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Longrée M, Colleye O, Collins P, Waxweiler C, Lebas E, Nikkels AF. [Unilocular cutaneous lymphoma : the hand and the blade]. Rev Med Liege 2022; 77:692-695. [PMID: 36484744] [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] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Mycosis fungoides (MF) is the most frequent form of cutaneous lymphomas. MF is known as the great mimicker. The tumour d'emblee form is an exceptional presentation, for which there is no precise treatment guidance. A 45-year old man presented with tumoral MF on the dorsal side of his right hand with an extension to the forefinger. After the histological, immunohistological and the TCR monoclonality proof of MF, different topical and systemic treatments have been administered. As none of these treatments provided satisfying clinical responses, a surgical excision was finally proposed, with a very good clinical outcome and no recurrence observed after 2 months. Although exceptional in the event of an MF in general, localized tumoral forms of MF could readily benefit from a surgical excision.
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Affiliation(s)
- M Longrée
- Étudiante, Faculté de Médecine, ULiège, Belgique
| | - O Colleye
- Laboratoire d'Anatomopathologie, CHU Liège, Belgique
| | - P Collins
- Service de Dermatopathologie, CHU Liège, Belgique
| | - C Waxweiler
- Service de Chirurgie de la Main, CHU Liège, Belgique
| | - E Lebas
- Service de Dermatologie, CHU Liège, Belgique
| | - A F Nikkels
- Service de Dermatologie, CHU Liège, Belgique
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Kentish-Barnes N, Chevret S, Valade S, Jaber S, Kerhuel L, Guisset O, Martin M, Mazaud A, Papazian L, Argaud L, Demoule A, Schnell D, Lebas E, Ethuin F, Hammad E, Merceron S, Audibert J, Blayau C, Delannoy PY, Lautrette A, Lesieur O, Renault A, Reuter D, Terzi N, Philippon-Jouve B, Fiancette M, Ramakers M, Rigaud JP, Souppart V, Asehnoune K, Champigneulle B, Goldgran-Toledano D, Dubost JL, Bollaert PE, Chouquer R, Pochard F, Cariou A, Azoulay E. A three-step support strategy for relatives of patients dying in the intensive care unit: a cluster randomised trial. Lancet 2022; 399:656-664. [PMID: 35065008 DOI: 10.1016/s0140-6736(21)02176-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/29/2021] [Accepted: 09/16/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND In relatives of patients dying in intensive care units (ICUs), inadequate team support can increase the prevalence of prolonged grief and other psychological harm. We aimed to evaluate whether a proactive communication and support intervention would improve relatives' outcomes. METHODS We undertook a prospective, multicentre, cluster randomised controlled trial in 34 ICUs in France, to compare standard care with a physician-driven, nurse-aided, three-step support strategy for families throughout the dying process, following a decision to withdraw or withhold life support. Inclusion criteria were relatives of patients older than 18 years with an ICU length of stay 2 days or longer. Participating ICUs were randomly assigned (1:1 ratio) into an intervention cluster and a control cluster. The randomisation scheme was generated centrally by a statistician not otherwise involved in the study, using permutation blocks of non-released size. In the intervention group, three meetings were held with relatives: a family conference to prepare the relatives for the imminent death, an ICU-room visit to provide active support, and a meeting after the patient's death to offer condolences and closure. ICUs randomly assigned to the control group applied their best standard of care in terms of support and communication with relatives of dying patients. The primary endpoint was the proportion of relatives with prolonged grief (measured with PG-13, score ≥30) 6 months after the death. Analysis was by intention to treat, with the bereaved relatives as the unit of observation. The study is registered with ClinicalTrials.gov, NCT02955992. FINDINGS Between Feb 23, 2017, and Oct 8, 2019, we enrolled 484 relatives of ICU patients to the intervention group and 391 to the control group. 379 (78%) relatives in the intervention group and 309 (79%) in the control group completed the 6-month interview to measure the primary endpoint. The intervention significantly reduced the number of relatives with prolonged grief symptoms (66 [21%] vs 57 [15%]; p=0·035) and the median PG-13 score was significantly lower in the intervention group than in the control group (19 [IQR 14-26] vs 21 [15-29], mean difference 2·5, 95% CI 1·04-3·95). INTERPRETATION Among relatives of patients dying in the ICU, a physician-driven, nurse-aided, three-step support strategy significantly reduced prolonged grief symptoms. FUNDING French Ministry of Health.
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Affiliation(s)
- Nancy Kentish-Barnes
- AP-HP Nord, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France.
| | - Sylvie Chevret
- Department of Biostatistics and Medical Information, UMR 1153, ECSTRRA Team, INSERM, Paris University, Saint Louis Hospital, AP-HP, Paris, France
| | - Sandrine Valade
- AP-HP Nord, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France; AP-HP Centre, Cochin Hospital, Medical Intensive Care, Paris, France
| | - Samir Jaber
- Saint Eloi University Hospital, Department of Anesthesia and Critical Care Medicine, Montpellier and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Lionel Kerhuel
- AP-HP Nord, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France
| | - Olivier Guisset
- Saint André University Hospital, Medical Intensive Care, Bordeaux, France
| | - Maëlle Martin
- Hôtel Dieu University Hospital, Medical Intensive Care, Nantes, France
| | - Amélie Mazaud
- Hospices Civils de Lyon, Edouard Herriot University Hospital, Surgical Intensive Care, Lyon, France
| | - Laurent Papazian
- AP-HM, Hôpital Nord, Medical Intensive Care and Aix-Marseille University, Faculté des Sciences Médicales et Paramédicales, Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, Marseille, France
| | - Laurent Argaud
- Hospices Civils de Lyon, Edouard Herriot Hospital, Medical Intensive Care, and Université de Lyon, Lyon, France
| | - Alexandre Demoule
- AP-HP Sorbonne Université, La Pitié-Salpêtrière University Hospital, Medical Intensive Care Unit and Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - David Schnell
- Angoulême Hospital, Medical and Surgical Intensive Care, Angoulême, France
| | - Eddy Lebas
- Bretagne Atlantique Hospital, Medical and Surgical Intensive Care, Vannes, France
| | - Frédéric Ethuin
- Côte de Nacre University Hospital, Surgical Intensive Care, Caen, France
| | - Emmanuelle Hammad
- AP-HM, Hospital Nord, Anaesthesia and Intensive Care, Marseille, France
| | - Sybille Merceron
- André Mignot Hospital, Medical Intensive Care, Le Chesnay, France
| | - Juliette Audibert
- Louis Pasteur Hospital, Medical and Surgical Intensive Care, Chartres, France
| | - Clarisse Blayau
- AP-HP Sorbonne University, Tenon Hospital, Medical Intensive Care, Paris, France
| | | | - Alexandre Lautrette
- Gabriel Montpied University Hospital, Medical Intensive Care, Clermont Ferrand, France
| | - Olivier Lesieur
- La Rochelle Hospital, Medical and Surgical Intensive Care, La Rochelle, France
| | - Anne Renault
- Cavale Blanche University Hospital, Medical Intensive Care, Brest, France
| | - Danielle Reuter
- Sud Francilien Hospital, Medical and Surgical Intensive Care, Evry, France
| | - Nicolas Terzi
- Grenoble Alpes University Hospital, Medical Intensive Care, Grenoble, France
| | | | - Maud Fiancette
- Les Oudairies Hospital, Medical and Surgical Intensive Care, La Roche-sur-Yon, France
| | - Michel Ramakers
- Saint Lô Hospital, Medical and Surgical Intensive Care, Saint Lô, France
| | | | - Virginie Souppart
- AP-HP Nord, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France
| | - Karim Asehnoune
- Hôtel Dieu University Hospital, Department of Anesthesia and Critical Care, Nantes, France
| | - Benoît Champigneulle
- AP-HP Centre, Hôpital Européen Georges Pompidou, Department of Aaesthesia and Critical Care, Paris, France
| | | | - Jean-Louis Dubost
- René Dubos Hospital, Medical and Surgical Intensive Care, Pontoise, France
| | | | - Renaud Chouquer
- Annecy Hospital, Medical and Surgical Intensive Care, Annecy, France
| | - Frédéric Pochard
- AP-HP Nord, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France; AP-HP Nord, Fernand Widal Hospital, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, Paris, France
| | - Alain Cariou
- AP-HP Centre, Cochin Hospital, Medical Intensive Care, Paris, France; Paris University, Paris, France
| | - Elie Azoulay
- AP-HP Nord, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France; Department of Biostatistics and Medical Information, UMR 1153, ECSTRRA Team, INSERM, Paris University, Saint Louis Hospital, AP-HP, Paris, France
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Massart N, Maxime V, Fillatre P, Razazi K, Ferré A, Moine P, Legay F, Voiriot G, Amara M, Santi F, Nseir S, Marque-Juillet S, Bounab R, Barbarot N, Bruneel F, Luyt CE, Pham T, Pavot A, Monnet X, Richard C, Demoule A, Dres M, Mayaux J, Beurton A, Daubin C, Descamps R, Joret A, Du Cheyron D, Pene F, Chiche JD, Jozwiak M, Jaubert P, Voiriot G, Fartoukh M, Teulier M, Blayau C, Bodenes L, Ferriere N, Auchabie J, Le Meur A, Pignal S, Mazzoni T, Quenot JP, Andreu P, Roudau JB, Labruyère M, Nseir S, Preau S, Poissy J, Mathieu D, Benhamida S, Paulet R, Roucaud N, Thyrault M, Daviet F, Hraiech S, Parzy G, Sylvestre A, Jochmans S, Bouilland AL, Monchi M, Déserts MDD, Mathais Q, Rager G, Pasquier P, Reignier J, Seguin A, Garret C, Canet E, Dellamonica J, Saccheri C, Lombardi R, Kouchit Y, Jacquier S, Mathonnet A, Nay MA, Runge I, Martino F, Flurin L, Rolle A, Carles M, Coudroy R, Thille AW, Frat JP, Rodriguez M, Beuret P, Tientcheu A, Vincent A, Michelin F, Tamion F, Carpentier D, Boyer D, Girault C, Gissot V, Ehrmann S, Gandonniere CS, Elaroussi D, Delbove A, Fedun Y, Huntzinger J, Lebas E, Kisoka G, Grégoire C, Marchetta S, Lambermont B, Argaud L, Baudry T, Bertrand PJ, Dargent A, Guitton C, Chudeau N, Landais M, Darreau C, Ferre A, Gros A, Lacave G, Bruneel F, Neuville M, JérômeDevaquet, Tachon G, Gallo R, Chelha R, Galbois A, Jallot A, Lemoine LC, Kuteifan K, Pointurier V, Jandeaux LM, Mootien J, Damoisel C, Sztrymf B, Schmidt M, Combes A, Chommeloux J, Luyt CE, Schortgen F, Rusel L, Jung C, Gobert F, Vimpere D, Lamhaut L, Sauneuf B, Charrrier L, Calus J, Desmeules I, Painvin B, Tadie JM, Castelain V, Michard B, Herbrecht JE, Baldacini M, Weiss N, Demeret S, Marois C, Rohaut B, Moury PH, Savida AC, Couadau E, Série M, Alexandru N, Bruel C, Fontaine C, Garrigou S, Mahler JC, Leclerc M, Ramakers M, Garçon P, Massou N, Van Vong L, Sen J, Lucas N, Chemouni F, Stoclin A, Avenel A, Faure H, Gentilhomme A, Ricome S, Abraham P, Monard C, Textoris J, Rimmele T, Montini F, Lejour G, Lazard T, Etienney I, Kerroumi Y, Dupuis C, Bereiziat M, Coupez E, Thouy F, Hoffmann C, Donat N, Chrisment A, Blot RM, Kimmoun A, Jacquot A, Mattei M, Levy B, Ravan R, Dopeux L, Liteaudon JM, Roux D, Rey B, Anghel R, Schenesse D, Gevrey V, Castanera J, Petua P, Madeux B, Hartman O, Piagnerelli M, Joosten A, Noel C, Biston P, Noel T, Bouar GLE, Boukhanza M, Demarest E, Bajolet MF, Charrier N, Quenet A, Zylberfajn C, Dufour N, Mégarbane B, Voicu S, Deye N, Malissin I, Legay F, Debarre M, Barbarot N, Fillatre P, Delord B, Laterrade T, Saghi T, Pujol W, Cungi PJ, Esnault P, Cardinale M, Ha VHT, Fleury G, Brou MA, Zafimahazo D, Tran-Van D, Avargues P, Carenco L, Robin N, Ouali A, Houdou L, Le Terrier C, Suh N, Primmaz S, Pugin J, Weiss E, Gauss T, Moyer JD, Burtz CP, La Combe B, Smonig R, Violleau J, Cailliez P, Chelly J, Marchalot A, Saladin C, Bigot C, Fayolle PM, Fatséas J, Ibrahim A, Resiere D, Hage R, Cholet C, Cantier M, Trouiler P, Montravers P, Lortat-Jacob B, Tanaka S, Dinh AT, Duranteau J, Harrois A, Dubreuil G, Werner M, Godier A, Hamada S, Zlotnik D, Nougue H, Mekontso-Dessap A, Carteaux G, Razazi K, De Prost N, Mongardon N, Lamraoui M, Alessandri C, de Roux Q, de Roquetaillade C, Chousterman BG, Mebazaa A, Gayat E, Garnier M, Pardo E, LeaSatre-Buisson, Gutton C, Yvin E, Marcault C, Azoulay E, Darmon M, Oufella HA, Hariri G, Urbina T, Mazerand S, Heming N, Santi F, Moine P, Annane D, Bouglé A, Omar E, Lancelot A, Begot E, Plantefeve G, Contou D, Mentec H, Pajot O, Faguer S, Cointault O, Lavayssiere L, Nogier MB, Jamme M, Pichereau C, Hayon J, Outin H, Dépret F, Coutrot M, Chaussard M, Guillemet L, Goffin P, Thouny R, Guntz J, Jadot L, Persichini R, Jean-Michel V, Georges H, Caulier T, Pradel G, Hausermann MH, Nguyen-Valat TMH, Boudinaud M, Vivier E, SylvèneRosseli, Bourdin G, Pommier C, Vinclair M, Poignant S, Mons S, Bougouin W, Bruna F, Maestraggi Q, Roth C, Bitker L, Dhelft F, Bonnet-Chateau J, Filippelli M, Morichau-Beauchant T, Thierry S, Le Roy C, Jouan MS, Goncalves B, Mazeraud A, Daniel M, Sharshar T, Cadoz C, RostaneGaci, Gette S, Louis G, Sacleux SC, Ordan MA, Cravoisy A, Conrad M, Courte G, Gibot S, Benzidi Y, Casella C, Serpin L, Setti JL, Besse MC, Bourreau A, Pillot J, Rivera C, Vinclair C, Robaux MA, Achino C, Delignette MC, Mazard T, Aubrun F, Bouchet B, Frérou A, Muller L, Quentin C, Degoul S, Stihle X, Sumian C, Bergero N, Lanaspre B, Quintard H, Maiziere EM, Egreteau PY, Leloup G, Berteau F, Cottrel M, Bouteloup M, Jeannot M, Blanc Q, Saison J, Geneau I, Grenot R, Ouchike A, Hazera P, Masse AL, Demiri S, Vezinet C, Baron E, Benchetrit D, Monsel A, Trebbia G, Schaack E, Lepecq R, Bobet M, Vinsonneau C, Dekeyser T, Delforge Q, Rahmani I, Vivet B, Paillot J, Hierle L, Chaignat C, Valette S, Her B, Brunet J, Page M, Boiste F, Collin A, Bavozet F, Garin A, Dlala M, KaisMhamdi, Beilouny B, Lavalard A, Perez S, Veber B, Guitard PG, Gouin P, Lamacz A, Plouvier F, Delaborde BP, Kherchache A, Chaalal A, Ricard JD, Amouretti M, Freita-Ramos S, Roux D, Constantin JM, Assefi M, Lecore M, Selves A, Prevost F, Lamer C, Shi R, Knani L, Floury SP, Vettoretti L, Levy M, Marsac L, Dauger S, Guilmin-Crépon S, Winiszewski H, Piton G, Soumagne T, Capellier G, Putegnat JB, Bayle F, Perrou M, Thao G, Géri G, Charron C, Repessé X, Vieillard-Baron A, Guilbart M, Roger PA, Hinard S, Macq PY, Chaulier K, Goutte S, Chillet P, Pitta A, Darjent B, Bruneau A, Lasocki S, Leger M, Gergaud S, Lemarie P, Terzi N, Schwebel C, Dartevel A, Galerneau LM, Diehl JL, Hauw-Berlemont C, Péron N, Guérot E, Amoli AM, Benhamou M, Deyme JP, Andremont O, Lena D, Cady J, Causeret A, De La Chapelle A, Cracco C, Rouleau S, Schnell D, Foucault C, Lory C, Chapelle T, Bruckert V, Garcia J, Sahraoui A, Abbosh N, Bornstain C, Pernet P, Poirson F, Pasem A, Karoubi P, Poupinel V, Gauthier C, Bouniol F, Feuchere P, Heron A, Carreira S, Emery M, Le Floch AS, Giovannangeli L, Herzog N, Giacardi C, Baudic T, Thill C, Lebbah S, Palmyre J, Tubach F, Hajage D, Bonnet N, Ebstein N, Gaudry S, Cohen Y, Noublanche J, Lesieur O, Sément A, Roca-Cerezo I, Pascal M, Sma N, Colin G, Lacherade JC, Bionz G, Maquigneau N, Bouzat P, Durand M, Hérault MC, Payen JF. Correction to: Characteristics and prognosis of bloodstream infection in patients with COVID‑19 admitted in the ICU: an ancillary study of the COVID‑ICU study. Ann Intensive Care 2022; 12:4. [PMID: 35015163 PMCID: PMC8748185 DOI: 10.1186/s13613-022-00979-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Giet G, Senterre Y, Lebas E, Libon F, Dezfoulian B, Nikkels AF. [Köbner's phenomenon in dermatology]. Rev Med Liege 2021; 76:651-656. [PMID: 34477334] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Köbner's phenomenon and its related phenomena are dermatological curiosities that are still partially misunderstood. The Köbner phenomenon is by far the best known and the most studied. It is characterized as the appearance of an inflammatory or infectious dermatosis in an area of healthy skin after skin trauma. The dermatoses most frequently concerned are psoriasis, lichen planus and vitiligo. The inverse Köbner phenomenon and the Renbök phenomenon are two very similar phenomena. The first represents the disappearance of a skin lesion after skin trauma. The second is characterized by a skin trauma that is more specifically induced by another dermatosis. Finally, the Wolf's isotopic phenomenon corresponds to the appearance of a new dermatosis on an area of the skin that was previously the site of another healed dermatosis.
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Affiliation(s)
- G Giet
- Service de Dermatologie, CHU Liège, Belgique
| | - Y Senterre
- Service de Dermatologie, CHU Liège, Belgique
| | - E Lebas
- Service de Dermatologie, CHU Liège, Belgique
| | - F Libon
- Service de Dermatologie, CHU Liège, Belgique
| | | | - A F Nikkels
- Service de Dermatologie, CHU Liège, Belgique
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Laurent A, Fournier A, Lheureux F, Louis G, Nseir S, Jacq G, Goulenok C, Muller G, Badie J, Bouhemad B, Georges M, Mertes PM, Merdji H, Castelain V, Abdulmalak C, Lesieur O, Plantefeve G, Lacherade JC, Rigaud JP, Sedillot N, Roux D, Terzi N, Beuret P, Monsel A, Poujol AL, Kuteifan K, Vanderlinden T, Renault A, Vivet B, Vinsonneau C, Barbar SD, Capellier G, Dellamonica J, Ehrmann S, Rimmelé T, Bohé J, Bouju P, Gibot S, Lévy B, Temime J, Pichot C, Schnell D, Friedman D, Asfar P, Lebas E, Mateu P, Klouche K, Audibert J, Ecarnot F, Meunier-Beillard N, Loiseau M, François-Pursell I, Binquet C, Quenot JP. Mental health and stress among ICU healthcare professionals in France according to intensity of the COVID-19 epidemic. Ann Intensive Care 2021; 11:90. [PMID: 34089117 PMCID: PMC8177250 DOI: 10.1186/s13613-021-00880-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 05/21/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND We investigated the impact of the COVID-19 crisis on mental health of professionals working in the intensive care unit (ICU) according to the intensity of the epidemic in France. METHODS This cross-sectional survey was conducted in 77 French hospitals from April 22 to May 13 2020. All ICU frontline healthcare workers were eligible. The primary endpoint was the mental health, assessed using the 12-item General Health Questionnaire. Sources of stress during the crisis were assessed using the Perceived Stressors in Intensive Care Units (PS-ICU) scale. Epidemic intensity was defined as high or low for each region based on publicly available data from Santé Publique France. Effects were assessed using linear mixed models, moderation and mediation analyses. RESULTS In total, 2643 health professionals participated; 64.36% in high-intensity zones. Professionals in areas with greater epidemic intensity were at higher risk of mental health issues (p < 0.001), and higher levels of overall perceived stress (p < 0.001), compared to low-intensity zones. Factors associated with higher overall perceived stress were female sex (B = 0.13; 95% confidence interval [CI] = 0.08-0.17), having a relative at risk of COVID-19 (B = 0.14; 95%-CI = 0.09-0.18) and working in high-intensity zones (B = 0.11; 95%-CI = 0.02-0.20). Perceived stress mediated the impact of the crisis context on mental health (B = 0.23, 95%-CI = 0.05, 0.41) and the impact of stress on mental health was moderated by positive thinking, b = - 0.32, 95% CI = - 0.54, - 0.11. CONCLUSION COVID-19 negatively impacted the mental health of ICU professionals. Professionals working in zones where the epidemic was of high intensity were significantly more affected, with higher levels of perceived stress. This study is supported by a grant from the French Ministry of Health (PHRC-COVID 2020).
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Affiliation(s)
- Alexandra Laurent
- Laboratoire de Psychologie: Dynamiques Relationnelles et Processus Identitaires (PsyDREPI), Université de Bourgogne Franche-Comté, Dijon, France.,Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, Dijon, France
| | - Alicia Fournier
- Laboratoire de Psychologie: Dynamiques Relationnelles et Processus Identitaires (PsyDREPI), Université de Bourgogne Franche-Comté, Dijon, France
| | - Florent Lheureux
- Laboratoire de Psychologie, Université de Bourgogne Franche-Comté, Besançon, France
| | - Guillaume Louis
- Service de Réanimation Polyvalente et USC, Hôpital de Mercy, CHR Metz-Thionville, Thionville, France
| | - Saad Nseir
- Critical Care Center, CHU Lille and Lille University, Lille, France
| | - Gwenaelle Jacq
- Medical-Surgical Intensive Care Unit, CH de Versailles, Le Chesnay, France
| | - Cyril Goulenok
- Medical-Surgical Intensive Care Unit, Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, Massy, France
| | - Grégoire Muller
- Service de Médecine Intensive-Réanimation, CHR d'Orléans, Orléans, France
| | - Julio Badie
- Service de Réanimation Polyvalente-USC, Hôpital Nord Franche-Comté, Trevenans, France
| | - Bélaïd Bouhemad
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, Dijon, France
| | | | - Paul-Michel Mertes
- Department of Anesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Hamid Merdji
- Faculté de Médecine, Université de Strasbourg (UNISTRA), Strasbourg, France.,Service de Médecine Intensive-Réanimation, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Vincent Castelain
- Hôpitaux Universitaires de Strasbourg, Médecine Intensive - Réanimation, Hôpital de Hautepierre, Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg, Faculté de Médecine, Université de Strasbourg, Strasbourg, France
| | - Caroline Abdulmalak
- Service de Médecine Intensive-Réanimation, CH de Chalon sur Saône, Chalon sur Saône, France
| | - Olivier Lesieur
- Intensive Care Unit, Groupement Hospitalier La Rochelle-Ré-Aunis, La Rochelle, France
| | | | - Jean-Claude Lacherade
- Service de Médecine Intensive-Réanimation, CH de La Roche-sur-Yon, Chalon sur Saône, France
| | - Jean-Philippe Rigaud
- Service de Médecine Intensive-Réanimation, CH de Dieppe, Dieppe, France.,Espace de Réflexion Éthique de Normandie, Université de Caen, Caen, France
| | - Nicholas Sedillot
- Réanimation Polyvalente, CH de Bourg-en-Bresse, Bourg-en-Bresse, France
| | - Damien Roux
- Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris, Hôpital Louis Mourier, Colombes, France.,Université de Paris, INSERM, UMR 1137 Infection, Antimicrobials, Modelling, Evolution, Paris, France
| | - Nicolas Terzi
- Service de Réanimation Médicale, CHU de Grenoble, Grenoble, France
| | - Pascal Beuret
- Service de Réanimation-Soins Continus du CH de Roanne, Roanne, France
| | - Antoine Monsel
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France.,Sorbonne University, INSERM, UMR-S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, France.,Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Anne-Laure Poujol
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France.,Équipe VCR, École de Psychologues Praticiens, Université Catholique de Paris, EA, 7403, Paris, France.,Laboratoire APEMAC, Université de Lorraine, EA 4360, Université́ de Lorraine, Metz, France
| | | | - Thierry Vanderlinden
- Service de Médecine Intensive Réanimation, Groupe des Hôpitaux de L'Institut Catholique de Lille (GHICL), France, Université Catholique de Lille, Lille, France
| | - Anne Renault
- Service de Réanimation Médicale et Urgences Médicales, CHU de Brest, Brest, France
| | - Bérengère Vivet
- Service de Réanimation Polyvalente, Groupe Hospitalier Intercommunal de La Haute-Saône, Site de Vesoul, Luxeuil-les-Bains, France
| | - Christophe Vinsonneau
- Service de Médecine Intensive Réanimation-Unité de Sevrage Ventilatoire et Réhabilitation, CH de Bethune, Bethune, France
| | - Saber Davide Barbar
- Service des Réanimations, Faculté de Médecine de Montpellier-Nîmes, CHU de Nîmes, France and Université de Montpellier, Nîmes, France
| | - Gilles Capellier
- Réanimation Médicale, University Hospital Besançon, Besançon, France.,EA3920, University of Burgundy-Franche-Comté, Besançon, France
| | | | - Stephan Ehrmann
- Service de Médecine Intensive-Réanimation, Tours, France.,CIC INSERM 1415, CRICS-TriggerSep Network, Tours, France.,INSERM, Centre d'étude des pathologies respiratoires, Université de Tours, U1100, Tours, France
| | - Thomas Rimmelé
- Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France
| | - Julien Bohé
- Service D'anesthésie - Réanimation-Médecine Intensive, CH Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite, Tours, France
| | - Pierre Bouju
- Service Réanimation Polyvalente, Groupe Hospitalier Bretagne Sud, Lorient, France
| | - Sébastien Gibot
- Service de Réanimation Médicale, Hôpital Central, Nancy, France
| | - Bruno Lévy
- Service de Réanimation Médicale, Centre Hospitalier Universitaire Nancy Brabois, Nancy-France-Institut du Cœur et des Vaisseaux. Groupe Choc, équipe 2, Inserm U1116. Faculté de Médecine, Nancy-Brabois, France
| | | | - Cyrille Pichot
- Unité de Surveillance Continue, CH de Dôle, Dôle, France
| | - David Schnell
- Service de Réanimation Polyvalente et USC, CH d'Angoulême, Angoulême, France
| | - Diane Friedman
- Service de Médecine Intensive et Réanimation, Hôpital Raymond Poincaré, Garches, France
| | - Pierre Asfar
- Département de Médecine Intensive-Réanimation, CHU Angers, Angers, France
| | - Eddy Lebas
- Service de Réanimation-USC de Bretagne Atlantique, Vannes, France
| | - Philippe Mateu
- Service de Médecine Intensive-Réanimation-Unité de Recherche Clinique Ardennes Nord, CH de Charleville-Mézieres, Charleville-Mézieres, France
| | - Kada Klouche
- Intensive Care Medicine Department, Lapeyronie Hospital, University Hospital of Montpellier-PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Juliette Audibert
- Service de Réanimation Polyvalente, CH de Chartres, Hôpital Louis Pasteur, Le Coudray, France
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital, Besançon, and EA3920, University of Burgundy-Franche-Comté, Besançon, France
| | - Nicolas Meunier-Beillard
- CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France.,DRCI, USMR, Francois Mitterrand University Hospital, Dijon, France
| | - Mélanie Loiseau
- Service de Médecine Légale CHU Dijon, Cellule D'Urgence Médico-Psychologique de Bourgogne Franche-Comté, Dijon, France
| | - Irène François-Pursell
- Service de Médecine Légale CHU Dijon, Cellule D'Urgence Médico-Psychologique de Bourgogne Franche-Comté, Dijon, France
| | - Christine Binquet
- Inserm et CHU Dijon-Bourgogne, CIC1432, Module Epidémiologie Clinique, Dijon, France
| | - Jean-Pierre Quenot
- Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, France-Equipe Lipness, centre de recherche INSERM UMR1231 et LabEx LipSTIC, Université de Bourgogne-Franche Comté, Dijon, France. .,INSERM, Module Épidémiologie Clinique, Université de Bourgogne Franche-Comté, CIC 1432, Dijon, France. .,Espace de Réflexion Éthique Bourgogne Franche-Comté (EREBFC), Besançon, France. .,Critical Care Department, University Hospital François Mitterrand, 14 rue Paul Gaffarel, 21079, Dijon, France.
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6
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Shahid A, Shepherd K, Shivamurthy V, Lebas E, Calonje E, Baron S, Abdelrahman W. Progressive atrophic indurated plaques in a 16-year-old boy. Clin Exp Dermatol 2021; 46:1146-1149. [PMID: 34042224 DOI: 10.1111/ced.14668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 12/01/2022]
Affiliation(s)
- A Shahid
- Departments of, Dermatology, St John's Institute of Dermatology, London, UK
| | - K Shepherd
- Department of Rheumatology, Evelina London Children's Hospital, London, UK
| | - V Shivamurthy
- Department of Rheumatology, Evelina London Children's Hospital, London, UK
| | - E Lebas
- Dermatopathology, St John's Institute of Dermatology, London, UK
| | - E Calonje
- Dermatopathology, St John's Institute of Dermatology, London, UK
| | - S Baron
- Departments of, Dermatology, St John's Institute of Dermatology, London, UK
| | - W Abdelrahman
- Departments of, Dermatology, St John's Institute of Dermatology, London, UK
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7
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Absil G, Damsin T, Lebas E, Libon F, Somja J, Collins P, Reginster MA, Quatresooz P, Rorive A, Marchal N, Jacquemin D, Bous A, Piret P, Nikkels AF. [Melanoma : the patient's care pathway. From diagnosis to therapy]. Rev Med Liege 2021; 76:489-495. [PMID: 34080385] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The management of melanoma is a typical example of a pluridisciplinary approach, in order to provide the patient with a rapid and adequate treatment plan after the initial diagnosis. Both in the domains of dermatology, pathology and oncology, enormous progress has been made. Recent advances permit a rapid access to diagnostic techniques using teledermoscopy, an improved diagnostic accuracy using dermoscopy, pre-interventional high-frequency ultrasound and optical coherence tomography, a determination of risk factors using immunohistochemistry and genetic analyses on the pathology samples. Furthermore, the development of immunotherapies, in particular the anti-PD1 antibodies, and the directed therapies, therapies permitting an increased number of patients to experience an increased survival with an acceptable tolerance profile in the event of metastatic lesions. This article describes the patient's care pathway, from the initial diagnosis, staging, to an eventual treatment and follow-up.
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Affiliation(s)
- G Absil
- Service de Dermatologie, CHU Liège, Belgique
| | - T Damsin
- Service de Dermatologie, CHU Liège, Belgique
| | - E Lebas
- Service de Dermatologie, CHU Liège, Belgique
| | - F Libon
- Service de Dermatologie, CHU Liège, Belgique
| | - J Somja
- Service de Dermatopathologie, CHU Liège, Belgique
| | - P Collins
- Service de Dermatopathologie, CHU Liège, Belgique
| | | | - P Quatresooz
- Service de Dermatopathologie, CHU Liège, Belgique
| | - A Rorive
- Service d'Oncologie médicale, CHU Liège, Belgique
| | - N Marchal
- Service d'Oncologie médicale, CHU Liège, Belgique
| | - D Jacquemin
- Service de Chirurgie plastique, CHU Liège, Belgique
| | - A Bous
- Service de Chirurgie plastique, CHU Liège, Belgique
| | - P Piret
- Service de Radiothérapie, CHU Liège, Belgique
| | - A F Nikkels
- Service de Dermatologie, CHU Liège, Belgique
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8
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Lebas E, Collins P, Bonnet C, Libon F, Dezfoulian B, Nikkels AF. [Management of mycosis fungoide : focus on brentuximab vedotin]. Rev Med Liege 2021; 76:224-231. [PMID: 33830684] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Recently, brentuximab vedotin (BV) (Adcetris®) obtained the reimbursement in Belgium for the treatment of the primary cutaneous NKT-cell lymphomas mycosis fungoides (MF), large cell anaplastic lymphoma and lymphomatoid papulosis type A. BV is a monoclonal antibody directed against the CD30 expressed on tumoral T cells. The inhibition of this pathway releases the process of apoptosis leading to the cell death of the tumoral cells. BV is reimbursed after the use of another systemic treatment without success and if the number of CD30 positive atypical T-cells is larger than 10 %. BV is administered intravenously every 3 weeks with a dosing of 1,8 mg/kg with a maximum of 16 courses. The response rates exceed 75 %. In some instances, interesting treatment responses have been observed with BV in CD30 negative patients. The principal adverse effects are neutropenia and peripheral neuropathy. Two patients are presented with longstanding multi-resistant MF that were successfully treated with BV.
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Affiliation(s)
- E Lebas
- ) Service de Dermatologie, CHU Liège, Belgique
| | - P Collins
- Service de Dermatopathologie, CHU Liège, Belgique
| | - C Bonnet
- Service d'Hématologie, CHU Liège, Belgique
| | - F Libon
- ) Service de Dermatologie, CHU Liège, Belgique
| | | | - A F Nikkels
- ) Service de Dermatologie, CHU Liège, Belgique
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9
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Demiselle J, Duval G, Hamel JF, Renault A, Bodet-Contentin L, Martin-Lefèvre L, Vivier D, Villers D, Lefèvre M, Robert R, Markowicz P, Lavoué S, Courte A, Lebas E, Chevalier S, Annweiler C, Lerolle N. Determinants of hospital and one-year mortality among older patients admitted to intensive care units: results from the multicentric SENIOREA cohort. Ann Intensive Care 2021; 11:35. [PMID: 33595733 PMCID: PMC7889762 DOI: 10.1186/s13613-021-00804-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 10/09/2020] [Accepted: 01/07/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Improving outcomes of older patients admitted into intensive care units (ICU) is a raising concern. This study aimed at determining which geriatric and ICU parameters were associated with in-hospital and long-term mortality in this population. METHODS We conducted a prospective multicentric observational cohort study, including patients aged 75 years and older requiring mechanical ventilation, admitted between September 2012 and December 2013 into ICU of 13 French hospitals. Comprehensive geriatric assessment at ICU admission and ICU usual parameters were registered in a standardized manner. Survival was recorded and comprehensive geriatric assessment was updated after 1 year during a dedicated home visit. RESULTS 501 patients were analyzed. 108 patients (21.6%) died during the hospital stay. One-year survival rate was 53.8% (IC 95% [49.2%; 58.2%]). Factors associated with increased in-hospital mortality were higher acute illness severity score, resuscitated cardiac arrest as primary ICU diagnosis, perception of anxiety and low quality of life by the proxy, and living in a chronic care facility before ICU admission. Among patients alive at hospital discharge, factors associated with increased 1-year mortality in multivariate analysis were longer duration of mechanical ventilation, all primary ICU diagnoses other than septic shock, a Katz-activities of daily living (ADL) score below 5 and living in a chronic care facility before ICU admission. Among the 163 survivors at 1 year who received a second comprehensive geriatric assessment, the ADL score (functional abilities) showed a significant but moderate decline over time, whereas the Mini-Zarit score (family burden) improved. No significant change in patients' place of life was observed after 1 year, and quality of life was reported as happy-to-very-happy in 88% of survivors. CONCLUSIONS The mortality rate remains high among older ICU patients requiring mechanical ventilation. Factors associated with short- and long-term mortality combined geriatric and ICU criteria, which should be jointly evaluated in routine care. Clinical trial registration NCT01679171.
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Affiliation(s)
- Julien Demiselle
- Service de Médecine Intensive Réanimation et Médecine Hyperbare, Centre Hospitalier Universitaire, 4, Rue Larrey, 49933, Angers Cedex 9, France
| | - Guillaume Duval
- Department of Geriatric Medicine, Angers University Hospital, 4 rue du Larrey, 49933 cedex 9, Angers, France.,Angers University Memory Clinic, Research Center on Autonomy and Longevity, UPRES EA 4638, University of Angers, 4 rue du Larrey, 49933 cedex 9, Angers, France
| | - Jean-François Hamel
- Maison de la Recherche, Centre Hospitalier Universitaire, 4, Rue Larrey, 49933, Angers Cedex 9, France
| | - Anne Renault
- Service de Réanimation Médicale, Centre Hospitalier Universitaire, Boulevard Tanguy Prigent, 29609, Brest, France
| | - Laetitia Bodet-Contentin
- Hôpital Bretonneau, Service de Réanimation Médicale, Centre Hospitalier Régional Universitaire de Tours, 2 Bis Boulevard Tonnellé, 37044, Tours Cedex 09, France
| | - Laurent Martin-Lefèvre
- Service de Réanimation Polyvalente, Centre Hospitalier Départemental Vendée-Hôpital de La-Roche-sur-Yon, Les Oudairies, 85925, La-Roche-sur-Yon Cedex 09, France
| | - Dominique Vivier
- Service de Réanimation Médico-Chirurgicale, Centre Hospitalier du Mans, 194 Avenue Rubillard, 72037, Le Mans Cedex 09, France
| | - Daniel Villers
- Hôtel-Dieu, Service de Médecine Intensive et Réanimation, Centre Hospitalier Universitaire de Nantes, 30 bd Jean Monnet, 44093, Nantes, France
| | - Montaine Lefèvre
- Centre Hospitalier Des Pays de Morlaix, Service de Réanimation Polyvalente, 15, Rue de Kersaint Gilly, BP 97237, 29672, Morlaix Cedex, France
| | - René Robert
- CHU de Poitiers, Service de Réanimation Médicale, 2, Rue de la Milétrie, CS 90577, 86021, Poitiers Cedex, France
| | - Philippe Markowicz
- Centre Hospitalier de Cholet, Service de Réanimation Polyvalente, 1 Rue de Marengo, BP 507, 49325, Cholet Cedex, France
| | - Sylvain Lavoué
- Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, Unité de Réanimation Médicale, 2, Rue Henri Le Guilloux, 35033, Rennes Cedex 9, France
| | - Anne Courte
- Centre Hospitalier de Saint Brieuc, Service de Réanimation Polyvalente, 10, Rue Marcel Proust, BP 2367, 22027, Saint Brieux Cedex 01, France
| | - Eddy Lebas
- Centre Hospitalier Bretagne Atlantique, 20 Boulevard Général Maurice Guillaudot, BP 70555, 56017, Vannes Cedex, France
| | - Stéphanie Chevalier
- Centre Hospitalier de Saint Malo, Service de Réanimation Polyvalente, 1, Rue de la Marne, 35403, Saint Malo Cedex, France
| | - Cédric Annweiler
- Department of Geriatric Medicine, Angers University Hospital, 4 rue du Larrey, 49933 cedex 9, Angers, France.,Angers University Memory Clinic, Research Center on Autonomy and Longevity, UPRES EA 4638, University of Angers, 4 rue du Larrey, 49933 cedex 9, Angers, France.,Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Nicolas Lerolle
- Service de Médecine Intensive Réanimation et Médecine Hyperbare, Centre Hospitalier Universitaire, 4, Rue Larrey, 49933, Angers Cedex 9, France.
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Boissier F, Seegers V, Seguin A, Legriel S, Cariou A, Jaber S, Lefrant JY, Rimmelé T, Renault A, Vinatier I, Mathonnet A, Reuter D, Guisset O, Cracco C, Durand-Gasselin J, Éon B, Thirion M, Rigaud JP, Philippon-Jouve B, Argaud L, Chouquer R, Papazian L, Dedrie C, Georges H, Lebas E, Rolin N, Bollaert PE, Lecuyer L, Viquesnel G, Leone M, Chalumeau-Lemoine L, Garrouste-Orgeas M, Azoulay E, Kentish-Barnes N. Assessing physicians' and nurses' experience of dying and death in the ICU: development of the CAESAR-P and the CAESAR-N instruments. Crit Care 2020; 24:521. [PMID: 32843097 PMCID: PMC7448438 DOI: 10.1186/s13054-020-03191-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/18/2020] [Accepted: 07/20/2020] [Indexed: 11/27/2022] Open
Abstract
Background As an increasing number of deaths occur in the intensive care unit (ICU), studies have sought to describe, understand, and improve end-of-life care in this setting. Most of these studies are centered on the patient’s and/or the relatives’ experience. Our study aimed to develop an instrument designed to assess the experience of physicians and nurses of patients who died in the ICU, using a mixed methodology and validated in a prospective multicenter study. Methods Physicians and nurses of patients who died in 41 ICUs completed the job strain and the CAESAR questionnaire within 24 h after the death. The psychometric validation was conducted using two datasets: a learning and a reliability cohort. Results Among the 475 patients included in the main cohort, 398 nurse and 417 physician scores were analyzed. The global score was high for both nurses [62/75 (59; 66)] and physicians [64/75 (61; 68)]. Factors associated with higher CAESAR-Nurse scores were absence of conflict with physicians, pain control handled with physicians, death disclosed to the family at the bedside, and invasive care not performed. As assessed by the job strain instrument, low decision control was associated with lower CAESAR score (61 (58; 65) versus 63 (60; 67), p = 0.002). Factors associated with higher CAESAR-Physician scores were room dedicated to family information, information delivered together by nurse and physician, families systematically informed of the EOL decision, involvement of the nurse during implementation of the EOL decision, and open visitation. They were also higher when a decision to withdraw or withhold treatment was made, no cardiopulmonary resuscitation was performed, and the death was disclosed to the family at the bedside. Conclusion We described and validated a new instrument for assessing the experience of physicians and nurses involved in EOL in the ICU. This study shows important areas for improving practices.
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Affiliation(s)
- Florence Boissier
- Medical Intensive Care, University Hospital of Poitiers, Poitiers, France.,INSERM CIC 1402 (ALIVE group), Poitiers University, Poitiers, France
| | - Valérie Seegers
- Data Management Research Department DRCI, Angers Hospital and SFR ICAT, University of Angers, Angers, France
| | - Amélie Seguin
- Medical Intensive Care, Caen University Hospital, Caen, France
| | | | - Alain Cariou
- Medical Intensive Care, Assistance Publique Hôpitaux de Paris, Cochin University Hospital, Paris, France.,Paris Descartes University, Paris, France
| | - Samir Jaber
- Saint Eloi Hospital, Centre Hospitalier Universitaire Montpellier, Anesthesia and Critical Care Department B, Montpellier, France.,PhyMedExp, University of Montpellier, Montpellier, France.,INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Jean-Yves Lefrant
- Anesthesia and Intensive Care, Carémeau University Hospital, Nîmes, France.,Nîmes University, Nîmes, France
| | - Thomas Rimmelé
- Anaesthesia and Intensive Care Medicine, Hospices Civils de Lyon, Edouard Herriot University Hospital, Lyon, France.,University Claude Bernard Lyon 1, Lyon, France
| | - Anne Renault
- Medical Intensive Care, Cavale Blanche University Hospital, Brest, France
| | - Isabelle Vinatier
- Medical Intensive Care, Les Oudairies Hospital, La Roche Sur Yon, France
| | | | - Danielle Reuter
- Medical Intensive Care, Assistance Publique Hôpitaux de Paris, Saint Louis University Hospital, Paris, France
| | - Olivier Guisset
- Medical Intensive Care, Saint André University Hospital, Bordeaux, France
| | | | | | - Béatrice Éon
- Anaesthesia and Intensive Care, La Timone University Hospital, Marseille, France
| | - Marina Thirion
- Medical Intensive Care, Victor Dupouy Hospital, Argenteuil, France
| | | | | | - Laurent Argaud
- Medical Intensive Care, Hospices Civils de Lyon, Edouard Herriot University Hospital, Lyon, France.,Lyon Est University, Lyon, France
| | | | - Laurent Papazian
- Medical Intensive Care, Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Marseille, France.,Aix-Marseille University, Marseille, France
| | | | | | - Eddy Lebas
- Intensive Care, Bretagne Atlantique Hospital, Vannes, France
| | - Nathalie Rolin
- Medical Intensive Care, Groupe Hospitalier Sud Ile de France, Melun, France
| | - Pierre-Edouard Bollaert
- Medical Intensive Care, Nancy University Hospital, Nancy, France.,Lorraine University, Nancy, France
| | - Lucien Lecuyer
- Medical Intensive Care, Sud Francilien Hospital, Evry, France
| | | | - Marc Leone
- Aix-Marseille University, Marseille, France.,Anaesthesia and Intensive Care, Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | | | | | - Elie Azoulay
- Medical Intensive Care, Assistance Publique Hôpitaux de Paris, Saint Louis University Hospital, Paris, France.,Biostatistics and Clinical Epidemiology Research Team, U1153, INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Nancy Kentish-Barnes
- Biostatistics and Clinical Epidemiology Research Team, U1153, INSERM, Paris Diderot Sorbonne University, Paris, France. .,Famiréa Research Group, Assistance Publique Hôpitaux de Paris, Saint Louis University Hospital, Paris, France. .,Medical ICU, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.
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11
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Darreau C, Martino F, Saint-Martin M, Jacquier S, Hamel JF, Nay MA, Terzi N, Ledoux G, Roche-Campo F, Camous L, Pene F, Balzer T, Bagate F, Lorber J, Bouju P, Marois C, Robert R, Gaudry S, Commereuc M, Debarre M, Chudeau N, Labroca P, Merouani K, Egreteau PY, Peigne V, Bornstain C, Lebas E, Benezit F, Vally S, Lasocki S, Robert A, Delbove A, Lerolle N. Use, timing and factors associated with tracheal intubation in septic shock: a prospective multicentric observational study. Ann Intensive Care 2020; 10:62. [PMID: 32449053 PMCID: PMC7245631 DOI: 10.1186/s13613-020-00668-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 01/10/2020] [Accepted: 04/22/2020] [Indexed: 01/20/2023] Open
Abstract
Background No recommendation exists about the timing and setting for tracheal intubation and mechanical ventilation in septic shock. Patients and methods This prospective multicenter observational study was conducted in 30 ICUs in France and Spain. All consecutive patients presenting with septic shock were eligible. The use of tracheal intubation was described across the participating ICUs. A multivariate analysis was performed to identify parameters associated with early intubation (before H8 following vasopressor onset). Results Eight hundred and fifty-nine patients were enrolled. Two hundred and nine patients were intubated early (24%, range 4.5–47%), across the 18 centers with at least 20 patients included. The cumulative intubation rate during the ICU stay was 324/859 (38%, range 14–65%). In the multivariate analysis, seven parameters were significantly associated with early intubation and ranked as follows by decreasing weight: Glasgow score, center effect, use of accessory respiratory muscles, lactate level, vasopressor dose, pH and inability to clear tracheal secretions. Global R-square of the model was only 60% indicating that 40% of the variability of the intubation process was related to other parameters than those entered in this analysis. Conclusion Neurological, respiratory and hemodynamic parameters only partially explained the use of tracheal intubation in septic shock patients. Center effect was important. Finally, a vast part of the variability of intubation remained unexplained by patient characteristics. Trial registration Clinical trials NCT02780466, registered on May 23, 2016. https://clinicaltrials.gov/ct2/show/NCT02780466?term=intubatic&draw=2&rank=1.
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Affiliation(s)
- C Darreau
- Medical and Surgical Intensive Care Unit, Le Mans Hospital, Le Mans, France
| | - F Martino
- Medical and Surgical Intensive Care Unit, Guadeloupe University Hospital, Les Abymes, Guadeloupe, France
| | - M Saint-Martin
- Medical and Surgical Intensive Care Unit, Le Mans Hospital, Le Mans, France
| | - S Jacquier
- Medical Intensive Care Unit, Tours University Hospital, Tours, France
| | - J F Hamel
- Methodology and Statistics Department, Angers University Hospital, Angers, France
| | - M A Nay
- Medical Intensive Care Unit, Orleans Regional Hospital, Orléans, France
| | - N Terzi
- Medical Intensive Care Unit, Grenoble University Hospital, La Tronche, France
| | - G Ledoux
- Medical and Surgical Intensive Care Unit, Lille University Hospital, Lille, France
| | - F Roche-Campo
- Intensive Care Unit, Hospital Verge de la Cinta, Tortosa, Spain
| | - L Camous
- Medical Intensive Care Unit, Bicêtre Hospital, AP-HP, Paris, France
| | - F Pene
- Medical Intensive Care Unit, Cochin Hospital, AP-HP, Paris, France
| | - T Balzer
- Medical Intensive Care Unit, Brest University Hospital, Brest, France
| | - F Bagate
- Medical Intensive Care Unit, Henri Mondor Hospital, AP-HP, Paris, France
| | - J Lorber
- Medical and Surgical Intensive Care Unit, La-Roche-sur-Yon Hospital, La Roche-sur-Yon, France
| | - P Bouju
- Medical and Surgical Intensive Care Unit, Sud Bretagne Hospital, Lorient, France
| | - C Marois
- Medical Intensive Care Unit, Pitié-Salpétrière Hospital, AP-HP, Paris, France
| | - R Robert
- Medical Intensive Care Unit, Poitiers University Hospital, Poitiers, France
| | - S Gaudry
- Medical Intensive Care Unit, Louis Mourier Hospital, AP-HP, Colombes, France
| | - M Commereuc
- Medical Intensive Care Unit, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - M Debarre
- Medical and Surgical Intensive Care Unit, Saint Brieuc Hospital, Saint Brieuc, France
| | - N Chudeau
- Medical and Surgical Intensive Care Unit, Le Mans Hospital, Le Mans, France
| | - P Labroca
- Medical Intensive Care Unit, Nancy University Central Hospital, Nancy, France
| | - K Merouani
- Medical and Surgical Intensive Care Unit, Alençon Hospital, Alençon, France
| | - P Y Egreteau
- Medical and Surgical Intensive Care Unit, Morlaix Hospital, Morlaix, France
| | - V Peigne
- Medical and Surgical Intensive Care Unit, Métropole Savoie Hospital, Chambéry, France
| | - C Bornstain
- Medical Intensive Care Unit, Le Raincy-Montfermeil Hospital, Montfermeil, France
| | - E Lebas
- Medical and Surgical Intensive Care Unit, Bretagne Atlantique Hospital, Vannes, France
| | - F Benezit
- Medical and Surgical Intensive Care Unit, Rennes University Hospital, Rennes, France
| | - S Vally
- Medical and Surgical Intensive Care Unit, Martinique University Hospital, Fort-de-France, Martinique, France
| | - S Lasocki
- Surgical Intensive Care Unit, Angers University Hospital, Angers, France
| | - A Robert
- Medical Intensive Care Unit, Nice University Hospital, Nice, France
| | - A Delbove
- Medical Intensive Care Unit, Nantes University Hospital, Nantes, France
| | - N Lerolle
- Medical Intensive Care Unit, Angers University Hospital, Angers, France.
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12
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Libon F, Lebas E, El Hayderi L, De Schaetzen V, Dezfoulian B, Nikkels AF. [Actual treatments of psoriasis : from etanercept to anti-IL17 and anti-IL23 antagonists]. Rev Med Liege 2020; 75:376-381. [PMID: 32496683] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Psoriasis is a chronic inflammatory skin disease affecting around 2-3 % of the population. The disease spectrum evolves from to the knees and elbows limited disease to erythrodermic psoriasis. The impact on the quality of life, the pruritus, the pain from palmo-plantar disease, arthropathic psoriasis and the comorbidities are the major complaints of the patients. The treatment relies on topical treatments with dermocorticosteroids with or without vitamin D derivatives, UVA or UVB phototherapy, conventional treatments including methotrexate, ciclosporin and acitretin, and, since around 15 years, biological treatments. The biological treatments for moderate to severe psoriasis progressed in a spectacular way with an improvement of clinical results and an amelioration of the safety profile at every step. This article discusses these developments from the TNF? antagonists, including etanercept, adalimumab and infliximab to the newly arrivals, the anti-IL17 and anti-IL23 antagonists, the anti-PDE-4 antagonists and the JAK inhibitors.
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Affiliation(s)
- F Libon
- Service de Dermatologie et de Vénéréologie, CHU Liège, Belgique
| | - E Lebas
- Service de Dermatologie et de Vénéréologie, CHU Liège, Belgique
| | - L El Hayderi
- Service de Dermatologie et de Vénéréologie, CHU Liège, Belgique
| | - V De Schaetzen
- Service de Dermatologie et de Vénéréologie, CHU Liège, Belgique
| | - B Dezfoulian
- Service de Dermatologie et de Vénéréologie, CHU Liège, Belgique
| | - A F Nikkels
- Service de Dermatologie et de Vénéréologie, CHU Liège, Belgique
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13
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Doan T, Hinterwirth A, Worden L, Arzika AM, Maliki R, Abdou A, Kane S, Zhong L, Cummings ME, Sakar S, Chen C, Cook C, Lebas E, Chow ED, Nachamkin I, Porco TC, Keenan JD, Lietman TM. Gut microbiome alteration in MORDOR I: a community-randomized trial of mass azithromycin distribution. Nat Med 2019; 25:1370-1376. [PMID: 31406349 DOI: 10.1038/s41591-019-0533-0] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 06/25/2019] [Indexed: 01/25/2023]
Abstract
The MORDOR I trial1, conducted in Niger, Malawi and Tanzania, demonstrated that mass azithromycin distribution to preschool children reduced childhood mortality1. However, the large but simple trial design precluded determination of the mechanisms involved. Here we examined the gut microbiome of preschool children from 30 Nigerien communities randomized to either biannual azithromycin or placebo. Gut microbiome γ-diversity was not significantly altered (P = 0.08), but the relative abundances of two Campylobacter species, along with another 33 gut bacteria, were significantly reduced in children treated with azithromycin at the 24-month follow-up. Metagenomic analysis revealed functional differences in gut bacteria between treatment groups. Resistome analysis showed an increase in macrolide resistance gene expression in gut microbiota in communities treated with azithromycin (P = 0.004). These results suggest that prolonged mass azithromycin distribution to reduce childhood mortality reduces certain gut bacteria, including known pathogens, while selecting for antibiotic resistance.
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Affiliation(s)
- T Doan
- Francis I Proctor Foundation, University of California, San Francisco, CA, USA.
- Department of Ophthalmology, University of California, San Francisco, CA, USA.
| | - A Hinterwirth
- Francis I Proctor Foundation, University of California, San Francisco, CA, USA
| | - L Worden
- Francis I Proctor Foundation, University of California, San Francisco, CA, USA
| | | | - R Maliki
- The Carter Center, Niamey, Niger
| | - A Abdou
- Ministry of Public Health, Niamey, Niger
- Programme National de Soins Oculaires, Niamey, Niger
| | - S Kane
- The Carter Center, Niamey, Niger
| | - L Zhong
- Francis I Proctor Foundation, University of California, San Francisco, CA, USA
| | - M E Cummings
- Francis I Proctor Foundation, University of California, San Francisco, CA, USA
| | - S Sakar
- Francis I Proctor Foundation, University of California, San Francisco, CA, USA
| | - C Chen
- Francis I Proctor Foundation, University of California, San Francisco, CA, USA
| | - C Cook
- Francis I Proctor Foundation, University of California, San Francisco, CA, USA
| | - E Lebas
- Francis I Proctor Foundation, University of California, San Francisco, CA, USA
| | - E D Chow
- Department of Biochemistry and Biophysics, University of California, San Francisco, CA, USA
| | - I Nachamkin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - T C Porco
- Francis I Proctor Foundation, University of California, San Francisco, CA, USA
- Department of Ophthalmology, University of California, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - J D Keenan
- Francis I Proctor Foundation, University of California, San Francisco, CA, USA
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - T M Lietman
- Francis I Proctor Foundation, University of California, San Francisco, CA, USA
- Department of Ophthalmology, University of California, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
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14
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Vanhakendover L, Lebas E, Libon F, Wauters O, Dezfoulian B, Marchal N, Rorive A, Piret P, Quatresooz P, Jacquemin D, Nikkels AF. [Locally advanced and metastatic cutaneous squamous cell carcinoma treated with cemiplimab]. Rev Med Liege 2019; 74:436-440. [PMID: 31373461] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The treatment of locally advanced or metastatic cutaneous squamous cell carcinoma (cSCC) essentially relies on surgery and eventually radiotherapy of the treated site and afferent lymph nodes. Unfortunately, some cases are no candidates for surgery or radiotherapy and a systemic treatment may be indicated. Chemotherapies are only partially efficacious and associated with potential toxicities. A recent study evaluating the efficacy and tolerance of cemiplimab, a PD1 antagonist for locally advanced and metastatic cSCC demonstrated an objective response rate of 49 % and 47 % for locally advanced and metastatic cSCC, while maintaining a response of at least 6 months of 63 % and 60 %, respectively. We present a clinical case of a patient with a locally advanced cSCC of the forehead with bone resorption and cervical lymphadenopathies. After failure of multiple surgical interventions and radiotherapies, he responded partially to cemiplimab immunotherapy with a good safety profile.
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Affiliation(s)
| | - E Lebas
- Service de Dermatologie, CHU Liège, Belgique
| | - F Libon
- Service de Dermatologie, CHU Liège, Belgique
| | - O Wauters
- Service de Dermatologie, CHU Liège, Belgique
| | | | - N Marchal
- Service d'Oncologie médicale, CHU Liège, Belgique
| | - A Rorive
- Service d'Oncologie médicale, CHU Liège, Belgique
| | - P Piret
- Service de Radiothérapie, CHU Liège, Belgique
| | - P Quatresooz
- Service de Dermatopathologie, CHU Liège, Belgique
| | - D Jacquemin
- Service de Chirurgie plastique, CHU Liège, Belgique
| | - A F Nikkels
- Service de Dermatologie, CHU Liège, Belgique
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15
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Lebas E, Clerc B, Mangavelle J, Megard R, Franck N. [Impact of therapeutic advice on prescription of psychotropics for patients with serious mental illness]. Encephale 2019; 45:304-311. [PMID: 30902340 DOI: 10.1016/j.encep.2018.11.006] [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: 07/24/2018] [Revised: 11/13/2018] [Accepted: 11/24/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The improvement of prescription constitutes a major challenge for public health. In France, medication is the third cause of serious adverse reaction. The report of the Parliamentary Commission for Evaluation of Health Policy on adequate use of psychotropics mentions their overconsumption. Promoting practices' dissemination and guidelines' respect is one of the missions of the referral psychosocial rehabilitation centers. Therapeutic advice that is offered consists of suggestions for revision in the patient's treatment with the aim of improving the patient's health. To our knowledge, to date no study has focused on the evaluation of therapeutic advice in psychiatry. The present study aimed at analyzing benefits of therapeutic advice for the patients. To this end: (1) a state of things related to actual practices was carried out: psychotropics prescriptions' problems and therapeutic advice proposed by psychiatrists (quantitative and qualitative assessment); (2) the impact of advice on prescription was assessed; (3) patients' benefits were identified. METHOD This monocentric trial was carried out at the referral psychosocial rehabilitation center of Lyon. This audit was a retrospective observation of electronic medical records (software CortexteNet V2.6). This project was developed by a multidisciplinary staff (pharmacists and psychiatrists) during summer 2015. All patients treated in this center between September 2010 and December 2014 were included. The collection of data was made by two auditors (pharmacist students) thanks to a collection grid with six parts: identification and epidemiology of patients with therapeutic advice, coding tips, benefits, quantitative and qualitative assessment of prescriptions before and after advice. RESULTS Of the 601 records explored during this study, 66 advices (8.3% of patients) were identified. Patients concerned by therapeutic advice were mainly men with schizophrenia between 35 and 40 years, living in a town and addressed by public psychiatrists. Advice was taken into account in 81.7%, partially in 8.1%, and was beneficial in 97%. The main benefits were clinical improvement (48.5%) and reduction of adverse drug events (36.4%). There were no statistically significant differences between prescriptions (quantitatively and qualitatively) before and after therapeutic advice. CONCLUSION In most cases, prescriptions of psychotropics were adequate since only 66 advices (8.3% of patients) were given. Psychosocial rehabilitation centers give medication prescribing advice and promote respect of the guidelines. The collaboration between rehabilitation's psychiatrists and other psychiatrists optimizes patient management. It reduces iatrogenic disorders and improves quality and safety of care. Very few studies deal with the prescription of psychotropics in adult psychiatry. This work highlights the positive effect of therapeutic advice for this population. Further controlled studies should clarify the benefits of therapeutic advice.
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Affiliation(s)
- E Lebas
- Pharmacie à Usage Intérieur, centre hospitalier Le Vinatier, 95, boulevard Pinel, 69678 Bron, France.
| | - B Clerc
- Pharmacie à Usage Intérieur, centre hospitalier Le Vinatier, 95, boulevard Pinel, 69678 Bron, France
| | - J Mangavelle
- Pharmacie à Usage Intérieur, centre hospitalier Le Vinatier, 95, boulevard Pinel, 69678 Bron, France
| | - R Megard
- Pharmacie à Usage Intérieur, centre hospitalier Le Vinatier, 95, boulevard Pinel, 69678 Bron, France
| | - N Franck
- Centre ressource de réhabilitation psychosociale et de remédiation cognitive, Centre hospitalier Le Vinatier, UMR 5229, CNRS & Université Claude Bernard Lyon 1, Université de Lyon, 69678 Bron, France
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16
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Damsin T, Collignon J, Lebas E, Libon F, Dezfoulian B, Nikkels AF. [Treatment of mucocutaneous toxicity of target therapy in oncology]. Rev Med Liege 2019; 74:7-14. [PMID: 30680967] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The spectrum of the mucocutaneous adverse effects of directed oncologic therapies, such as anti-EGFR, anti-VEGF, anti-TK and anti-BRAF, presents similarities but also differences compared to that of the classic chemotherapeutics. This article reviews the dermatological toxicities of the targeted therapies, with 11 clinical cases, including mucositis and oral toxicities, the acne-like eruptions, nail changes and complications, the «hand/foot» syndrome, radiosensitization, alopecias, xerosis and skin fissures. After a brief clinical case presentation and theoretical issues, the clinical management is discussed in detail.
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Affiliation(s)
- Th Damsin
- Service de Dermatologie, CHU Sart Tilman, Liège, Belgique
| | - J Collignon
- Service d'Oncologie Médicale, CHU Sart Tilman, Liège, Belgique
| | - E Lebas
- Service de Dermatologie, CHU Sart Tilman, Liège, Belgique
| | - F Libon
- Service de Dermatologie, CHU Sart Tilman, Liège, Belgique
| | - B Dezfoulian
- Service de Dermatologie, CHU Sart Tilman, Liège, Belgique
| | - A F Nikkels
- Service de Dermatologie, CHU Sart Tilman, Liège, Belgique
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17
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Nikkels A, Lebas E. Should we provide anti‐human papillomavirus vaccination for patients with genital hidradenitis suppurativa? Br J Dermatol 2018; 180:233. [DOI: 10.1111/bjd.17255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A. Nikkels
- Department of Dermatology CHU du Sart Tilman Liège Belgium
- CHU du Sart Tilman University of Liège Liège 4000 Belgium
| | - E. Lebas
- Department of Dermatology CHU du Sart Tilman Liège Belgium
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18
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Giet G, Lebas E, Libon F, Dezfoulian B, Nikkels AF. [What's new in the treatment of suppurative hidradenitis in 2018 ?]. Rev Med Liege 2018; 73:468-473. [PMID: 30188033] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Hidradenitis suppurativa (HS), also known as Verneuil's disease and acne inversa, is a chronic inflammatory skin disease characterized by a dysfunction of the pilosebaceous structures resulting in occlusion and inflammation. The disease usually starts after puberty, on average between twenty and thirty years, with subcutaneous painful inflammatory nodules, abscess collections, fistulization and scars mainly in the axillary, inguinal, sub-mammary, perineal and perianal regions. It is a multifactorial disease with the most commonly cited risk factors or aggravating factors being smoking, obesity, and HS family history. The first line of treatment relies on antibiotics, including tetracyclins, clindamycin and rifampycin. In case of non-response, TNF? antagonists, more specifically adalimumab, may be considered.
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Affiliation(s)
- G Giet
- Service de Dermatologie,CHU Sart Tilman, Liège, Belgique
| | - E Lebas
- Service de Dermatologie,CHU Sart Tilman, Liège, Belgique
| | - F Libon
- Service de Dermatologie,CHU Sart Tilman, Liège, Belgique
| | - B Dezfoulian
- Service de Dermatologie,CHU Sart Tilman, Liège, Belgique
| | - A F Nikkels
- Service de Dermatologie,CHU Sart Tilman, Liège, Belgique
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19
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Kentish-Barnes N, Chaize M, Seegers V, Legriel S, Cariou A, Jaber S, Lefrant JY, Floccard B, Renault A, Vinatier I, Mathonnet A, Reuter D, Guisset O, Cohen-Solal Z, Cracco C, Seguin A, Durand-Gasselin J, Éon B, Thirion M, Rigaud JP, Philippon-Jouve B, Argaud L, Chouquer R, Adda M, Dedrie C, Georges H, Lebas E, Rolin N, Bollaert PE, Lecuyer L, Viquesnel G, Léone M, Chalumeau-Lemoine L, Garrouste M, Schlemmer B, Chevret S, Falissard B, Azoulay É. Complicated grief after death of a relative in the intensive care unit. Eur Respir J 2015; 45:1341-52. [PMID: 25614168 DOI: 10.1183/09031936.00160014] [Citation(s) in RCA: 195] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 10/16/2014] [Indexed: 11/05/2022]
Abstract
An increased proportion of deaths occur in the intensive care unit (ICU). We performed this prospective study in 41 ICUs to determine the prevalence and determinants of complicated grief after death of a loved one in the ICU. Relatives of 475 adult patients were followed up. Complicated grief was assessed at 6 and 12 months using the Inventory of Complicated Grief (cut-off score >25). Relatives also completed the Hospital Anxiety and Depression Scale at 3 months, and the Revised Impact of Event Scale for post-traumatic stress disorder symptoms at 3, 6 and 12 months. We used a mixed multivariate logistic regression model to identify determinants of complicated grief after 6 months. Among the 475 patients, 282 (59.4%) had a relative evaluated at 6 months. Complicated grief symptoms were identified in 147 (52%) relatives. Independent determinants of complicated grief symptoms were either not amenable to changes (relative of female sex, relative living alone and intensivist board certification before 2009) or potential targets for improvements (refusal of treatment by the patient, patient died while intubated, relatives present at the time of death, relatives did not say goodbye to the patient, and poor communication between physicians and relatives). End-of-life practices, communication and loneliness in bereaved relatives may be amenable to improvements.
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Affiliation(s)
| | - Marine Chaize
- For a list of the authors' affiliations see the Acknowledgements section
| | - Valérie Seegers
- For a list of the authors' affiliations see the Acknowledgements section
| | - Stéphane Legriel
- For a list of the authors' affiliations see the Acknowledgements section
| | - Alain Cariou
- For a list of the authors' affiliations see the Acknowledgements section
| | - Samir Jaber
- For a list of the authors' affiliations see the Acknowledgements section
| | - Jean-Yves Lefrant
- For a list of the authors' affiliations see the Acknowledgements section
| | - Bernard Floccard
- For a list of the authors' affiliations see the Acknowledgements section
| | - Anne Renault
- For a list of the authors' affiliations see the Acknowledgements section
| | - Isabelle Vinatier
- For a list of the authors' affiliations see the Acknowledgements section
| | - Armelle Mathonnet
- For a list of the authors' affiliations see the Acknowledgements section
| | - Danielle Reuter
- For a list of the authors' affiliations see the Acknowledgements section
| | - Olivier Guisset
- For a list of the authors' affiliations see the Acknowledgements section
| | - Zoé Cohen-Solal
- For a list of the authors' affiliations see the Acknowledgements section
| | - Christophe Cracco
- For a list of the authors' affiliations see the Acknowledgements section
| | - Amélie Seguin
- For a list of the authors' affiliations see the Acknowledgements section
| | | | - Béatrice Éon
- For a list of the authors' affiliations see the Acknowledgements section
| | - Marina Thirion
- For a list of the authors' affiliations see the Acknowledgements section
| | | | | | - Laurent Argaud
- For a list of the authors' affiliations see the Acknowledgements section
| | - Renaud Chouquer
- For a list of the authors' affiliations see the Acknowledgements section
| | - Mélanie Adda
- For a list of the authors' affiliations see the Acknowledgements section
| | - Céline Dedrie
- For a list of the authors' affiliations see the Acknowledgements section
| | - Hugues Georges
- For a list of the authors' affiliations see the Acknowledgements section
| | - Eddy Lebas
- For a list of the authors' affiliations see the Acknowledgements section
| | - Nathalie Rolin
- For a list of the authors' affiliations see the Acknowledgements section
| | | | - Lucien Lecuyer
- For a list of the authors' affiliations see the Acknowledgements section
| | - Gérard Viquesnel
- For a list of the authors' affiliations see the Acknowledgements section
| | - Marc Léone
- For a list of the authors' affiliations see the Acknowledgements section
| | | | - Maïté Garrouste
- For a list of the authors' affiliations see the Acknowledgements section
| | - Benoit Schlemmer
- For a list of the authors' affiliations see the Acknowledgements section
| | - Sylvie Chevret
- For a list of the authors' affiliations see the Acknowledgements section
| | - Bruno Falissard
- For a list of the authors' affiliations see the Acknowledgements section
| | - Élie Azoulay
- For a list of the authors' affiliations see the Acknowledgements section
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20
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Yates VM, Lebas E, Orpiay R, Bale BJ. Management of snakebites by the staff of a rural clinic: the impact of providing free antivenom in a nurse-led clinic in Meserani, Tanzania. Annals of Tropical Medicine & Parasitology 2013; 104:439-48. [DOI: 10.1179/136485910x12743554760306] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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21
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Failla V, Sabatiello M, Lebas E, de Schaetzen V, Dezfoulian B, Nikkels AF. [Cutaneous adverse effects of TNFalpha antagonists]. Rev Med Liege 2012; 67 Spec No:3-7. [PMID: 22690479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The TNFalpha antagonists, including adalimumab, etanercept and infliximab, represent a class of anti-inflammatory and immunosuppressive drugs. Although cutaneous adverse effects are uncommon, they are varied. There is no particular risk profile to develop cutaneous adverse effects. The principal acute side effects are injection site reactions and pruritus. The major long term cutaneous side effects are infectious and inflammatory conditions. Neoplastic skin diseases are exceptional. The association with other immunosuppressive agents can increase the risk of developing cutaneous adverse effects. Some adverse effects, such as lupus erythematosus, require immediate withdrawal of the biological treatment, while in other cases temporary withdrawal is sufficient. The majority of the other cutaneous adverse effects can be dealt without interrupting biologic treatment. Preclinical and clinical investigations revealed that the new biologics, aiming IL12/23, IL23 and IL17, present a similar profile of cutaneous adverse effects, although inflammatory skin reactions may be less often encountered compared to TNFalpha antagonists.
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Affiliation(s)
- V Failla
- Service de Dermatologie, CHU de Liège, Belgique
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22
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Abstract
There are no demographic data published on those with viral infections of the pubis (VIPs). We conducted a two-year prospective study to collect demographic information on patients with VIPs. Data were gathered on age, sex, diagnosis, low (≤10) or high (>10) lesion number, symptoms, how the patient discovered the lesions, localization, lesions beyond the pubis, risk factors, shaving habits, human papillomavirus (HPV) vaccination status and treatment. In a total of 61 patients, molluscum contagiosum (MC) was identified in 71%, condylomata acuminata (CA) in 11%, concomitant MC and CA infections in 11% and herpes simplex virus (HSV) infection in 4.8%. Shaving represented a risk factor for a high lesion number, but not for the extension beyond the pubis. MC, CA and HSV infections affecting the pubis are uncommon and often asymptomatic. As they may represent a hidden source of infection we recommend thorough inspection of the pubis during routine skin examination.
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Affiliation(s)
- C Castronovo
- Department of Dermatology, Liège University Hospital, Liège, Belgium
| | - E Lebas
- Department of Dermatology, Liège University Hospital, Liège, Belgium
| | | | - A F Nikkels
- Department of Dermatology, Liège University Hospital, Liège, Belgium
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23
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Caucanas M, El Hayderi L, Lebas E, Richert B, Dezfoulian B, Nikkels AF. [Dermatological complications of temporary and indelible tattoos]. Ann Dermatol Venereol 2010; 138:161-2. [PMID: 21333832 DOI: 10.1016/j.annder.2010.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 09/08/2010] [Indexed: 11/18/2022]
Affiliation(s)
- M Caucanas
- Service de dermatologie, CHU Sart-Tilman, université de Liège, Liège, Belgique
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24
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Gérard J, Lebas E, Godon A, Blanchet O, Geneviève F, Mercat A, Zandecki M. [Free and intracellular bacteria on peripheral blood smears: an uncommon situation related to an adverse prognosis]. Ann Biol Clin (Paris) 2007; 65:87-91. [PMID: 17264045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Accepted: 11/23/2006] [Indexed: 05/13/2023]
Abstract
Bacterial infections are responsible for several changes in the cell blood count, which are usually non specific, although some morphological changes of polymorphonuclear neutrophils may be indicative of sepsis. The presence of bacteria on peripheral blood smears is a rare but extreme situation, related in most instances to a fatal prognosis. The presence of both free and intracellular bacteria was observed in the peripheral blood smear of a critically ill patient with a pneumococcal septicaemia which led to a fatal outcome within the next following hours. If the finding of bacteria on the blood smear is a sign of severe sepsis, the literature review shows that less than 10% of septic patients demonstrate bacteria on the blood smear, and routine search for the diagnosis of sepsis is not recommended. Samples taken from infected central venous catheters are another situation of bacteraemia which must be known, but prognosis is usually not fatal if prompt medical care is performed. Some preanalytical conditions are also associated with the presence of bacteria on the peripheral blood smear, but unrelated to infection of the relevant patient.
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Affiliation(s)
- J Gérard
- Laboratoire d'Hématologie Biologique, Centre Hospitalo-Universitaire, Angers.
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25
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Lebas E, Gielen S, Nguyen M, Ghaye B, Bartsch P, Belaiche J. [Acute colitis in Wegener's disease: a case report]. Rev Med Liege 2006; 61:163-8. [PMID: 16681002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
We report the case of a 52 year old man who was hospitalized within a context of a persistent deterioration of his general condition. He was suspected of having a chronic inflammatory colitis. A pulmonary radiography revealed the presence of voluminous bilateral excavated masses with hydro-aerical levels. After having refuted among others a suspicion of tuberculosis, the results of a thoracic percutaneous transpleural lung aspiration by needle under tomodensitometric control steered our diagnosis towards a vascularitis of the Wegener disease type. A treatment with corticotherapy in large doses completed with cyclophosphamid allowed for clinical, biological and radiological improvement. Wegener's granulomatosis usually starts in an insidious manner with febrile episodes and an impairment of the general condition associated with inflammatory biological signs, as observed in our patient. After these warning symptoms, come ORL and/or pulmonary and/or renal impairment, which represent the classical triad of diffused GW. However a certain number of particularities unusual for that diagnosis characterized our patient and prompted the discussion of this case.
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Affiliation(s)
- E Lebas
- Service d'Hépato-Gastro-Entérologie, CHU Sart-Tilman, Liège
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Lebas E, Paquot N, Scheen AJ. [Adiponectin: a new adipocytokine]. Rev Med Liege 2003; 58:554-8. [PMID: 14626649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Adipose tissue is not simply a store of excess energy, but also secretes a variety of proteins into circulating blood that influence systemic metabolism. These include tumor necrosis factor (TNF-alpha), plasminogen activator inhibitor type 1 (PAI-1), leptin, resistine and adiponectin. These are collectively known as adipocytokines. Adiponectin (also referred to as AdipoQ, Acrp 30, apM1 or GBP28) is a novel adipose-specific protein. A recent genome study mapped a susceptibility locus for type 2 diabetes and the metabolic syndrome on chromosome 3q27, where the adiponectin gene is located. Adiponectin is a peculiar adipocytokine because in contrast to the markedly increased levels of many others, as leptin or TNF-alpha, its level is reduced in obesity and type 2 diabetes. The administration of thiazolidinediones, which are synthetic PPARs-gamma ligands, significantly increases the plasma adiponectin concentrations, an effect that could improve insulin sensitivity. Thus, the administration of adiponectin may provide a novel treatment modality for insulin resistance and type 2 diabetes.
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Affiliation(s)
- E Lebas
- Service de Diabétologie, Nutrition et Maladies métaboliques, Département de Médecine, CHU Sart Tilman, Liège
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Fryns JP, Kleczkowska A, Lebas E, Goffaux P, Van den Berghe H. Complex chromosomal rearrangement in a mentally retarded boy without gross dysmorphic stigmata. Acta Paediatr Scand 1984; 73:138-40. [PMID: 6702444 DOI: 10.1111/j.1651-2227.1984.tb09914.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A boy with severe mental retardation and complex, apparently balanced chromosomal rearrangement (CCR) of autosomes 1, 3 and 5 is described. This complex chromosomal rearrangement involved three translocations and one insertion; five breakpoints were found, at 1p31, 3p22, 3p26, 5p14 and 5q23.
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Lebas E. The state in British and French urban research, or the crisis of the urban question. Sociol Rev Monogr 1983; 30:9-30. [PMID: 6612380 DOI: 10.1111/j.1467-954x.1982.tb00071.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Parloir C, Fryns JP, Deroover J, Lebas E, Goffaux P, van den Berghe H. Short stature, craniofacial dysmorphism and dento-skeletal abnormalities in a large kindred. A variant of K.B.G. syndrome or a new mental retardation syndrome. Clin Genet 1977; 12:263-6. [PMID: 589847 DOI: 10.1111/j.1399-0004.1977.tb00939.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A possibly new mental retardation syndrome is described in a large family. The major features of the syndrome are: short statue, craniofacial dysmorphism and dento-skeletal abnormalities. The mode of inheritance of this syndrome appears to be autosomal dominant with a variable degree of expressivity. The possible similarity to another autosomally dominant inherited mental retardation syndrome, "the K.B.G. syndrome" as described by Hermann et al. (1975), is discussed.
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Fryns JP, Deroover J, Parloir C, Goffaux P, Lebas E, Van Den Berghe H. The foetal alcohol syndrome. Acta Paediatr Belg 1977; 30:117-21. [PMID: 888693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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