19 research outputs found
Évolution et pronostic à long terme des néphropathies lupiques prolifératives traitées par faible dose de cyclophosphamide en Martinique
No full textLupus nephritis (LN) has been described as having worse survival and renal outcomes in African-descent patients compared to Caucasians. Although Cyclophosphamide (CYC) is a cornerstone of proliferative LN induction therapy, long-term outcomes of lupus nephritis treated with low-dose CYC in the African descent population are still unknown. We seek to provide long-term data on global and renal survival rates in an Afro-descendant cohort of LN treated with low-dose intraveinous CYCWe performed a longitudinal retrospective population-based analysis using data from 1991 to 2022 at the University Hospital of Martinique (French West Indies). All adults with systemic lupus erythematosus who presented a proliferative LN proven by biospy and treated with IV CYC as induction therapy were included. A total of 49 patients were included. At a mean follow-up of 9.24 years, 45,2% of patients presented an adverse outcome of either death or ESRD. The cumulative rates of end-stage renal disease were 4,17%, 10,51%, and 18,49% at 5, 10, and 15 years (until the end of the 30 years follow-up) respectively. Mortality rates were at 0% at 5 and 10 years, 11,73% at 15 years, 19,75%% at 20 and 25 years and 33,13% at 30 years of follow-up, respectively. The survival of our Afro-Caribbean patients with proliferative LN treated by IV CYC is similar to the one observed in Caucasians. It Emphasizes the lack of impact of ethnicity on global and renal prognosis and supports the need of managing other modifiable risk factors.La néphropathie lupique est décrite comme possédant un moins bon pronostic global et rénal chez les patients d'ascendance Africaine comparés aux patients Caucasiens. Si le Cyclophosphamide intraveineux à faible dose est la pierre angulaire du traitement d'induction de la néphropathie lupique proliférative, le pronostic à long terme des patients Antillais sous ce traitement pour cette indication reste inconnu. Nous avons réalisé une étude longitudinale descriptive rétrospective basée sur les registres de patients du service de médecine interne du CHU de la Martinique entre 1991 et 2022. Sont inclus les adultes lupiques présentant une néphropathie confirmée par biopsie et traités par cyclophosphamide intraveineux à faible dose en induction. Avec une durée de suivi moyenne à 9,24 ans, sur 49 patients inclus, 45,2% ont présenté une évolution défavorable (décès ou insuffisance rénale terminale). Les taux de survie rénale cumulés sont de 4,17%, 10,51%, and 18,49% à 5, 10, et 15 ans de suivi respectivement (jusqu'à 30 ans de suivi). Les taux de mortalité sont estimés à 0% à 5 et10 ans, 11,73% à 15 ans, 19,75%% à 20 et 25 ans et 33,13% à 30 ans de suivi. La survie à long terme des patients Afro-Caribéens présentant une néphropathie lupique proliférative et traités par Cyclophosphamide intraveineux faible dose est similaire à celle observée chez les Caucasiens. Cela souligne le manque d'impact de l'ethnie sur le pronostic global et rénal et nécessite d'améliorer la prise en charge des autres facteurs de risque modifiables. D'autres études prospectives sur le pronostic à long terme mais aussi à court terme dans cette population sont nécessaires
Les troubles de la déglutition au cours des myopathies idiopathiques inflammatoires en Martinique
No full textBackground and objective: Dysphagia is a life-threatening manifestation of idiopathic inflammatory myopathies (IIM). Some features and associated factors have been reported in individuals of Caucasian and Asian ancestry, but little is known in individuals of African ancestry. We aim to describe dysphagia during IIM in a population of African ancestry, and to determine associated factors. Patients and methods: We reviewed the medical records of patients with IIM between 2004 and 2022 in the Caribbean island of Martinique. To be included, patients had to be 18 years of age or older and meet the diagnostic criteria for probable or definite IIM. Dysphagia was retained after evaluation by a speech-language pathologist and/or otolaryngologist, supported by flexible endoscopic swallowing assessment (FEES). Date of diagnosis, clinical and biological characteristics, treatment and disease course were collected and compared between patients suffering from IIM with and without dysphagia. To identify independent associated factors for the onset of dysphagia, we performed a multivariate analysis using a logistic regression model. Results: 169 patients with IIM (31 patients with dysphagia and 138 controls without dysphagia) were included. Food aspiration was the most frequent dysphagia symptom (77.4%), and salivary stasis (59.1%) the most frequent finding in FEES. Comparatively, patients with dysphagia had more dermatomyositis (p=0.021), which was diagnosed earlier (p=0.003) than no dysphagia group. Clinical muscular involvement was also more frequent in patients with dysphagia than controls (p<0.001). The multivariate analysis identified anti-Mi2 positivity (OR 4.605, 95%CI [1.386 to 15.661]; p=0.013) and dysphonia (OR 10.119 95%CI [1.549 to 90.560]; p=0.020) as independent factors of dysphagia in IIM. Regarding treatments, patients with dysphagia received more corticosteroid pulses (p=0.010), intravenous immunoglobulins (p<0.001), and methotrexate (p=0.006) than patients without dysphagia. Finally, patients with dysphagia were more likely to experience undernutrition (p=0.002), aspiration pneumonia (p=0.004) and IIM relapses (p=0.013) than those without dysphagia. Conclusion: Anti-Mi2 positivity and dysphonia are independent predictive factors of occurrence of dysphagia in patients of African ancestry with IIM. There may be a potential correlation with ethnicity but additional comparative data are required.Introduction : Les myopathies inflammatoires sont des maladies auto-immunes rares acquises qui affectent les muscles, y compris ceux de la déglutition. Il existe peu de données sur les troubles de la déglutition et la majorité portent sur des populations caucasiennes ou asiatiques. L’objectif de notre étude est de décrire les caractéristiques cliniques et les facteurs associés aux troubles de la déglutition dans les myopathies inflammatoires en Martinique, une population afro-caribéenne. Patients et méthodes : Nous avons conduit une étude descriptive rétrospective entre 2004 et 2022 en Martinique. Les patients éligibles à l’étude étaient âgés de plus de 18 ans et remplissaient les critères diagnostiques de myopathie inflammatoire. Les données cliniques, biologiques, histopathologiques, radiologiques et thérapeutiques ont été recueillies et comparées entre les patients avec et sans troubles de la déglutition. Résultats : Au total, 169 patients ont été inclus parmi lesquels des troubles de la déglutition étaient décrits chez 60 patients (35,5 %) et confirmés pour 31 d'entre eux (53,4 %). Les patients atteints de troubles de déglutition avaient un diagnostic plus précoce (p=0,003), présentaient plus fréquemment une dysphonie (p<0,001) et avaient une atteinte musculaire plus fréquente (p<0,001). Les troubles de la déglutition étaient également significativement plus présents chez les patients avec une dermatomyosite (p=0,04) et notamment des anticorps anti-MI2 (p<0,001). La présence d'anticorps anti-MI2 a été identifiée comme un facteur prédictif de survenue de trouble de déglutition en analyse multivariée, tout comme la présence de dysphonie (respectivement: OR 4,605, p=0,013, et OR 10,119, p=0,020). Concernant la prise en charge thérapeutique, les patients avec des troubles de déglutition recevaient plus de bolus de corticoïdes (p=0,01), du méthotrexate (p=0,006) et des immunoglobulines intraveineuses (p<0,001). Ils étaient plus susceptibles d’être dénutris (p=0,002), de développer des pneumopathies d’inhalation (p=0,004) et de faire une rechute (p=0,013). Conclusion : Les troubles de la déglutition dans les MII chez les afro-caribéens ont certaines caractéristiques qui ne sont pas retrouvées dans d’autres ethnies, ils sont notamment plus fréquents dans les dermatomyosites et chez les patients avec des anticorps anti-Mi2. Ces derniers ainsi que la dysphonie sont des facteurs prédictifs de survenue des troubles de déglutition avec une possible prédominance chez les afro-descendants. Des études comparatives similaires sont nécessaires pour affirmer ces résultats
Relation between composition, microstructure and oxidation in iron aluminides
No full textThe relation between chemical composition, microstructure and oxidation properties has been investigated on various FeAl based alloys, the aim being to induce changes in the microstructure of the compound by selective oxidation of aluminium. Oxidation kinetics that was evaluated on bulk specimens showed that, due to fast diffusion in the alloys, no composition gradient is formed during the aluminium selective oxidation. Accordingly, significant aluminium depletion in the compound could be observed in the thinnest part of oxidised wedge-shape specimens. Another way to obtain samples of variable aluminium content was to prepare diffusion couples with one aluminide and pure iron as end members. These latter specimens have been characterised using electron microscopy and first results of oxidation experiments are presented
"La forêt comme un théâtre ou les conditions d'une mise en scène réussie"
No full textThe forest plays a major social role in France : it is a place where townspeople searching for nature enjoy to relax or to ramble, and it is a source of emotions and of dreams for the grown ups “not so grown up”. It is a true cultural and symbolical heritage. In this respect, the public manager is in charge of more than a simple natural resource to be developed and protected. He is also the stage director of forest theaters to which visitors willingly come to attend the performance of nature. Spinning the theatrical metaphor all along this thesis, not only did we endeavor to understand the mechanisms of the public forest mises en scène but also what is at stake.This narrative tool was borrowed to the interactionist sociologists and was used for the study of two forest areas : the national forests of La Grande Chartreuse in Isère and that of Le Val Suzon in Côte d'Or. We tried to identify the actors, the spectators and the stage directors of these forest theaters. Our work required interdisciplinary approaches in so far as we focused on the deciphering of scenarios writing and interpretation rules, on the role distribution between actors and walk-ons and on the definition of the unities of place, time and action. We lead ethnographic investigations, relied on multiple-choice questionnaires and we went through media corpuses. Several scientific and artistic disciplines shed light on our study : geography, history, sociology, anthropology, scenography.The analysis of the data at hand shows that the forest is not a constituted sociological object, that is to say not underlined by structured theories or opinions. Within the forest set, each visitor can imagine and rehearse his or her own plays. Our relationship to the forest is linked to the psychoaffective sphere ; it is experienced rather than thought of. Our individual creeds are inherited from the past with universally shared archetypes and they echo one another.Our reflection is aimed at highlighting the conditions of a successful, appreciated and acknowledged mise en scène of the public forests. Therefore, this thesis relies on a constructive approach leading to practical and useful recommendations and suggestions both meant for the Office National des Forêts which financed and ordered this research and for all actors of the French forest.Lieu de détente et de promenade pour citadins en quête de nature, source d'émotions et de rêves pour « grands » enfants, la forêt joue un rôle social majeur pour les Français. Elle constitue un véritable patrimoine culturel et symbolique. Le gestionnaire public gère donc plus qu'une simple ressource naturelle à valoriser et à protéger : il est aussi le metteur en scène de théâtres forestiers au sein desquels des visiteurs viennent, avec plaisir, assister au spectacle de la nature. Filant la métaphore théâtrale tout au long de cette thèse, nous avons cherché à comprendre les enjeux et les mécanismes des mises en scène de la forêt publique.Ce procédé narratif, emprunté aux sociologues interactionnistes, a été utilisé pour l'étude de deux massifs forestiers : les forêts domaniales de la Grande Chartreuse en Isère et du Val Suzon en Côte d'Or. Nous nous sommes attachés à identifier les acteurs, les spectateurs et les metteurs en scène de ces théâtres forestiers. Le décryptage des règles d'écriture et d'interprétation des scenarii, de la distribution des rôles entre acteurs et figurants, de la définition des unités de temps, de lieu et d'action a nécessité des approches interdisciplinaires. Des enquêtes ethnographiques, des questionnaires fermés et des dépouillements de corpus médiatiques ont été menés. Plusieurs disciplines scientifiques et artistiques ont été convoquées : la géographie, l'histoire, la sociologie, l'anthropologie, la scénographie.L'analyse des matériaux recueillis montre que la forêt n'est pas un objet sociologique constitué, c'est-à-dire construit et sous-tendu par des discours et des opinions structurés. Au milieu du décor forestier, chaque visiteur s'invente et se joue ses propres pièces. Ressentie plutôt que pensée, la relation aux sylves relève avant tout de la sphère psychoaffective, mettant en résonance des croyances individuelles héritées du passé avec des archétypes universellement partagés.La réflexion proposée vise à dégager les conditions d'une mise en scène réussie, appréciée et reconnue des forêts publiques. Cette thèse se place ainsi dans une démarche constructive, débouchant sur des recommandations et des suggestions, utiles et pratiques pour l'Office National des Forêts, financeur et commanditaire de cette recherche, mais aussi pour tous les acteurs de la forêt française
"La forêt comme un théâtre ou les conditions d'une mise en scène réussie"
No full textThe forest plays a major social role in France : it is a place where townspeople searching for nature enjoy to relax or to ramble, and it is a source of emotions and of dreams for the grown ups “not so grown up”. It is a true cultural and symbolical heritage. In this respect, the public manager is in charge of more than a simple natural resource to be developed and protected. He is also the stage director of forest theaters to which visitors willingly come to attend the performance of nature. Spinning the theatrical metaphor all along this thesis, not only did we endeavor to understand the mechanisms of the public forest mises en scène but also what is at stake.This narrative tool was borrowed to the interactionist sociologists and was used for the study of two forest areas : the national forests of La Grande Chartreuse in Isère and that of Le Val Suzon in Côte d'Or. We tried to identify the actors, the spectators and the stage directors of these forest theaters. Our work required interdisciplinary approaches in so far as we focused on the deciphering of scenarios writing and interpretation rules, on the role distribution between actors and walk-ons and on the definition of the unities of place, time and action. We lead ethnographic investigations, relied on multiple-choice questionnaires and we went through media corpuses. Several scientific and artistic disciplines shed light on our study : geography, history, sociology, anthropology, scenography.The analysis of the data at hand shows that the forest is not a constituted sociological object, that is to say not underlined by structured theories or opinions. Within the forest set, each visitor can imagine and rehearse his or her own plays. Our relationship to the forest is linked to the psychoaffective sphere ; it is experienced rather than thought of. Our individual creeds are inherited from the past with universally shared archetypes and they echo one another.Our reflection is aimed at highlighting the conditions of a successful, appreciated and acknowledged mise en scène of the public forests. Therefore, this thesis relies on a constructive approach leading to practical and useful recommendations and suggestions both meant for the Office National des Forêts which financed and ordered this research and for all actors of the French forest.Lieu de détente et de promenade pour citadins en quête de nature, source d'émotions et de rêves pour « grands » enfants, la forêt joue un rôle social majeur pour les Français. Elle constitue un véritable patrimoine culturel et symbolique. Le gestionnaire public gère donc plus qu'une simple ressource naturelle à valoriser et à protéger : il est aussi le metteur en scène de théâtres forestiers au sein desquels des visiteurs viennent, avec plaisir, assister au spectacle de la nature. Filant la métaphore théâtrale tout au long de cette thèse, nous avons cherché à comprendre les enjeux et les mécanismes des mises en scène de la forêt publique.Ce procédé narratif, emprunté aux sociologues interactionnistes, a été utilisé pour l'étude de deux massifs forestiers : les forêts domaniales de la Grande Chartreuse en Isère et du Val Suzon en Côte d'Or. Nous nous sommes attachés à identifier les acteurs, les spectateurs et les metteurs en scène de ces théâtres forestiers. Le décryptage des règles d'écriture et d'interprétation des scenarii, de la distribution des rôles entre acteurs et figurants, de la définition des unités de temps, de lieu et d'action a nécessité des approches interdisciplinaires. Des enquêtes ethnographiques, des questionnaires fermés et des dépouillements de corpus médiatiques ont été menés. Plusieurs disciplines scientifiques et artistiques ont été convoquées : la géographie, l'histoire, la sociologie, l'anthropologie, la scénographie.L'analyse des matériaux recueillis montre que la forêt n'est pas un objet sociologique constitué, c'est-à-dire construit et sous-tendu par des discours et des opinions structurés. Au milieu du décor forestier, chaque visiteur s'invente et se joue ses propres pièces. Ressentie plutôt que pensée, la relation aux sylves relève avant tout de la sphère psychoaffective, mettant en résonance des croyances individuelles héritées du passé avec des archétypes universellement partagés.La réflexion proposée vise à dégager les conditions d'une mise en scène réussie, appréciée et reconnue des forêts publiques. Cette thèse se place ainsi dans une démarche constructive, débouchant sur des recommandations et des suggestions, utiles et pratiques pour l'Office National des Forêts, financeur et commanditaire de cette recherche, mais aussi pour tous les acteurs de la forêt française
Long-term home parenteral nutrition in systemic sclerosis-related intestinal failure is feasible but unveils occult cardiac disease
No full textInternational audienceObjective: The aim of this study was to compare safety and efficacy of long-term home parenteral nutrition between patients with systemic sclerosis and intestinal failure (IF) and controls with IF from another etiology.Methods: A retrospective study was conducted in a referral center for systemic sclerosis (SSc) in Montpellier, France. Patients followed between 1985 and 2020 with SSc-related IF were included and compared with control patients with IF from another etiology. The patients included had to be treated for 4 wk by home parenteral nutrition (HPN). Primary outcome was occurrence of HPN-related complications. Secondary outcomes included duration of parenteral nutrition, body mass index at 12 mo, and survival.Results: Cumulative duration of HPN was 23 397 catheter days. HPN resulted in body mass index increase in both groups. There was no statistical difference regarding catheter-related bloodstream infections and thrombosis between the groups, despite use of immunosuppressive drugs and autologous hematopoietic stem cell transplantation in patients with SSc. However, the patients with SSc had significantly more HPN- related cardiac overload than the controls (P < 0.0001). Overloads occurred in SSc patients with and without cardiac disease, arguing for comprehensive hemodynamic screening in this condition.Conclusion: Long-term HPN in SSc-related IF is feasible but unveils occult cardiac disease
Lumbar Spinal Stenosis Treatment: Is Surgery Better than Non-Surgical Treatments in Afro-Descendant Populations?
No full text(1) Background: Limited data are available on lumbar spine stenosis management in sub-Saharan African populations and Afro-descendant patients are underrepresented in European and US clinical trials. We aimed to compare the clinical response between decompressive surgery and conservative treatments in a population of self-reported Afro-Caribbean patients with lumbar spine stenosis over a 2-year follow-up period. (2) Methods: Prospective cohort of 137 self-reported Afro Caribbeans with lumbar spine stenosis based on clinical and radiological criteria. Patients were assigned to decompression surgery or to conservative treatments according to their outcome after a first course of steroid epidural injection and their preferences. The primary outcome was evolution of the Oswestry disability index at 3 months (3 M), 12 M, 18 M and 24 M follow-up. (3) Results: Decrease of ODI was significantly more important in the “decompression surgery” arm compared to “conservative treatment” arm at 3 M, 12 M and 18 M: −17.36 vs. 1.03 p < 10−4; −16.38 vs. −1.53 p = 0.0059 and −19.00 vs. −4.52 p = 0.021, respectively. No difference was reported at 24 M. (4) Conclusions: In this first comparative study between surgery and conservative treatments in an exclusively afro-descendant lumbar spine stenosis cohort, we report long term superiority of decompression surgery versus conservative treatments over an 18-month period
Epidemiology and Characteristics of Spondyloarthritis in the Predominantly Afro-Descendant Population of Martinique, a French Caribbean Island
No full text(1) Background: The prevalence of Spondyloarthritis (SpA) varies significantly in different regions and ethnic groups due several factors such as heterogeneity in study populations, the diversity of classification criteria used in epidemiological studies, the prevalence variability of HLA-B27 or disparity in healthcare access. To our knowledge, there is no data on SpA in Martinique, a French region in the Caribbean with a predominantly Afro-descendant population and a high level of healthcare. (2) Methods: This was a retrospective study of all SpA patients treated at the Fort de France University Hospital between 1 January 1997 and 1 January 2008. (3) Results: In our cohort of 86 SpA patients, age at diagnosis was late (41 years old), ankylosing spondylitis (AS) was the most frequent sub-type (60.5%), inflammatory bowel disease was the most frequent extra articular feature (23.3%) and no one had personal familial history of the disease. Inflammatory syndrome concerned 55.6% of patients, no one was positive for HIV and HLA-B27 positivity was low (42.2%). However, HLA-B27 was statistically associated with AS. Out of 64 patients, 41 had sacroiliitis. (4) Conclusion: To our knowledge, this is the first comprehensive descriptive study of SpA subtypes in Martinique, a French region in the Caribbean. We report clinical and biological similarities in our SpA cohort with those of sub-Saharan Africa and with SpA subtypes reported in Afro-descendant populations
Lifetime clinical presentation of Still's disease in the Afro-descendant population of the French West Indies
No full textInternational audienc
Behçet’s Disease In Children And Adults Of Sub-Saharan Ancestry: A Systematic Review And Meta-Analysis
No full textInternational audienceAbstract Background The characteristics of Behçet’s disease (BD) in individuals of Sub-Saharan ancestry (sub-SA) are poorly understood. Methods Herein, we conducted a PRISMA-compliant systematic review using the PubMed/Medline, Scopus, and Web of Science databases. Articles published up to September 1, 2023 were searched with the following keywords: "Behçet's disease" OR "Behcet's syndrome" AND "sub-Saharan African" OR "Black" OR “African”. Data on the year, type and country of study, sample size, region of origin, nationality, age, sex, time to diagnosis, death, HLAB51 status, mucosal, and organ involvement were collected. Involvement of the central nervous system was retained on the basis of objective criteria, and dichotomized into parenchymal or non-parenchymal/vascular lesions. The pooled frequency of patients’ main characteristics was calculated using a DerSimonian-Laird random-effects meta-analysis. Results This study included 42 full-text reports, with study periods ranging from 1970 to 2023. Overall, 230 adult patients (69% of males) were included, of whom 195 (85%) were from sub-Saharan African countries, 22 (10%) patients were from the Caribbean, and 13 (5%) patients were from the Americas, including 12 African Americans, and 1 African Brazilian. Oral and genital ulcers were reported in 98% [95% CI 91 to 100%] and 85% [72 to 92%], respectively. Ocular involvement occurred in 43% [31 to 56%] of patients. Central nervous system (CNS) involvement affected 39% [25 to 54] of the patients. Among them, 30% of patients had a cerebro-vascular disease, and 72% had a parenchymal involvement. The patients were mostly treated with oral steroids and colchicine, and remission was achieved in 35/54 (65%) patients, but 15 (69%) of them suffered severe sequelae, particularly ophthalmological and neurological. Conclusion Behçet’s disease in patients of sub-Saharan ancestry appears to be predominantly HLA B51/B5-negative, and more severe than in other ethnicities, owing to a high prevalence of CNS involvement
