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P0362 Bowel urgency in inflammatory bowel disease: The URGENT index
No full textInternational audienceBackground Bowel urgency is commonly defined as the sudden need to rush to the bathroom to empty one’s bowel. In a systematic review including 321 studies evaluating bowel urgency, definition of bowel urgency was heterogeneous (1). In most of these studies, non-validated questionnaires, based on subjective responses of the patients, were used. The objective of this study were to develop the URGENT index, an IBD-specific bowel urgency index, and to evaluate correlation between the URGENT index and the Urgency Numeric Rating Scale (UNRS). Methods URGENT-1 was a cross-sectional, multicenter study with prospective inclusions of IBD patients and with an optional follow-up for a subset of patients. A stratification on the type of IBD was performed. The components of the URGENT index were based on variables describing in systematic review and expert opinion. All the symptoms potentially associated with bowel urgency were collected, and assessed with a 10-point visual analog scale. Results The content validity of the symptoms potentially associated with bowel urgency was tested by five experts. Face validity of the selected items was checked for clarity, comprehension, and ease of response with 20 patients. Then data corresponding to the selected items were collected. The overall Cronbach’s alpha coefficient was 0.972. We systematically removed items based on their individual impact on the overall Cronbach’s Alpha. Three main factors explained most of the variance (87.9%): immediate urgency and action, ability to delay to go to toilets, and emotional and behavioral responses to urgency. There was no difference in gender and IBD type in the distribution in the factorial structure. To construct the index, we extracted the loadings from the PCA results and identified significant loadings with a threshold of 0.6. Next, we calculated the row means for these significant items to create subscale scores for each component. These scores were then weighted by the variance explained by each component. The weights were normalized, and the final index, named URGENT index, was calculated as a weighted sum of the subscale scores. A sample of 40 patients, who were considered as stable, were studied to evaluate the test-retest reliability after a 3- week-period. Consistency of the URGENT index with the UNRS was tested using Spearman correlation test (0.77). Overall, the ICC values indicated good to excellent reliability across different models. Each index proposal will be tested prospectively. Conclusion This study developed an IBD-specific bowel urgency index. This will allow to have a homogeneous and standardized definition of bowel urgency, measure the effectiveness of treatments, and systematically assess this symptom in clinical practice for IBD patients. References Caron B, Ghosh S, Danese S, Peyrin-Biroulet L. Identifying, Understanding, and Managing Fecal Urgency in Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol. 2023 Jun;21(6):1403-1413.e27. doi: 10.1016/j.cgh.2023.02.029. Epub 2023 Mar 9. PMID: 36906079
Évolution des exigences méthodologiques des publications chirurgicales
No full textInternational audienceIl y a près d’une trentaine d’années, Richard Horton, Éditeur du Lancet a qualifié la recherche en chirurgie (et les articles qui la rapportent) d’opéra-comique. Depuis, les études chirurgicales correspondant à un bon niveau de preuves (essais randomisés, méta-analyses) se sont heureusement multipliées et les articles publiés se sont de plus en plus structurés. Les articles de recherche sont généralement classés en différentes catégories : les revues de la littérature qu’elles soient narratives (mises au point et revues systématiques qualitatives) ou quantitatives (méta-analyses et revues parapluie), les articles originaux (essais randomisés et études non-randomisées ou observationnelles et études diagnostiques et études médicoéconomiques), les cas cliniques (techniques chirurgicales et vidéos et images), et les recommandations de pratique clinique
ASO Visual Abstract: Prognosis Associated with Complete Pathological Response Following Neoadjuvant Treatment for Pancreatic AdenOcarciNOma in the FOFLIRINOX Era: The Multicenter TONO Study
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Microsporidiosis in patients with autoimmune diseases undergoing monoclonal antibody associated therapy
No full textInternational audienceWe present Enterocytozoon bieneusi infection in four patients with autoimmune diseases undergoing prolonged monoclonal antibody therapies. Two patients suffered from inflammatory bowel disease and received anti-TNF therapies, whereas two other patients suffered from systemic lupus erythematosus with renal involvement and received anti-CD20 or anti-BLyS protein therapies. Three out of four patients consulted for diarrhea with abdominal pain without intestinal inflammation or bleeding at the time of sampling. The fourth patient did not declare intestinal troubles. Microsporidia genotype detected in this study were S9, C, Wildboard3 with one patient harboring 2 genotypes S6 and EBCMAP-038Management of microsporidia infection included albendazole and reduction of immunosuppression treatment, but no specific treatment was implemented in two other patients. In conclusion, microsporidia infection occurs in patients with autoimmune diseases undergoing prolonged monoclonal antibody therapies. Diagnosis should be carefully assessed in this population and a thorough benefit-risk analysis is essential prior to initiating therapeutic interventions
French protocol for the diagnosis and management of giant cell arteritis
No full textInternational audienceGiant cell arteritis (GCA) is a large-vessel vasculitis that mainly affects women over fifty. GCA usually involves branches from the external carotid arteries, causing symptoms such as headaches, scalp tenderness, and jaw claudication. The most severe complication is ophthalmologic involvement, including acute anterior ischemic optic neuropathy and, less frequently, central retinal artery occlusion with a risk of permanent blindness. Approximately 40% of patients may have involvement of the aorta or its branches, which has a poor prognosis, although this is often asymptomatic at diagnosis. Diagnosis is largely based on imaging techniques such as FDG-PET combined with CT, CT angiography, or MRI angiography of the aorta and its branches. Polymyalgia rheumatica is associated with GCA in 30-50% of cases but may also occur independently. Treatment must be initiated urgently in the presence of ophthalmologic signs or when GCA is strongly suspected to prevent vision loss. The gold standard to confirm the diagnosis is temporal artery biopsy. However, Doppler ultrasound and vascular imaging are also reliable diagnostic techniques. Initially, high doses of corticosteroids like prednisone (40-80mg per day) are the mainstay of treatment. Tocilizumab can be discussed in combination with prednisone for corticosteroid sparing. Long-term management is essential, including monitoring for disease recurrence and corticosteroid-related side effects. General practitioners play a crucial role in early diagnosis, directing patients to specialized centres, and in managing ongoing treatment in collaboration with specialists. This collaboration is essential to address potential long-term complications such as cardiovascular events. They can occur five to ten years after the diagnosis of GCA even when the disease is no longer active, meaning that vigilant follow-up is required due to the patients' age and status
Long term noninvasive respiratory support in children with OSA-I and OSA-II: data of a nation-wide study
No full textInternational audiencePurposeThe aim of the study was to analyze the characteristics of otherwise healthy children with obstructive sleep apnea (OSA; OSA-I) and children with OSA and non-syndromic obesity (OSA-II) treated with long term continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV) in 2019 in France.MethodsData were collected from a national survey on paediatric home noninvasive ventilatory support. CPAP/NIV initiation criteria and duration, age at CPAP/NIV initiation, equipment used and CPAP/NIV settings, and objective compliance were analyzed.ResultsPatients with OSA-I and OSA-II represented 6% (n=84, 71% males) and 10% (n=144, 72% males) of the national cohort, respectively. The apnea-hypopnea index (63% vs 76%), alone or combined with nocturnal gas exchange (25% vs 21%, for OSA-II and OSA-I patients respectively) were used as initiation criteria of CPAP/NIV. OSA-II patients were older at CPAP/NIV initiation (mean age 11.0±4.0 vs 6.8±4.5 years, p<0.001) and were treated for a longer time (2.3±2.6 vs 1.3±1.5 years, p=0.008) than OSA-I patients. NIV was used in 6% of OSA-I patients and 13% of OSA-II patients (p=0.142). Both groups used preferentially a nasal mask. Mean CPAP level was higher in OSA-II patients as compared to OSA-I patients (8.7±2.0 vs 7.7±2.4 cmH2O, p=0.02). Objective compliance was comparable (mean use 6.8±2.6 vs 5.9±3.0 hours/night in OSA-I and OSA-II, respectively, p=0.054).ConclusionSix and 10% of children treated with long term CPAP/NIV in France in 2019 had OSA-I and OSA-II, respectively. Both groups were preferentially treated with CPAP and were comparable except for age, with OSA-II patients being older at CPAP/NIV initiation
Comparative analyses of time efficiency and cost in fabricating fixed implant-supported prostheses in digital, hybrid, and conventional workflows: A systematic review and meta-analysis
No full textInternational audienceStatement of problem: Economic considerations affect whether new technologies are adopted in dental practice. Limited evidence exists regarding the time and cost efficiency of different workflows for fabricating implant-supported restorations.Purpose: The purpose of this systematic review and meta-analysis was to compare the time and cost involved in fabricating fixed implant-supported prostheses using digital, hybrid, and conventional methods throughout the entire prosthetic treatment by analyzing both clinical and laboratory steps.Material and methods: A systematic review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-P 2015 guidelines. The methods and inclusion criteria were specified in a protocol registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration number CRD42023458734). The databases PubMed, Cochrane, and PROSPERO were searched using keywords: (Prosthodontic OR restorative dentistry OR denture) AND (CAD CAM OR Digital workflow OR Computer Dentistry OR Digital Design) AND (Economic OR cost OR Financial OR time efficiency). Two investigators selected articles independently.Results: A qualitative synthesis of 12 articles published from 2010 to 2023 showed that digital scans took less time than conventional impressions (P<.05) in 7 out of 9 articles. Additionally, 8 articles revealed significant reductions in laboratory working time with digital workflows, intermediate times with hybrid workflows, and longer times with conventional workflows (P<.001). Meta-analysis confirmed the time efficiency of digital scanning over conventional impressions (Hedges g=1.65, 95% CI [0.33, 2.98]) and a substantial reduction in laboratory time with digital workflows compared with other workflows (Hedges g=6.55, 95% CI [2.69; 10.42]). However, no significant difference was found in adjustment time between digital and other workflows (Hedges g=0.91, 95% CI [-0.72; 2.55]). Direct laboratory costs were observed to be higher in conventional workflows compared with hybrid or digital workflows, with hybrid workflows also showing elevated costs compared with digital workflows (P<.05).Conclusions: The digital workflow demonstrates potential benefits in reducing scan time, laboratory processing time, and direct laboratory costs for implant-supported restorations in partial edentulism. Further research is needed to validate these findings, particularly for long-span implant-supported fixed partial prostheses
Addressing health inequalities: a case study on an oral health promotion program in New Caledonia
No full textInternational audienceBackgroundDisparities in oral health are deeply rooted in socio-environmental determinants that shape health behaviors and outcomes throughout life. These disparities appear from an early age and disproportionately affect indigenous peoples and socio-economically disadvantaged groups (1, 2). As a result, oral health serves both as a reflection of broader social inequalities and as a potential lever for social justice. The vision of health promotion set out in the Ottawa Charter recognizes the importance of addressing social determinants to achieve health equity, a principle aimed at ensuring equal opportunities for optimal health and well-being (3, 4). However, transforming these determinants requires more than targeted interventions; it requires fundamental change in the political, social, and economic power structures that perpetuate inequalities (5, 6).As a French overseas territory located in the South Pacific, New Caledonia (NC) offers a unique perspective on the implementation of equity principles. NC currently enjoys an innovative status with broad autonomy and has authority over health matters. However, NC faces ongoing challenges related to socio-economic disparities and geographical isolation with a complex political landscape linked to the legacy of its post-colonial context. The territory's multi-ethnic population and geographical disparities lead to significant health inequalities. NC is divided into three provinces (North, South, Loyalty Islands), each characterized by distinct socio-economic conditions and varying access to healthcare. According to the 2019 census, 41% of the population identifies as Oceanian, 24% as European and 11% as Polynesian (7), with Oceanian people residing mainly in the North and Loyalty Islands provinces.This article presents a case study that draws on field experience and epidemiological data to examine the outcomes of a territory-wide oral health promotion program (OHP) implemented in NC in 2014. Indeed, in the pursuit of health equity, research plays a crucial role in providing evidence on health inequalities, guiding policy decisions, and supporting the implementation and long-term evaluation of HP interventions (8). This case study therefore explores the program's results, the persistent challenges observed in the fight against health inequalities, particularly among indigenous and isolated populations, andFrontiers in Public Health 01 frontiersin.org</div
A western diet amplified the deleterious consequences of collagen-induced arthritis on cardiac homeostasis in female rats
No full textInternational audienceThis study aimed at determining the effects of type II collagen (CII)-induced arthritis (CIA) on cardiac homeostasis in the contexts of a laboratory chow (LC) and a Western diet (WD).The influence of dietary docosahexaenoic acid (DHA) was also examined. Sixty female Wistar rats were assigned to five groups. The first two groups were fed the LC and were treated or not with CII (LC+CIA and LC); the third and fourth groups were fed a WD with or without CII treatment (WD+CIA and WD); and the fifth group was treated with CII and it was fed the WD whose 2.5% of the lipid fraction was replaced by DHA (DHA+CIA). Ionic homeostasis, redox status, inflammation markers, and mitochondrial stress were analysed in the heart. CIA reduced the body weight and favoured wasting of the lipid and protein stores. It also reduced cardiac cell density. The CIA subgroups, particularly the WD+CIA rats, showed higher cardiac calcium and lower reduced glutathione to oxidized glutathione ratio. In the LC+CIA rats, no oxidative/nitrosative stress (ONS) was noticed and the mitochondrial extraction yield (MEY) was similar to that measured in the LC subgroup. In contrast, the ONS was higher and the MEY was lower in the WD+CIA subgroup compared to the WD one. The observed differences were not due to inflammation. DHA had little effect on the cardiac consequences of CIA. In conclusion, the WD amplified the deleterious effects of CIA on cardiac homeostasis by weakening the mitochondria via an increased ONS.Key points:-Type II collagen-induced arthritis favoured lipid, protein and carbohydrate wasting maybe via calcium intracellular accumulation and this led to a decreased body weight -A Western diet increased the deleterious cardiac consequences of collagen-induced arthritis by weakening the mitochondria through an amplified oxidative/nitrosative stress -Dietary docosahexaenoic acid had little effect on these parameters, although it tended to increase lipid peroxidation and to decrease intracellular calcium</div
Systematic review of gabapentinoid use during pregnancy and its impact on pregnancy and childhood outcomes: A ConcePTION study
No full textInternational audienceObjective: In the general population, there has been a noticeable rise in the dispensing of gabapentinoids in recent years. The aim of this study was to provide an overview of all available data on the use and safety of gabapentinoids during pregnancy.Methods: A systematic review was performed in PubMed and Reprotox using the search terms: "gabapentin", "pregabalin", "antiepileptic drugs" and terms associated with pregnancy. We included all studies in English that reported on the use and safety of gabapentin and pregabalin during pregnancy. We excluded abstracts, literature reviews, case reports and studies involving fewer than 5 exposures. Descriptive analyses and narrative syntheses were performed.Results: A total of 27 high-quality studies were described. The prevalence of gabapentinoid use during pregnancy remained very low, at less than 1%. Five studies reported significant findings with increased risks of overall congenital anomalies, specific anomalies (nervous system, eyes, oro-facial clefs, urinary and genital system), miscarriage, stillbirth and specific neurodevelopmental outcomes after exposure to pregabalin during pregnancy. Concerning exposure to gabapentin, increased risks of preterm birth, preeclampsia, small-for-gestational-age and NICU admission were reported in two studies.Conclusions: Prenatal exposure to pregabalin is associated with an increased risk of congenital anomalies and long-term neurodevelopmental outcomes while gabapentin exposure was associated with an increased risk of preeclampsia, preterm birth and small-for-gestational age. Larger studies are needed to confirm these data and explore additional outcomes. The combined evidence from this systematic review and animal studies raises concerns about the safety of using gabapentinoids during pregnancy. Careful evaluation of the benefit-risk balance for both mother and fetus/infant is essential when these medications cannot be avoided during pregnancy