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Avis. Risques zoonotiques et traumatiques liés aux contacts des enfants avec les animaux de compagnie non traditionnels (ACNT)
No full textInternational audienceThis report aims to present the risks caused by the child's contact with animals other than dogs and cats (non-traditional companion animal or NTCA). The popularity of these NTCA is constantly growing, whether in the family home (reptiles, amphibians, small rodents, etc.) or in public places (educational farms, petting zoos, zoos, pet stores, aquariums, etc.). These risks are increased in young children aged under 5 years due to their greater vulnerability, their unawareness of the traumatic or infectious risk as well as their natural behavior of always putting their hands in their mouth, the recommendation to wash their hands being inadequate in this case. Unlike certain zoonoses considered very common, such as ringworm, which can be observed simultaneously in the animal and its owner, there is certainly an underestimation or even ignorance of certain risks for the child when it comes to a ACNT apparently healthy but shedding a pathogen. The examples are numerous: rats and Seoul hantavirus, hamsters and lymphocytic choriomeningitis, birds and Chlamydia psittaci, ruminants and enterohemorrhagic colibacillosis, rodents, poultry or reptiles and salmonellosis, etc. This may explain an underestimation or even ignorance of these risks for the child at home or in a public place where we forget to apply biosecurity measures to avoid direct or indirect contamination. Therefore, it is important: to warn the public of these risks; to display the necessary biosecurity measures in establishments welcoming children and animals; to strengthen health control of the trade of these NTCA; to create an epidemiological surveillance platform bringing together all the stakeholders concerned (diagnostic laboratories, doctors, veterinarians, etc.) and by promoting the sharing of informative data; to advise against any close contact between children under 5 years old and in particular certain NTCA at home (reptiles, amphibians, birds) as well as in public places (ruminants, etc.); avoid the establishment of catering areas near petting zoos intended for children.Cet avis a pour objectif de présenter les risques occasionnés par des contacts de l’enfant avec des animaux autres que le chien et le chat (Animaux de compagnie non traditionnels ou ACNT). L’engouement pour ces ACNT est en progression constante qu’il s’agisse du domicile familial (reptiles, amphibiens, petits rongeurs…) ou dans des lieux publics (fermes pédagogiques, mini-fermes, zoos, animaleries, aquariums…). Ces risques sont accrus chez le jeune enfant âgé de moins de 5 ans du fait de sa plus grande vulnérabilité, de son inconscience du risque traumatique ou infectieux ainsi que son comportement naturel de mettre toujours ses mains à la bouche, la recommandation de lui laver les mains étant inadéquate dans ce cas. À la différence de certaines zoonoses considérées comme très fréquentes comme la teigne observable simultanément chez l’animal et son propriétaire, il existe certainement une sous-estimation voire l’ignorance de certains risques pour l’enfant quand il s’agit d’un ACNT apparemment en bonne santé mais excréteur d’un agent pathogène. Les exemples sont nombreux : rat et hantavirus de Séoul, hamster et chorioméningite lymphocytaire, oiseau et Chlamydia psittaci, ruminants et colibacillose entérohémorragique, rongeurs, volailles ou reptiles et salmonellose… Ceci peut expliquer une sous-estimation voire l’ignorance de ces risques pour l’enfant à son domicile ou dans un lieu public où l’on oubliera d’appliquer les mesures de biosécurité permettant d’éviter une contamination directe ou indirecte. Par conséquent, il importe : d’avertir le public de ces risques ; d’afficher les mesures de biosécurité nécessaires dans les établissements accueillant enfants et animaux ; de renforcer le contrôle sanitaire du commerce de ces ACNT ; de créer une plateforme d’épidémiosurveillance regroupant tous les acteurs concernés (laboratoires de diagnostic, médecins, vétérinaires…) et en favorisant le partage des données informatives ; de déconseiller tout contact étroit entre l’enfant âgé de moins de 5 ans et certains ACNT au domicile (reptiles, amphibiens, oiseaux) comme dans les lieux publics (ruminants…) ; d’éviter l’implantation des zones de restauration près des mini-fermes destinées aux enfants
Severe enterovirus infections in patients with immune-mediated inflammatory diseases receiving anti-CD20 monoclonal antibodies
No full textInternational audienceObjective Patients with X linked agammaglobulinemia are susceptible to enterovirus (EV) infections. Similarly, severe EV infections have been described in patients with impaired B-cell response following treatment with anti-CD20 monoclonal antibodies (mAbs), mostly in those treated for haematological malignancies. We aimed to describe severe EV infections in patients receiving anti-CD20 mAbs for immune-mediated inflammatory diseases (IMIDs). Methods Patients were included following a screening of data collected through the routine surveillance of EV infections coordinated by the National Reference Center and a review of the literature. Additionally, neutralising antibodies were assessed in a patient with chronic EV-A71 meningoencephalitis. Results Nine original and 17 previously published cases were retrieved. Meningoencephalitis (n=21/26, 81%) associated with EV-positive cerebrospinal fluid (n=20/22, 91%) was the most common manifestation. The mortality rate was high (27%). EV was the only causal agents in all reported cases. Patients received multiple anti-CD20 mAbs infusions (median 8 (5–10)), resulting in complete B-cell depletion and moderate hypogammaglobulinemia (median 4.9 g/L (4.3–6.7)), and had limited concomitant immunosuppressive treatments. Finally, in a patient with EV-A71 meningoencephalitis, a lack of B-cell response to EV was shown. Conclusion EV infection should be evoked in patients with IMIDs presenting with atypical organ involvement, especially meningoencephalitis. Anti-CD20 mAbs may lead to impaired B-cell response against EV, although an underlying primary immunodeficiency should systematically be discussed
Traduction et republication de : « Prise en charge de la maladie thromboembolique veineuse associée au cancer chez les populations vulnérables »
No full textInternational audienceAlthough all patients with cancer-associated thrombosis (CAT) have a high morbidity and mortality risk, certain groups of patients are particularly vulnerable. This may expose the patient to an increased risk of thrombotic recurrence or bleeding (or both), as the benefit-risk ratio of anticoagulant treatment may be modified. Treatment thus needs to be chosen with care. Such vulnerable groups include older patients, patients with renal impairment or thrombocytopenia, and underweight and obese patients. However, these patient groups are poorly represented in clinical trials, limiting the available data on which treatment decisions can be based. Meta-analysis of data from randomised clinical trials suggests that the relative treatment effect of direct oral factor Xa inhibitors (DXIs) and low molecular weight heparin (LMWH) with respect to major bleeding could be affected by advanced age. No evidence was obtained for a change in the relative risk-benefit profile of DXIs compared to LMWH in patients with renal impairment or of low body weight. The available, albeit limited, data do not support restricting the use of DXIs in patients with TAC on the basis of renal impairment or low body weight. In older patients, age is not itself a critical factor for choice of treatment, but frailty is such a factor. Patients over 70 years of age with CAT should undergo a systematic frailty evaluation before choosing treatment and modifiable bleeding risk factors should be addressed. In patients with renal impairment, creatine clearance should be assessed and monitored regularly thereafter. In patients with an eGFR less than 30mL/min/1.72m2, the anticoagulant treatment may need to be adapted. Similarly, platelet count should be assessed prior to treatment and monitored regularly. In patients with grade 3-4, thrombocytopenia (less than 50,000platelets/μL) treatment with a LMWH at a reduced dose should be considered. For patients with CAT and low body weight, standard anticoagulant treatment recommendations are appropriate, whereas in obese patients, apixaban may be preferred.Bien que tous les patients atteints de thrombose associée au cancer (TAC) présentent un risque élevé de morbidité et de mortalité, certains groupes de patients sont particulièrement vulnérables. Cela peut exposer le patient à un risque accru de récidive thrombotique ou d’hémorragie (ou les deux), car le rapport bénéfice/risque du traitement anticoagulant peut être modifié. Le traitement doit donc être choisi avec soin. Ces groupes vulnérables comprennent les patients âgés, les patients souffrant d’insuffisance rénale ou de thrombopénie, ainsi que les patients obèses ou en sous-poids. Cependant, ces groupes de patients sont peu représentés dans les essais cliniques, ce qui limite les données disponibles sur lesquelles les décisions thérapeutiques peuvent être basées. Une méta-analyse des données issues d’essais cliniques randomisés suggère que l’impact relatif des inhibiteurs directs du facteur Xa par voie orale (DXI) et des héparines de bas poids moléculaire (HBPM) en ce qui concerne les hémorragies majeures pourrait être influencé par l’âge avancé. Aucune preuve n’a été obtenue quant à une modification du balance bénéficie risque relatif des DXI par rapport aux HBPM, chez les patients souffrant d’insuffisance rénale ou de faible poids corporel. Les données disponibles, bien que limitées, ne permettent pas de restreindre l’utilisation des DXI chez les patients de faible poids corporel ou souffrant d’insuffisance rénale. Chez les patients plus âgés, l’âge n’est pas en soi un facteur déterminant pour le choix du traitement, contrairement à la fragilité. La fragilité des patients âgés de plus de 70 ans ayant une TAC mérite d’être évaluée avant de choisir un traitement. Les facteurs de risque hémorragique modifiables devraient également être pris en compte. Chez les patients souffrant d’insuffisance rénale, la clairance de la créatine doit être évaluée et surveillée régulièrement par la suite. Chez les patients dont le DFGe est inférieur à 30 mL/min/1,72 m2, il peut être nécessaire d’adapter le traitement anticoagulant. De même, la numération plaquettaire doit être évaluée avant le traitement et surveillée régulièrement. Chez les patients ayant une thrombopénie de grade 3–4 (moins de 50 000 plaquettes/L), un traitement par HBPM à dose réduite doit être envisagé. Pour les patients de faible poids corporel, les recommandations de traitement anticoagulant standard sont appropriées, tandis que pour les patients obèses, l’apixaban peut être préféré
P733 Long-term effectiveness and acceptability of switching from intravenous to subcutaneous infliximab in patients with inflammatory bowel diseases treated with intensified doses: the REMSWITCH-LT study
No full textMeeting abstract du "19th Congress of ECCO", Stockholm, Suède, 21-24 février, 2024International audienceBackground We recently demonstrated that switching from intravenous to subcutaneous infliximab is safe and well-accepted at short-term in IBD patients including those with intensified IV regimen. However, the long-term risk of relapse in these patients remains unknown. We assessed the long-term effectiveness and acceptability of switching from intravenous to subcutaneous infliximab in patients with inflammatory bowel diseases (IBDs) treated with or without intensified intravenous regimen. Methods In this prospective multicenter observational study, IBD patients in clinical remission (partial Mayo score ≤ 2 or Harvey-Bradshaw index ≤ 4) were switched to a unique dose of subcutaneous infliximab (120 mg every other week). Pharmacological and biological data were collected at baseline, 6 months and at last follow-up (median follow-up : 18 [15-20] months). Relapse was defined as clinical relapse or fecal calprotectin increase ≥ 150 mg/g compared with baseline. Results Among 184 eligible patients, 72.3% (n = 133/184) agreed to switch. At M6, a relapse occurred in 10.2% (n = 6/59), 7.3% (n = 3/41), 16.7% (n=3/18), and 66.7% (n=10/15) (P < .001) of patients receiving 5 mg/kg every 8 wks, 10 mg/kg every 8 wks, 10 mg/kg every 6 wks, and 10 mg/kg every 4 wks, respectively. At 18 months, the rate of relapse was 13.6% (n=8/59), 17.7% (n=7/41), 33.3% (n=6/18), and 86.7% (n=13/15) (P < .001) of patients receiving 5 mg/kg every 8 wks, 10 mg/kg every 8 wks, 10 mg/kg every 6 wks, and 10 mg/kg every 4 wks, respectively. Dose escalation led to recapture clinical remission in 82.1% (23/28) of the patients, including 83.3% (15/18) and 80.0% (8/10) in those receiving 240 mg every other week or 120 mg every week, respectively. Infliximab serum levels increased after the switch (P < .0001) except for patients receiving 10 mg/kg every 4 wks. In multivariable analysis, 10 mg/kg every 4 wks regimen (OR= 61.0; [6.0-600.1], p <0.001) and 10 mg/kg every 6 wks regimen (OR=4.7; [1.1-20.2], p = 0.039) had a higher risk of relapse at 18 months as well as reduced (58.3%) or stable (52.6%) infliximab serum levels between baseline and visit 1 compared with increased serum levels (19.7%) (P = 0.006 and P = 0.008, respectively). Patients’ acceptability (10-point scale) was improved by the switch (6.9 ± 1.6 for IV vs 8.6 ± 1.4 at V1 after the switch; P < .0001) and did not decrease over time during SC maintenance regimen 8.8 ± 1.3 at 6 months and 8.8 ± 1.3 at 18 months. No severe adverse event was reported. Conclusion Switching from IV to SC infliximab 120mg eow is safe and well-accepted leading to a low long-term risk of relapse in IBD patients. Tight monitoring and escalated dose should be recommended for patients receiving 10mg/kg/6 weeks and 4 weeks, respectively
Effects of Exercise Training on Muscle Mass and Physical Function in Patients with Hepatocellular Carcinoma After Diagnosis: A Systematic Review
No full textInternational audienc
How Many is Enough? The Influence of patient count on structural normative template quality.
No full textInternational audienceStructural brain templates are the foundational element for group analysis in neuroscience, providing an anatomical reference when analyzing data from different patients. When creating such templates, the topic of the appropriate number of brains to obtain a stable anatomy must be addressed. The goal of this study was to estimate the number of patients required to reach convergence in the creation of a cohort-specific anatomical template through exemplary calculations for data (Ptolemee Electrophysiologie project: IRB 5921, CE-CIC-GREN-18-03) from Clermont-Ferrand university hospital (France). Preoperative imaging data from a group of 47 patients (Parkinson’s: 30, essential tremor: 17) who received deep brain stimulation was used in an iterative, non-linear, mixed-modality, unbiased anatomical normalization pipeline published previously. It consists of iterative non-linear normalization of all original images to an anatomical template updated after each iteration and implemented to use both T1 and WAIR (white matter attenuated inversion recovery, a modality specially designed to enhance grey matter contrast). During the pre-operative planning, up to 35 deep brain structures were manually labeled by a single expert. The normalization process was repeated, increasing the number of included patients, resulting in 5 different templates. The performance of the normalization was quantified using the pairwise overlap between anatomical structures across patients. A logistic function was then fitted on the median values of that score for each template to estimate the number of patients necessary to obtain a variation lower than 5%. In this study we estimated the number of patient images required to obtain a stable group-specific anatomical template. Manual segmentation of deep brain structures was used to benchmark templates with increasing number of patients included. Results might differ depending on the specific MR sequences used
Transfusion needs after CAR T-cell therapy for large B-cell lymphoma: predictive factors and outcome. A DESCAR-T study
No full textInternational audienceChimeric antigen receptor (CAR) T-cells targeting CD19 have been approved for the treatment of relapse/refractory large B-cell lymphoma. Hematotoxicity is the most frequent CAR T-cell-related adverse event. Transfusion support is a surrogate marker of severe cytopenias. Transfusion impacts patients’ quality of life, presents specific toxicities and is known to affect immunity through the so-called transfusion-related immunomodulation, that may impact CAR T-cell efficacy. We analyzed data from 671 patients from the French DESCAR-T registry for whom exhaustive transfusion data were available. Overall, 401 (59.8%) and 378 (56.3%) patients were transfused in the 6-month period before and after CAR T-cell, respectively. The number of transfused patients and the mean number of transfused products increased during the 6-month period before CAR-T, peaked during the first month after infusion (early phase) and decreased over time. Predictive factors for transfusion at the early phase were age > 60 years, ECOG PS ≥2, treatment with axi-cel, pre-CAR T-cell transfusions and CAR-HEMATOTOX score ≥ 2. Predictive factors for late transfusion (between 1 and 6 months after infusion) were pre-CAR T-cell transfusions, CAR-HEMATOTOX score ≥ 2, ICANS ≥ 3 (for red blood cells [RBC] transfusion) and tocilizumab use (for platelets transfusion). Early transfusions and late platelets (but not RBC) transfusions were associated with a shorter progression-free survival and overall survival. Lymphoma-related mortality and non-relapse mortality were both increased in the transfused population. Our data shed light on the mechanisms of early and late cytopenia, and on the potential impact of transfusions on CAR T-cell efficacy and toxicity
Activité physique et sédentarité durant la grossesse : étude de faisabilité et d’impact sur les comportements sédentaires
No full textInternational audienc
Comprehensive Ophthalmological Evaluation in Atopic Dermatitis
No full textInternational audienceIntroduction: Atopic dermatitis (AD), a chronic type 2 inflammatory skin disease, is frequently associated with ocular surface diseases (OSD) which may appear or worsen under anti-type 2-targeted treatments. However, the exact prevalence of OSD and the ophthalmology referral criteria remain ill-defined in AD patients before initiating such biotherapies. We aimed to characterize the prevalence, the nature and the factors related to OSD development in AD that may justify an ophthalmological management. Methods: A total of 98 consecutive AD inpatients without biological treatment were retrospectively included. These were systematically evaluated by an ophthalmologist during their dermatological care. Clinical and laboratory data were analysed to characterize OSD and their risk factors. Results: OSD were found in 83/98 AD patients (85%); mainly dry eye syndrome (64%, 63/98), allergic conjunctivitis (42%, 41/98), posterior (33%, 32/98), and anterior blepharitis (27%, 26/98). In AD patients without ocular symptoms, OSDs were also frequently found (63%, 12/19) and were mostly mild. Risk factors for OSD were history of allergic rhinitis, allergic sensitization, head and neck AD, ocular symptoms (foreign body sensation in the eye, burning, itching, photophobia), and total IgE level >3,000 kU/L. Conclusion: The prevalence of OSD was high, even in asymptomatic patients. The risk factors identified may indicate the need for ophthalmological examination for therapeutic management, especially when biological agents targeting type 2 inflammation are considered
Le risque du cancer dans la SEP : une étude de cohorte nationale (2012–2021)
No full textNational audienceObjectifs :Comparer le risque de cancer entre les pSEP et la population générale entre 2012 et 2021 à partir du Système national des données en santé (SNDS ; 99 % population française)