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No evidence of clinical efficacy of oxomemazine in cough, according to a systematic review
No full textInternational audiencePurposeCough is a prevalent symptom driving patients to seek medical attention in general practice. Despite its widespread use, the clinical efficacy of oxomemazine, the second most reimbursed molecule in France for symptomatic cough treatment, remains uncertain. This study aims to systematically evaluate the clinical efficacy of oxomemazine in cough.MethodsA systematic literature review with meta-analysis of randomized controlled trials (RCTs) was conducted according to the Rebuild the Evidence Base (REB) protocol. Clinical trials comparing the efficacy of oxomemazine versus placebo or active comparator in cough were searched for. Trials with insufficient data were excluded. Searches were conducted across major databases (Medline, Cochrane Central Register of Controlled Trials, and Embase) and trial registries (World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov). RCTs comparing oxomemazine versus placebo or active comparators in cough were sought. Risk of bias was assessed using the Cochrane Collaboration's RoB2 tool. The protocol was preregistered on PROSPERO under the number CRD42022345496 (15). This study received no funding.ResultsNo RCTs were at low risk of bias. Therefore, no meta-analysis was conducted, in accordance to the pre-specified protocol.ConclusionsThis systematic review highlights the lack of evidence regarding the efficacy of oxomemazine in cough treatment and underscores the need for further well-designed clinical trials to inform its clinical utility in primary care settings
Childhood Langerhans cell histiocytosis hematological involvement: severity associated with BRAFV600E loads
No full textInternational audienceHematological involvement (HI) is one of the life-threatening risk organs (ROs) in Langerhans cell histiocytosis (LCH). Lahey criteria have defined HI since 1975 as hemoglobin <10 g/dL and/or platelets <100 G/L and/or leukopenia (white blood cell count <4 G/L) and/or neutrophils <1.5 G/. Among the 2313 patients <18 years old enrolled in the French National Histiocytosis Registry (1983-2023), 331 developed HI (median age at diagnosis: 1 year); median follow-up lasted 8.1 years. Bone-marrow aspirate smears and biopsies may show reactive histiocytes, hemophagocytosis or myelofibrosis but never confirm the diagnosis. Fifty-eight (17%) patients developed macrophage-activation syndrome, sometimes related to acute Epstein-Barr virus or cytomegalovirus infection, sometimes months before typical LCH manifestations appeared. Hemoglobin and platelet thresholds for initiating transfusion(s) appear to accurately distinguish 2 groups: mild HI (MHI; >7 g/dL and >20 G/L, respectively) and severe HI (SHI; ≤7 g/dL and ≤20 G/L). Each entity has different organ involvements, laboratory parameters, mutational status, blood BRAFV600E loads, drug sensitivities and outcomes (respective MHI and SHI 10-year survival rates: 98% and 73%). Since 1998, mortality first declined with combination Cladribine-cytarabine therapy, and then with mitogen-activated protein-kinase inhibitors since 2014. Forty-one (12%) patients developed neurodegenerative complications that have emerged as a risk for long-term survivors. These results suggest limiting the HI-RO definition to SHI, as it encompasses almost all medical complications of LCH. Future clinical trials might demonstrate that targeted-therapy approaches would be better adapted for these patients, while MHI can be managed with classic therapies
Drastic Reduction in Time to Controlled Viral Load in People With Human Immunodeficiency Virus in France, 2009–2019: A Longitudinal Cohort Study
No full textInternational audienceBackground: Aspirational targets to end AIDS by 2030 include having 95% of people with human immunodeficiency virus (HIV; PWH) diagnosed, 95% treated, and 95% with controlled viral load (VL). Our objective was to describe, using a large French prospective cohort, the median transition times through the cascade of care between 2009 and 2019.Methods: We analyzed patients whose first HIV diagnosis was made between 1 January 2009 and 31 December 2019. Using the Kaplan-Meier method, we estimated the time to linkage to care (from HIV diagnosis to first biological assessment), to treatment (date of first antiretroviral therapy [ART] prescription), and to controlled VL (first value <200 copies/mL). Analyses were disaggregated by time periods and patients' characteristics. Censoring date was 31 December 2021.Results: Among the 16 864 patients linked to care since 2009, the median [Q1; Q3] time from HIV diagnosis to controlled VL decreased from 254 [127-745] to 73 [48-132] days in 2009-2011 and 2018-2019, respectively. Transition times from linkage to care to first ART decreased from 67 [17; 414] in 2009-2011 to 13 [5; 26] days in 2018-2019, and from ART to controlled VL from 83 [35; 130] in 2009-2011 to 38 [28; 90] days in 2018-2019. Differences were observed depending on patients' characteristics.Conclusions: We describe drastic reductions in transition time through the cascade of care, allowing reduction in the transmission period following each new infection. Delayed diagnosis remains the main obstacle to ending AIDS in the next decade
Faire vivre et grandir une communauté de chefs de service : acte 2 en hématologie
No full textInternational audienceIn response to the French hospital system crisis and the challenges faced by the heads of departments, we have undertaken an initiative to create a community of heads of haematology departments willing to assist each other. Our inaugural seminar, held in January 2023, established the foundational "core" group of heads of department. Throughout 2023, this emerging community has prospered, offering sustained support to peers. In January 2024, we broadened our community to include other heads of departments, following a second seminar gathering 36 participants. During this event, we took the time to exchange thoughts and reflect on our missions. Building on the experience of guest speakers and employing methods of co-development and co-construction in plenary sessions, small-group workshops, and social gathering, we were able to discover and experience the collective intelligence, creativity, strength, and support stemming from such a group. This peer community of heads of departments stands as a powerful tool for management support, whereby personal experiences nourish and enrich the experience of others. We hope that our initiative will inspire heads of departments from other specialties so that, together, we can better work towards our missions as heads of departments and collaborate on rebuilding the hospital "from the bottom up"
A comparative study of secondary metabolites profiling and biological activity of Smyrnium olusatrum L. leaf, flower and fruit
No full textInternational audienceEssential oil (EO) composition of Smyrnium olusatrum was characterised by high proportion of furanosesquiterpenes (51.66-69.35%). The leaf methanolic extract composition was found to be rich with Quercetin-O-hexoside (39.78%). Apigenin 6,8-di-Chexoside represent the major component of flower (18.2%) and fruits (18.82%). Flower extract exhibited the highest contents of total phenolic (48.97 mg GAE/g) and flavonoid (52.63 mg RE/g). The β-carotene and lycopene contents were in the order of 4.55-26.14 mg/100g, and 8.00-49.45 mg/100g, respectively. Methanolic extracts and EOs of different organs were found to possess antioxidant activities, as determined by scavenging effect, chelating activity and β-carotene-linoleic acid model system. Furthermore, Fruit S. olusatrum EO exhibited a potent inhibitory activity against Acetylcholinesterase, while the methanolic extract showed a weaker activity. The methanolic extract displayed inhibitory effects on α-amylase, whereas the EOs was not as efficient in inhibiting this enzyme. The observed level of biological activities varied depending on the specific extracts and organs studied
Impact of the analytical optimization of a cation quantification method by capillary electrophoresis using the RGB tool.
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Pack d’accouchement par voie basse : de l’usage unique au réutilisable.
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Réémergence et dynamique spatio-temporelle de l'entérovirus A71 en Europe, 2016 -2022
No full textInternational audienceL’entérovirus A71 (EV-A71), un picornavirus associé à un fort neurotropisme chez l’enfant. Ce virus a réémergé en 2015 en Allemagne sous la forme d’une souche multi-recombinante qui a été à l’origine de deux rebonds épidémiques en 2016 (Espagne, France) et 2019 (France). Les entérovirus se manifestent sous la forme de >100 types antigéniques dont plusieurs dizaines co-circulent en permanence, ce qui facilite la survenue de coinfections. Celles-ci favorisent les échanges génomiques intertypiques par recombinaison génétique et l’émergence de formes recombinantes. Nos objectifs sont de retracer la dissémination de l’EV-A71 en Europe entre 2016 à 2022 et de déterminer l’origine de la réémergence du virus par une analyse génomique comparative incluant les autres types qui ont co-circulé.Une étude rétrospective multicentrique des cas d’infection à EV-A71 en Europe a inclus seize équipes réparties dans treize pays. Les participants ont fourni les données cliniques, les séquences génomiques et/ou des prélèvements biologiques. Les génomes d’EV-A71 et des autres types d’entérovirus ont été déterminés par séquençage Illumina. Les profils de recombinaison ont été établis entre l’EV-A71 et les autres types. La datation moléculaire a été utilisée pour déterminer la diffusion des différentes formes recombinantes.Parmi les 360 cas consolidés d’infections à EV-A71 analysés, 79% sont associés à la souche réémergente assignée au sous-génogroupe C1 (EV-A71/C1) et 10% sont liés au sous-génogroupe C2. L’analyse génomique comparative a permis d’identifier 9 formes recombinantes (notées RF1 à RF9). Deux d’entre elles, RF5 et RF6, sont épidémiques et retrouvées dans neuf pays ; les autres formes recombinantes sont sporadiques. La datation des lignages montre que les formes recombinantes RF5 et RF6 ont émergé entre 2013 et 2014. Les profils de similitude ont révélé de multiples évènements de recombinaison dans les génomes d’EV-A71. Sept formes recombinantes ont été rapportées dans des cas sporadiques, deux ont été épidémiques en Europe. Le taux d’évolution entre les différentes lignées sont similaires. L’analyse des génomes viraux complets améliore la surveillance épidémiologique des clades épidémiques d’EV-A71
The Role of Social Deprivation and Cannabis Use in Explaining Variation in the Incidence of Psychotic Disorders: Findings From the EU-GEI Study
No full textInternational audienceAbstract Background and Hypothesis Recent findings suggest the incidence of first-episode psychotic disorders (FEP) varies according to setting-level deprivation and cannabis use, but these factors have not been investigated together. We hypothesized deprivation would be more strongly associated with variation in FEP incidence than the prevalence of daily or high-potency cannabis use between settings. Study Design We used incidence data in people aged 18–64 years from 14 settings of the EU-GEI study. We estimated the prevalence of daily and high-potency cannabis use in controls as a proxy for usage in the population at-risk; multiple imputations by chained equations and poststratification weighting handled missing data and control representativeness, respectively. We modeled FEP incidence in random intercepts negative binomial regression models to investigate associations with the prevalence of cannabis use in controls, unemployment, and owner-occupancy in each setting, controlling for population density, age, sex, and migrant/ethnic group. Study Results Lower owner-occupancy was independently associated with increased FEP (adjusted incidence rate ratio [aIRR]: 0.76, 95% CI: 0.61–0.95) and non-affective psychosis incidence (aIRR: 0.68, 95% CI: 0.55–0.83), after multivariable adjustment. Prevalence of daily cannabis use in controls was associated with the incidence of affective psychoses (aIRR: 1.53, 95% CI: 1.02–2.31). We found no association between FEP incidence and unemployment or high-potency cannabis use prevalence. Sensitivity analyses supported these findings. Conclusions Lower setting-level owner-occupancy and increased prevalence of daily cannabis use in controls independently contributed to setting-level variance in the incidence of different psychotic disorders. Public health interventions that reduce exposure to these harmful environmental factors could lower the population-level burden of psychotic disorders
Global and risk-group stratified well-being and mental health during the COVID-19 pandemic in adults: Results from the international COH-FIT Study
No full textInternational audienceInternational studies measuring wellbeing/multidimensional mental health before/ during the COVID-19 pandemic, including representative samples for >2 years, identifying risk groups and coping strategies are lacking. COH-FIT is an online, international, anonymous survey measuring changes in well-being (WHO-5) and a composite psychopathology P-score, and their associations with COVID-19 deaths/restrictions, 12 a-priori defined risk individual/cumulative factors, and coping strategies during COVID-19 pandemic (26/04/2020-26/ 06/2022) in 30 languages (representative, weighted non-representative, adults). T-test, χ 2 , penalized cubic splines, linear regression, correlation analyses were conducted. Analyzing 121,066/142,364 initiated surveys, WHO-5/P-score worsened intra-pandemic by 11.1±21.1/13.2±17.9 points (effect size d=0.50/0.60) (comparable results in representative/weighted non-probability samples). Persons with WHO-5 scores indicative of depression screening (<50, 13% to 32%) and major depression (<29, 3% to 12%) significantly increased. WHO-5 worsened from those with mental disorders, female sex, COVID-19-related loss, low-income country location, physical disorders, healthcare worker occupations, large city location, COVID-19 infection, unemployment, firstgeneration immigration, to age=18-29 with a cumulative effect. Similar findings emerged for P-score. Changes were significantly but minimally related to COVID-19 deaths, returning to near-pre-pandemic values after >2 years. The most subjectively effective coping strategies were exercise and walking, internet use, social contacts. Identified risk groups, coping strategies and outcome trajectories can inform global public health strategies.</div