France
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Gendrot M, Passeron A, Michon A, Pouchot J. [Botulism: A case report and literature review]. Rev Med Interne 2020; 41:485-488. [PMID: 32061395 DOI: 10.1016/j.revmed.2020.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/07/2020] [Accepted: 01/24/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Botulism is a rare syndrome resulting from the action of a neurotoxin produced by Clostridium botulinum, that it is potentially life threatening if diagnosis is delayed. CASE REPORT We report a 26-year-old woman who presented an acute onset of bilateral cranial neuropathies associated with an anticholinergic syndrome in the absence fever leading to consider and confirm the diagnosis of botulism. At the end of follow-up, 7 weeks later, the outcome was favorable with an almost complete neurologic recovery. CONCLUSION Although botulism is uncommon, better awareness of its manifestations and high clinical suspicion should shorten diagnostic delay that makes the use of specific antitoxin ineffective. An acute onset of a bilateral oculomotor palsy, a fixed pupillary dilation and descending weakness in the absence of fever is typical of botulism. Outcome is usually favorable with a slow but full neurological recovery.
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Affiliation(s)
- M Gendrot
- Service de médecine interne, université Paris Descartes, AP-HP Centre-université de Paris, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris
| | - A Passeron
- Service de médecine interne, université Paris Descartes, AP-HP Centre-université de Paris, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris
| | - A Michon
- Service de médecine interne, université Paris Descartes, AP-HP Centre-université de Paris, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris
| | - J Pouchot
- Service de médecine interne, université Paris Descartes, AP-HP Centre-université de Paris, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris.
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De Luna G, Darnige L, Roueff S, Peyrard T, Pouchot J, Arlet JB. Usefulness of azacitidine therapy in a sickle cell disease patient with myelodysplastic syndrome. Ann Hematol 2020; 99:661-662. [PMID: 32006149 DOI: 10.1007/s00277-020-03940-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/24/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Gonzalo De Luna
- Internal Medicine Department, Sickle Cell Referral Center, Georges Pompidou European Hospital, AP-HP, Paris, France
- Université de Paris, Paris, France
| | - Luc Darnige
- Université de Paris, Paris, France
- Service d'Hématologie Biologique, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
- INSERM UMR-S1140, Paris, France
| | - Stéphane Roueff
- Nephrology Department, Georges Pompidou European Hospital, AP-HP, INSERM, Paris, France
| | - Thierry Peyrard
- Département Centre National de Référence pour les Groupes Sanguins (CNRGS), Institut National de la Transfusion Sanguine (INTS), 75011, Paris, France
- Laboratory of Excellence GR-Ex, Paris, France
| | - Jacques Pouchot
- Internal Medicine Department, Sickle Cell Referral Center, Georges Pompidou European Hospital, AP-HP, Paris, France
- Université de Paris, Paris, France
| | - Jean-Benoît Arlet
- Internal Medicine Department, Sickle Cell Referral Center, Georges Pompidou European Hospital, AP-HP, Paris, France.
- Université de Paris, Paris, France.
- Laboratory of Excellence GR-Ex, Paris, France.
- Service de Médecine Interne, Hôpital européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France.
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Denoix E, Bomahou C, Clavier L, Ribeil JA, Lionnet F, Bartolucci P, Courbebaisse M, Pouchot J, Arlet JB. Primary Hyperparathyroidism in Sickle Cell Disease: An Unknown Complication of the Disease in Adulthood. J Clin Med 2020; 9:jcm9020308. [PMID: 31979085 PMCID: PMC7073651 DOI: 10.3390/jcm9020308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 01/12/2020] [Accepted: 01/20/2020] [Indexed: 12/13/2022] Open
Abstract
Primary hyperparathyroidism (pHPT) is the third most common endocrine disorder and usually affects patients between 60 and 70 years of age. To our knowledge, this condition has never been studied in young patients with sickle cell disease (SCD). Our objective was to describe the clinical and biological characteristics of pHPT in adult patients with SCD and its management. We conducted a retrospective study that included SCD patients who were diagnosed with pHPT in four SCD referral centers. pHPT was defined by the presence of elevated serum calcium levels with inappropriate normal or increased parathyroid hormone (PTH) serum levels or histopathological evidence of parathyroid adenoma or hyperplasia. Patients with severe renal impairment (GFR <30 mL/min) were excluded. Twenty-eight patients (18 women, 64%; 22 homozygous genotype, 79%) were included. The median age at pHPT diagnosis was 41 years (interquartile range -IQR- 31.5-49.5). The median serum calcium and PTH concentration were, respectively, 2.62 mmol/L (IQR 2.60-2.78) and 105 pg/mL (IQR 69-137). Bone mineral density (BMD) revealed very low BMD (-2.5 SD) in 44% of patients explored (vs. 12.5% among 32 SCD patients matched for SCD genotype, sex, age, and BMI, p = 0.03). Fourteen patients (50%) received surgical treatment, which was successful in all cases, but four of these patients (29%) presented with pHPT recurrence after a median time of 6.5 years. Three of these patients underwent a second cervical surgery that confirmed the presence of a new parathyroid adenoma. These results suggest that SCD is a condition associated with pHPT in young subjects. SCD patients with pHPT have a high risk of very low BMD. A diagnosis of pHPT should be suspected in the presence of mild hypercalcemia or low BMD in SCD patients.
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Affiliation(s)
- Elsa Denoix
- Internal Medicine Department, Sickle Cell Referral Center, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France; (E.D.); (C.B.); (J.P.)
- Faculté de Médecine Paris Descartes, Université de Paris, 75015 Paris, France; (J.-A.R.); (M.C.)
| | - Charlène Bomahou
- Internal Medicine Department, Sickle Cell Referral Center, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France; (E.D.); (C.B.); (J.P.)
- Faculté de Médecine Paris Descartes, Université de Paris, 75015 Paris, France; (J.-A.R.); (M.C.)
| | - Lorraine Clavier
- Service de Diabétologie-Endocrinologie, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, 94010 Creteil, France;
| | - Jean-Antoine Ribeil
- Faculté de Médecine Paris Descartes, Université de Paris, 75015 Paris, France; (J.-A.R.); (M.C.)
- Laboratory of Excellence GR-Ex, 75015 Paris, France
- Biotherapy Department, Sickle Cell Referral Center, Necker Children’s Hospital, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - François Lionnet
- Service de Médecine Interne, Sickle Cell Referral Center, Hôpital Tenon (AP-HP), 4, rue de la Chine, 75020 Paris, France;
| | - Pablo Bartolucci
- Sickle Cell Referral Center, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, 94010 Creteil, France;
- Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de le Recherche Médicale (INSERM) U955, DHU A-TVB, F-94010 Créteil, France
| | - Marie Courbebaisse
- Faculté de Médecine Paris Descartes, Université de Paris, 75015 Paris, France; (J.-A.R.); (M.C.)
- Physiology Department, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - Jacques Pouchot
- Internal Medicine Department, Sickle Cell Referral Center, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France; (E.D.); (C.B.); (J.P.)
- Faculté de Médecine Paris Descartes, Université de Paris, 75015 Paris, France; (J.-A.R.); (M.C.)
| | - Jean-Benoît Arlet
- Internal Medicine Department, Sickle Cell Referral Center, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France; (E.D.); (C.B.); (J.P.)
- Faculté de Médecine Paris Descartes, Université de Paris, 75015 Paris, France; (J.-A.R.); (M.C.)
- Laboratory of Excellence GR-Ex, 75015 Paris, France
- Correspondence: ; Tel.: +33-1-56-09-33-31; Fax: +33-1-56-09-38-16
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Vétois D, Lheure C, Rosencher E, Zaanan A, Auclin E, Pouchot J, Lafont E. [A diffuse rash]. Rev Med Interne 2019; 41:425-426. [PMID: 31870651 DOI: 10.1016/j.revmed.2019.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Affiliation(s)
- D Vétois
- Service de médecine interne, Paris Sorbonne cité, université Paris Descartes, hôpital européen Georges Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - C Lheure
- Service de dermatologie-vénérologie, Paris Sorbonne cité, université Paris Descartes, AP-HP, hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - E Rosencher
- Service de dermatologie-vénérologie, Paris Sorbonne cité, université Paris Descartes, AP-HP, hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - A Zaanan
- Service d'oncologie digestive, Paris Sorbonne cité, université Paris Descartes, hôpital européen Georges Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - E Auclin
- Service d'oncologie digestive, Paris Sorbonne cité, université Paris Descartes, hôpital européen Georges Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - J Pouchot
- Service de médecine interne, Paris Sorbonne cité, université Paris Descartes, hôpital européen Georges Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - E Lafont
- Service de médecine interne, Paris Sorbonne cité, université Paris Descartes, hôpital européen Georges Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France.
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Mangon Q, Smets P, Terrier B, Borie R, Kerschen P, Pouchot J, Aumaître O, Andre M. Les atteintes musculaires dans les vascularites à ANCA. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Laanani M, Weill A, Blotière PO, Pouchot J, Carbonnel F, Coste J. Factors associated with mechanical and systemic adverse events after colonoscopy (France, 2010-2015). Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
More than one million colonoscopies are performed every year in France. They are associated with risks of mechanical and systemic serious adverse events (SAEs) which can be associated with patient, procedure, endoscopist, and facility characteristics. We tried to identify the factors associated with colonic perforation, gastrointestinal bleeding, splenic injury, shock, myocardial infarction, stroke, pulmonary embolism, acute renal failure, and urolithiasis after colonoscopy.
Methods
We analysed data from the French national claims databases (SNDS). A total of 4,088,799 patients, 30 years or older, undergoing a first screening or diagnostic colonoscopy between 2010 and 2015 were identified. SAE rates were estimated, and risk factors associated with SAEs were identified using multilevel logistic regression models, adjusted for patient, colonoscopy, endoscopist, and facility characteristics.
Results
Increasing age was associated with an increasing incidence of mechanical and systemic SAEs. Cancer and cardiovascular comorbidities were associated with mechanical SAEs, and a higher number of pre-existing conditions was associated with shock and acute renal failure. Polypectomy, especially of polyps larger than 1 cm, was associated with an increased risk of perforation (OR = 4.1; 95% CI, 3.4-5.0) and bleeding (OR = 13.3; 95% CI, 11.7-15.1). Mechanical SAEs were associated with the endoscopist’s experience, while systemic SAEs were more frequent in public hospitals than in private clinics.
Conclusions
SAEs related to colonoscopy were more frequent in older patients and in those with comorbidities. Mechanical SAEs were more frequent when colonoscopy was performed by less experienced endoscopists. Systemic SAEs were more frequent in public hospitals, reflecting patient selection processes. The risk of both mechanical and systemic SAEs should be taken into account when deciding to perform colonoscopy, particularly in older patients with multiple pre-existing conditions.
Key messages
Systemic SAEs are not uncommon after colonoscopy and, together with intestinal SAEs, should be considered when considering the need for colonoscopy. Patients at risk of SAEs should be identified and colonoscopy should be performed by experienced endoscopists in these patients. Less invasive alternatives should also be considered in these patients.
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Affiliation(s)
- M Laanani
- EPI-PHARE, Saint-Denis, France
- Department of Public Health Studies, French National Health Insurance, Paris, France
| | - A Weill
- EPI-PHARE, Saint-Denis, France
- Department of Public Health Studies, French National Health Insurance, Paris, France
| | - P O Blotière
- Department of Public Health Studies, French National Health Insurance, Paris, France
| | - J Pouchot
- Internal Medicine unit, Georges Pompidou European Hospital APHP, University Paris Descartes, Paris, France
| | - F Carbonnel
- Gastroenterology Unit, Paris Sud University Hospitals, APHP, Le Kremlin-Bicêtre, France
| | - J Coste
- Department of Public Health Studies, French National Health Insurance, Paris, France
- Biostatistics and Epidemiology Unit, Cochin Hospital APHP, University Paris Descartes, Paris, France
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Veil R, Bussy S, Looten V, Arlet JB, Pouchot J, Jannot AS, Ranque B. Trajectories of Biological Values and Vital Parameters: An Observational Cohort Study of Adult Patients with Sickle Cell Disease Hospitalized for a Non-Complicated Vaso-Occlusive Crisis. J Clin Med 2019; 8:jcm8091502. [PMID: 31546961 PMCID: PMC6780589 DOI: 10.3390/jcm8091502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 02/02/2023] Open
Abstract
Hospital admission of patients with sickle-cell disease (SCD) presenting with a vaso-occlusive crisis (VOC) can be justified by pain refractory to usual outpatient care and/or the occurrence of a complication. Yet, the trajectories of vital parameters and standard biomarkers throughout a non-complicated VOC has not been established. In this observational cohort study, we describe the course of routine parameters throughout 329 hospital stays for non-complicated VOC. We used a new spline-based approach to study and visualize non-specific time-dependent variables extracted from the hospital clinical data warehouse. We identified distinct trends during the VOC for hemoglobin level, leukocytes count, C-Reactive Protein (CRP) level and temperature. Hemoglobin decreased after admission and rarely returned to steady state levels before discharge. White blood cell counts were elevated at admission before immediately decreasing, whereas eosinophils increased slowly throughout the first five days of the stay. In over 95% of non-complicated VOC-related stays, the CRP value was below 100 mg/L within the first day following admission and above normal after 48 hours, and the temperature was below 38 °C throughout the entire stay. Knowing the typical trajectories of these routine parameters during non-complicated VOC may urge the clinicians to be more vigilant in case of deviation from these patterns.
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Affiliation(s)
- Raphael Veil
- Medical Information Department, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France.
- INSERM U1138, University Paris Descartes, Sorbonne University, 75006 Paris, France.
| | - Simon Bussy
- LPSM, CNRS UMR 8001, Sorbonne University, 75005, Paris, France.
| | - Vincent Looten
- Medical Information Department, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France.
- INSERM U1138, University Paris Descartes, Sorbonne University, 75006 Paris, France.
| | - Jean-Benoît Arlet
- Internal Medicine Department, Sickle Cell Referral Center, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France.
| | - Jacques Pouchot
- Internal Medicine Department, Sickle Cell Referral Center, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France.
| | - Anne-Sophie Jannot
- Medical Information Department, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France.
- INSERM U1138, University Paris Descartes, Sorbonne University, 75006 Paris, France.
| | - Brigitte Ranque
- Internal Medicine Department, Sickle Cell Referral Center, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France.
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Coste J, Karras A, Rudnichi A, Dray-Spira R, Pouchot J, Giral P, Zureik M. Statins for primary prevention of cardiovascular disease and the risk of acute kidney injury. Pharmacoepidemiol Drug Saf 2019; 28:1583-1590. [PMID: 31517431 PMCID: PMC6916201 DOI: 10.1002/pds.4898] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 08/02/2019] [Accepted: 08/24/2019] [Indexed: 12/20/2022]
Abstract
Purpose To investigate the risk of acute kidney injury (AKI) in subjects initiating statin therapy for primary prevention of cardiovascular disease (CVD). Methods A nationwide cohort study using French hospital discharge and claims databases was performed, studying subjects from the general population aged 40 to 75 years in 2009, with no history of CVD and no lipid‐lowering drugs during the preceding 3‐year period, followed for up to 7 years. Exposure to statins (type, dose, and time since first use) and to other drugs for CVD risk was assessed. The primary outcome was hospital admission for AKI. Results The cohort included 8 236 279 subjects, 818 432 of whom initiated a statin for primary prevention. During 598 487 785 person‐months exposed to statins, 700 events were observed, corresponding to an incidence of AKI of 4.59 per 10 000 person‐years (7.01 in men, 3.01 in women). AKI mainly occurred in the context of organ failure, sepsis, and genitourinary disease. A 19% increased rate of AKI (hazard ratio = 1.19, 95%CI: 1.08‐1.31) was observed in men exposed to statins, whereas no increase in the overall risk of AKI was observed in women. However, exposure to high‐potency statins was associated with a 72% to 116% increased risk in both genders and a dose‐effect relationship observed for rosuvastatin and atorvastatin. No temporal pattern of occurrence nor interaction with drugs for CVD risk was observed. Conclusions Although the overall risk of AKI appears moderately increased, more attention should be paid to renal function in subjects taking statins for primary prevention both in clinical practice and from a research viewpoint.
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Affiliation(s)
- Joël Coste
- Department of Public Health Studies, French National Health Insurance Fund (CNAM), Paris, France.,Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM), Saint-Denis, France.,Biostatistics and Epidemiology Unit, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Paris, France
| | - Alexandre Karras
- Nephrology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Annie Rudnichi
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM), Saint-Denis, France
| | - Rosemary Dray-Spira
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM), Saint-Denis, France
| | - Jacques Pouchot
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Philippe Giral
- Department of Endocrinology-Metabolism, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié, Paris, France
| | - Mahmoud Zureik
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM), Saint-Denis, France.,Versailles Saint-Quentin-en-Yvelines University, Versailles, France
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Villemur M, Belhadjkacem B, Fabre P, Bully N, Ganne-Carrie N, Jacquart C, Pouchot J, Hauser L, Martinowsky M, Pineau B, Courtois F, Djoudi R, Bierling P. Expérimentation : extension des dons saignées à l’établissement français du sang Île-de-France 2016–2018. Transfus Clin Biol 2019. [DOI: 10.1016/j.tracli.2019.06.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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