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Zulfiqar AA, Fresne M, Andres E. Assessing the Efficacy of the Modified SEGA Frailty (mSEGA) Screening Tool in Predicting 12-Month Morbidity and Mortality among Elderly Emergency Department Visitors. J Clin Med 2023; 12:6972. [PMID: 38002587 PMCID: PMC10672359 DOI: 10.3390/jcm12226972] [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: 09/04/2023] [Revised: 10/28/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
INTRODUCTION Rapid identification of frail elderly individuals upon admission to the emergency department is pivotal for enhancing their care and alleviating emergency room congestion. OBJECTIVE This pilot study aims to explore the relationship between morbidity, mortality, and frailty, as assessed by the mSEGA scale, among individuals aged 65 years or older in the emergency department. METHODS A retrospective cohort study was conducted at a single center. The pilot study included patients aged 65 and above who were admitted to Chaumont Hospital's emergency unit (Haute-Marne department) for medical and/or surgical reasons between 1 July 2017 and 31 January 2018. Data encompassed socio-demographic characteristics, medical profiles, and emergency department visit details. Outcomes for patients one year post-admission were obtained through consultation with their respective general practitioners. RESULTS A total of 255 subjects participated, with a mean age of 82.1 ± 8.2 years. Primary admission reasons were falls (n = 51, 20.0%), digestive issues (excluding hemorrhage) (n = 30, 11.8%), and "other" causes (n = 61, 23.9%). Among participants, 78 (30.6%) scored ≤8 on the mSEGA frailty scale, 49 (19.2%) scored 9 to 11, and 125 (50.2%) scored ≥12. Concerning post-emergency department outcomes, 152 patients (59.6%) were hospitalized, while 103 (40.4%) were discharged. No deaths were reported during the study period, and vital status was known for all subjects at the one-year mark. At that point, 63 out of 255 patients had passed away, with 30 of them being readmitted to the emergency department either before or at the time of their one-year death. The 12-month survival rate analysis based on frailty status revealed a significant difference. Low-frailty patients exhibited a survival rate of 87.2% (95% CI; [77.5-92.9]), whereas frail/very frail patients had a survival rate of 70.0% (95% CI; [62.7-76.2]). Similarly, the 12-month readmission-free survival rate demonstrated statistically significant disparities. Low-frailty patients had a rate of 76.9% (95% CI; [65.9-84.8]), compared to 51.4% (95% CI; [43.8-58.5]) for very frail patients. CONCLUSION Utilizing the mSEGA frailty scale in the Emergency Department could provide crucial prognostic insights, highlighting significant differences in 12-month survival and readmission-free survival rates based on frailty status.
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Affiliation(s)
- Abrar-Ahmad Zulfiqar
- Geriatric Readaptation Unit, Vitry-Le-François Hospital, 51300 Vitry-Le-François, France
| | - Mathieu Fresne
- General Medicine Department, University Hospital of Reims, 51100 Reims, France;
| | - Emmanuel Andres
- Internal Medicine Department, University Hospital of Strasbourg, 67000 Strasbourg, France;
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Kepka S, Heimann C, Severac F, Hoffbeck L, Le Borgne P, Bayle E, Ruch Y, Muller J, Roy C, Sauleau EA, Andres E, Ohana M, Bilbault P. Organizational Benefits of Ultra-Low-Dose Chest CT Compared to Chest Radiography in the Emergency Department for the Diagnostic Workup of Community-Acquired Pneumonia: A Real-Life Retrospective Analysis. Medicina (Kaunas) 2023; 59:1508. [PMID: 37763627 PMCID: PMC10532772 DOI: 10.3390/medicina59091508] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/01/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Chest radiography remains the most frequently used examination in emergency departments (ED) for the diagnosis of community-acquired pneumonia (CAP), despite its poor diagnostic accuracy compared with ultra-low-dose (ULD) chest computed tomography (CT). However, although ULD CT appears to be an attractive alternative to radiography, its organizational impact in ED remains unknown. Our objective was to compare the relevant timepoints in ED management of CT and chest radiography. Materials and Methods: We conducted a retrospective study in two ED of a University Hospital including consecutive patients consulting for a CAP between 1 March 2019 and 29 February 2020 to assess the organizational benefits of ULD chest CT and chest radiography (length of stay (LOS) in the ED, time of clinical decision after imaging). Overlap weights (OW) were used to reduce covariate imbalance between groups. Results: Chest radiography was performed for 1476 patients (mean age: 76 years [63; 86]; 55% men) and ULD chest CT for 133 patients (mean age: 71 [57; 83]; 53% men). In the weighted population with OW, ULD chest CT did not significantly alter the ED LOS compared with chest radiography (11.7 to 12.2; MR 0.96 [0.85; 1.09]), although it did significantly reduce clinical decision time (6.9 and 9.5 h; MR 0.73 [0.59; 0.89]). Conclusion: There is real-life evidence that a strategy with ULD chest CT can be considered to be a relevant approach to replace chest radiography as part of the diagnostic workup for CAP in the ED without increasing ED LOS.
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Affiliation(s)
- Sabrina Kepka
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, CHRU of Strasbourg, 67091 Strasbourg, France; (L.H.); (P.L.B.); (E.B.); (P.B.)
- ICUBE, UMR 7357, CNRS, 300 Bd Sébastien Brant, 67400 Illkirch-Graffenstaden, France; (F.S.); (E.A.S.)
| | - Charlène Heimann
- Emergency Department, Hôpital Emile Muller, 20 rue du Dr Laennec, 68100 Mulhouse, France;
| | - François Severac
- ICUBE, UMR 7357, CNRS, 300 Bd Sébastien Brant, 67400 Illkirch-Graffenstaden, France; (F.S.); (E.A.S.)
- Méthodes en Recherche Clinique (GMRC), Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, France
| | - Louise Hoffbeck
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, CHRU of Strasbourg, 67091 Strasbourg, France; (L.H.); (P.L.B.); (E.B.); (P.B.)
| | - Pierrick Le Borgne
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, CHRU of Strasbourg, 67091 Strasbourg, France; (L.H.); (P.L.B.); (E.B.); (P.B.)
- UMR 1260, INSERM/Université de Strasbourg CRBS, 1 Rue Eugene Boeckel, 67000 Strasbourg, France
| | - Eric Bayle
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, CHRU of Strasbourg, 67091 Strasbourg, France; (L.H.); (P.L.B.); (E.B.); (P.B.)
| | - Yvon Ruch
- Department of Infectious and Tropical Diseases, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, France;
| | - Joris Muller
- Public Health Units, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, CHRU of Strasbourg, 67091 Strasbourg, France;
| | - Catherine Roy
- Radiology Department, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, France; (C.R.); (M.O.)
| | - Erik André Sauleau
- ICUBE, UMR 7357, CNRS, 300 Bd Sébastien Brant, 67400 Illkirch-Graffenstaden, France; (F.S.); (E.A.S.)
- Méthodes en Recherche Clinique (GMRC), Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, France
| | - Emmanuel Andres
- Department of Internal Medicine, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, France;
| | - Mickaël Ohana
- Radiology Department, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, France; (C.R.); (M.O.)
| | - Pascal Bilbault
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, CHRU of Strasbourg, 67091 Strasbourg, France; (L.H.); (P.L.B.); (E.B.); (P.B.)
- UMR 1260, INSERM/Université de Strasbourg CRBS, 1 Rue Eugene Boeckel, 67000 Strasbourg, France
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Nguyen R, Barry M, Azevedo Loiola R, Ferret PJ, Andres E. PhotoSENSIL-18 assay development: Enhancing the safety testing of cosmetic raw materials and finished products to support the in vitro photosensitization assessment? Toxicology 2023; 495:153613. [PMID: 37558156 DOI: 10.1016/j.tox.2023.153613] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/07/2023] [Accepted: 08/06/2023] [Indexed: 08/11/2023]
Abstract
Although photosensitization remains a major toxicological endpoint for the safety assessment of cosmetic products and their raw materials, there is no validated in vitro method available for the evaluation of this adverse effect so far. Given that previous studies have proposed that the Interleukine-18 (IL-18) plays a key role in keratinocyte-driven pro-inflammatory responses specific of the skin sensitization process, we hypothesize that IL-18 might be used as a specific biomarker for in vitro photosensitization assessment. The aim of the present study was the set-up of a new in vitro assay using IL-18 as a biomarker for the identification of photosensitizers in a reconstructed human epidermis (RHE) model. EpiCS™ RHE were incubated with a set of 16 known sensitising / phototoxic / photosensitizing substances and exposed to ultra-violet (UV) irradiation. Then, the cell viability was analysed by MTT assay, while the IL-18 secretion was quantified by ELISA. Preliminary assays have shown that 1 h of incubation followed by a recovery period of 23 h induced the highest IL-18 production in response to UV exposure. This protocol was used to test 16 substances and a ratio of IL-18 production (UV+/UV- ratio) was then generated. Our data shows that the cut-off of 1.5 (UV+/UV- ratio) is the most predictive model among the tested conditions, being capable of identifying true positive photosensitizers (8 of 9) with a good prediction in comparison with in vivo data. In a nutshell, our data suggests that the PhotoSENSIL-18 is a promising in vitro method for identification of photosensitizing substances. Although further studies are necessary to optimize the model, we foresee that the PhotoSENSIL-18 assay can be used in the context of an Integrative Approach to Testing and Assessment (IATA) of chemicals.
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Affiliation(s)
- R Nguyen
- Laboratoires Pierre Fabre, 3 avenue Hubert Curien, BP 13562, 31035 Toulouse Cedex, France
| | - M Barry
- Oroxcell SAS, 102 avenue Gaston Roussel, 93230 Romainville, France
| | - R Azevedo Loiola
- Oroxcell SAS, 102 avenue Gaston Roussel, 93230 Romainville, France
| | - P-J Ferret
- Laboratoires Pierre Fabre, 3 avenue Hubert Curien, BP 13562, 31035 Toulouse Cedex, France
| | - E Andres
- Oroxcell SAS, 102 avenue Gaston Roussel, 93230 Romainville, France.
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Docquier L, Jannot X, Cordoba Sosa Z, Pierre L, Autrusseau PA, Andres E, Lorenzo-Villalba N. Focal Myositis of the Sternocleidomastoid Muscle: A Rare and Uncommon Cause of Cervical Mass. Eur J Case Rep Intern Med 2023; 10:003919. [PMID: 37305006 PMCID: PMC10253244 DOI: 10.12890/2023_003919] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 05/15/2023] [Indexed: 06/13/2023] Open
Abstract
We report on a 70-year-old male patient admitted to the internal medicine department for evaluation of a right cervical mass. He had been treated with antibiotics as an outpatient by his primary care doctor. Upon admission the patient was asymptomatic, but within a few hours his cervical mass enlarged; this enlargement was confined to the right sternocleidomastoid muscle. Complete blood investigations including serology and autoimmunity were negative. The neck scan and MRI were in favour of myositis. No other lesions were found either in the nasal fibre-optic exam or in the thoracic-abdominal-pelvic scan. The biopsy of the muscle showed a lymphoplasmacytic inflammatory infiltrate of the perimysium. The diagnosis of focal myositis was made. The patient clinically improved during hospitalisation with complete resolution of symptoms without any specific intervention. LEARNING POINTS A thorough clinical examination is essential in the evaluation and characterisation of cervical masses.The diagnostic approach must be rigorous in order not to ignore potentially serious diseases.A high level of clinical suspicion is needed in the diagnosis of focal myositis.
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Affiliation(s)
- Léa Docquier
- Service de Médecine Interne. Hôpitaux Universitaires de Strasbourg
| | - Xavier Jannot
- Service de Médecine Interne. Hôpitaux Universitaires de Strasbourg
| | | | - Léa Pierre
- Service de Médecine Interne. Hôpitaux Universitaires de Strasbourg
| | | | - Emmanuel Andres
- Service de Médecine Interne. Hôpitaux Universitaires de Strasbourg
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Zulfiqar AA, Dembele IA, Andres E. Evaluation of Nutritional Status in an Acute Geriatric Unit: Retrospective Study and Analysis of Frailty Syndrome. Medicines (Basel) 2023; 10:medicines10030022. [PMID: 36976311 PMCID: PMC10056240 DOI: 10.3390/medicines10030022] [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] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION The aim of our study is to evaluate the nutritional status of patients in an acute geriatric unit. METHODS Patients included in the study were hospitalized in an acute geriatric unit over a period of 6 months. The nutritional status of each patient was evaluated with anthropometric measurements (the BMI and MNA scales), and biological measurements (albumin). Frailty was evaluated using three scales: the Fried scale, the CFS and the modified SEGA scale. RESULTS A total of 359 patients were included, comprising 251 women (70%) with an average age of 85.28 years. The study showed that 102 elderly subjects were considered undernourished according to the BMI scale, 52 subjects were undernourished according to the MNA scale, and 50 subjects were undernourished according to their albumin levels. The relationships between undernutrition and frailty syndrome studied in our work show that elderly subjects who are undernourished according to the BMI and MNA scales are significantly frail according to Fried and Rockwood, whereas those who are undernourished according to their albumin levels are significantly frail according to Fried and the modified SEGA scale. CONCLUSION The relationship between undernutrition and the frailty syndrome is close, and their joint screening is necessary, whether on an outpatient or in-hospital basis, in order to prevent negative events related to comorbidities and geriatric syndromes.
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Affiliation(s)
- Abrar-Ahmad Zulfiqar
- Département de Médecine Interne, CHU Strasbourg, Clinique Médicale B, 67000 Strasbourg, France
| | - Ibrahima Amadou Dembele
- Département de Médecine Interne, CHU Strasbourg, Clinique Médicale B, 67000 Strasbourg, France
| | - Emmanuel Andres
- Département de Médecine Interne, CHU Strasbourg, Clinique Médicale B, 67000 Strasbourg, France
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Van Wambeke E, Bezler C, Kasprowicz AM, Charles AL, Andres E, Geny B. Two-Years Follow-Up of Symptoms and Return to Work in Complex Post-COVID-19 Patients. J Clin Med 2023; 12:jcm12030741. [PMID: 36769389 PMCID: PMC9917586 DOI: 10.3390/jcm12030741] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Many COVID-19 patients present with severe long-lasting symptoms. They might benefit from a coordination team to manage such complex situations, but late efficacy still needs to be determined. POPULATION AND METHODS Out of 105 contacts, 45 patients had two phone consultations separated by personalized support 15 and 22 months, respectively, after COVID infection. Self-reported symptoms, feelings of improvement and ability to return to work allowed us to determine the efficacy of the therapeutic strategy proposed. RESULTS Unlike what was expected, many post-COVID-19 patients directly contacted the coordination team and had significant pre-existing comorbidities. Despite exercise, respiratory, olfactory rehabilitations, cognition/speech therapy and/or psychological support, the more frequent self-reported symptoms (fatigue, neurocognitive disorders, muscles and joint pain) did not resolve. However, dyspnea, anxiety and chest pain were significantly reduced. Finally, 2/3 of the patients felt some degree of improvement and returned to work either partially or fully, but 1/3 remained complaining of symptoms and out of work as late as 22 months after COVID occurrence. All patients greatly appreciated the second phone consultation. CONCLUSIONS In such complex situations, besides early and adapted rehabilitations and psychological help allowing better symptom management, relatively simple actions such as a phone call might be very useful to reduce patients' feelings of abandonment.
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Affiliation(s)
- Erika Van Wambeke
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, NHC, 1 Place de l’Hôpital, CEDEX, 67091 Strasbourg, France
| | - Cécile Bezler
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, NHC, 1 Place de l’Hôpital, CEDEX, 67091 Strasbourg, France
| | - Anne-Marie Kasprowicz
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, NHC, 1 Place de l’Hôpital, CEDEX, 67091 Strasbourg, France
| | - Anne-Laure Charles
- Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, University of Strasbourg, 11 Rue Humann, 67000 Strasbourg, France
| | - Emmanuel Andres
- Department of Internal Medicine, University Hospital of Strasbourg, 1 Place de l’Hôpital, CEDEX, 67091 Strasbourg, France
| | - Bernard Geny
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, NHC, 1 Place de l’Hôpital, CEDEX, 67091 Strasbourg, France
- Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, University of Strasbourg, 11 Rue Humann, 67000 Strasbourg, France
- Correspondence:
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Alfatni A, Charles AL, Sauer F, Riou M, Goupilleau F, Talha S, Meyer A, Andres E, Kindo M, Mazzucotelli JP, Epailly E, Geny B. Peripheral Blood Mononuclear Cells Mitochondrial Respiration and Superoxide Anion after Heart Transplantation. J Clin Med 2022; 11:jcm11237247. [PMID: 36498821 PMCID: PMC9735976 DOI: 10.3390/jcm11237247] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The mitochondrial function of circulating peripheral blood mononuclear cells (PBMCs) is an interesting new approach to cardiac diseases. Thus, PBMC's mitochondrial respiration decreases in relation to heart failure severity. However, no data are available on heart-transplanted patients (Htx). POPULATION AND METHODS We determined PBMCs mitochondrial respiration by high-resolution respirometry (Oroboros Instruments) and superoxide anion production using electron paramagnetic resonance (Bruker-Biospin) in 20 healthy subjects and 20 matched Htx and investigated clinical, biological, echocardiographic, coronarography and biopsy characteristics. RESULTS PBMCs mitochondrial respiratory chain complex II respiration was decreased in Htx (4.69 ± 0.84 vs. 7.69 ± 1.00 pmol/s/million cell in controls and Htx patients, respectively; p = 0.007) and complex IV respiration was increased (24.58 ± 2.57 vs. 15.68 ± 1.67 pmol/s/million cell; p = 0.0035). Superoxide anion production was also increased in Htx (1.47 ± 0.10 vs. 1.15 ± 0.10 µmol/min; p = 0.041). The leucocyte-to-lymphocyte ratio was increased in Htx, whom complex II correlated with leucocyte number (r = 0.51, p = 0.02) and with the left ventricular posterior wall peak early diastolic myocardial velocity (r = -0.62, p = 0.005). Complex IV was increased in the two patients with acute rejection and correlated negatively with Htx's isovolumetric relation time (r = -0.45, p = 0.045). DISCUSSION Although presenting with normal systolic function, Htx demonstrated abnormal PBMC's mitochondrial respiration. Unlike immunosuppressive therapies, subclinical diastolic dysfunction might be involved in these changes. Additionally, lymphopenia might reduce complex II, and acute rejection enhances complex IV respirations. CONCLUSION PBMC's mitochondrial respiration appears modified in Htx, potentially linked to cellular shift, mild diastolic dysfunction and/or acute rejection.
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Affiliation(s)
- Abrar Alfatni
- Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, University of Strasbourg, 11 Rue Humann, 67000 Strasbourg, France
| | - Anne-Laure Charles
- Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, University of Strasbourg, 11 Rue Humann, 67000 Strasbourg, France
| | - François Sauer
- Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, University of Strasbourg, 11 Rue Humann, 67000 Strasbourg, France
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, NHC, 1 Place de l’Hôpital, CEDEX, 67091 Strasbourg, France
| | - Marianne Riou
- Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, University of Strasbourg, 11 Rue Humann, 67000 Strasbourg, France
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, NHC, 1 Place de l’Hôpital, CEDEX, 67091 Strasbourg, France
| | - Fabienne Goupilleau
- Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, University of Strasbourg, 11 Rue Humann, 67000 Strasbourg, France
| | - Samy Talha
- Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, University of Strasbourg, 11 Rue Humann, 67000 Strasbourg, France
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, NHC, 1 Place de l’Hôpital, CEDEX, 67091 Strasbourg, France
| | - Alain Meyer
- Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, University of Strasbourg, 11 Rue Humann, 67000 Strasbourg, France
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, NHC, 1 Place de l’Hôpital, CEDEX, 67091 Strasbourg, France
| | - Emmanuel Andres
- Department of Internal Medicine, University Hospital of Strasbourg, 1 Place de l’Hôpital, CEDEX, 67091 Strasbourg, France
| | - Michel Kindo
- Cardiovascular Service, University Hospital of Strasbourg, NHC, 1 Place de l’Hôpital, CEDEX, 67091 Strasbourg, France
| | - Jean-Philippe Mazzucotelli
- Cardiovascular Service, University Hospital of Strasbourg, NHC, 1 Place de l’Hôpital, CEDEX, 67091 Strasbourg, France
| | - Eric Epailly
- Cardiovascular Service, University Hospital of Strasbourg, NHC, 1 Place de l’Hôpital, CEDEX, 67091 Strasbourg, France
| | - Bernard Geny
- Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, University of Strasbourg, 11 Rue Humann, 67000 Strasbourg, France
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, NHC, 1 Place de l’Hôpital, CEDEX, 67091 Strasbourg, France
- Correspondence:
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Zulfiqar AA, Martin L, Habchi P, Massimbo DND, Dembele IA, Andres E. Zulfiqar Frailty Scale (ZFS): Concordance Study with the Clinical Frailty Scale (CFS). Medicines (Basel) 2022; 9:medicines9110058. [PMID: 36422119 PMCID: PMC9695739 DOI: 10.3390/medicines9110058] [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] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022]
Abstract
Introduction: We designed a new scale for the rapid detection of frailty for use in primary care, referred to as the Zulfiqar Frailty Scale (ZFS). Objective: To evaluate the performance of the “ZFS” tool to screen for frailty as defined in the Clinical Frailty Scale (CFS) criteria in an ambulatory population of patients at least 75 years old. Method: A prospective study conducted in Alsace, France, for a duration of 6 months that included patients aged 75 and over was judged to be autonomous with an ADL (Activity of Daily Living) > 4/6. Results: In this ambulatory population of 124 patients with an average age of 79 years, the completion time for our scale was less than two minutes, and the staff required no training beforehand. Sensibility was 67%, while specificity was 87%. The positive predictive value was 80%, and the negative predictive value was 77%. The Youden index was 59.8%. In our study, we have a moderate correlation between CFS and ZFS (r = 0.674 with 95%CI = [0.565; 0.760]; p-value < 2.2 × 10−16 < 0.05). The Pearson correlations between these two geriatric scores were all strong and roughly equivalent to each other. The kappa of Cohen (k) = 0.46 (Unweighted), moderate concordance between the ZFS and CFS scales according to Fleiss classification. Conclusion: The “ZFS” tool makes it possible to screen for frailty with a high level of specificity and positive/negative predictive value.
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Affiliation(s)
- Abrar-Ahmad Zulfiqar
- Service de Médecine Interne, Diabète et Maladies Métaboliques de la Clinique Médicale B, Hôpitaux Universitaires de Strasbourg et Equipe EA 3072 “Mitochondrie, Stress Oxydant et Protection Musculaire”, Faculté de Médecine-Université de Strasbourg, 67000 Strasbourg, France
- Correspondence:
| | - Léo Martin
- Service de Médecine Interne, Diabète et Maladies Métaboliques de la Clinique Médicale B, Hôpitaux Universitaires de Strasbourg et Equipe EA 3072 “Mitochondrie, Stress Oxydant et Protection Musculaire”, Faculté de Médecine-Université de Strasbourg, 67000 Strasbourg, France
| | - Perla Habchi
- Anesthesiology Department, Aman Hospital, F Ring Rd, Zone 47, Building 412, Doha P.O. Box 8199, Qatar
| | | | - Ibrahima Amadou Dembele
- Service de Médecine Interne, Diabète et Maladies Métaboliques de la Clinique Médicale B, Hôpitaux Universitaires de Strasbourg et Equipe EA 3072 “Mitochondrie, Stress Oxydant et Protection Musculaire”, Faculté de Médecine-Université de Strasbourg, 67000 Strasbourg, France
| | - Emmanuel Andres
- Service de Médecine Interne, Diabète et Maladies Métaboliques de la Clinique Médicale B, Hôpitaux Universitaires de Strasbourg et Equipe EA 3072 “Mitochondrie, Stress Oxydant et Protection Musculaire”, Faculté de Médecine-Université de Strasbourg, 67000 Strasbourg, France
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Sablón-González N, Parodis-Lopez Y, Alonso-Ortiz MB, Laurin A, Andres E, Lorenzo Villalba N. Recurrent Episodes of Hypokalaemia during Treatment with Inhaled Beta-2 Agonist Revealing Gitelman Syndrome, an Uncommon Clinical Entity. Eur J Case Rep Intern Med 2022; 9:003605. [DOI: 10.12890/2022_003605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 10/12/2022] [Indexed: 11/07/2022] Open
Abstract
A 28-year-old female patient was hospitalized for mild–moderate hypokalaemia which was persistent despite discontinuation of beta-2 agonist bronchodilator treatment. Her past medical history was relevant for two episodes of severe hypokalaemia after active inhaled beta-2 agonist treatment for asthma crisis. Investigations revealed increased potassium in spot urine with a transtubular potassium gradient <4. A 24-hour urine analysis showed hypophosphaturia, hypocalciuria, hypomagnesuria and normal urine prostaglandins in favour of Gitelman syndrome. Oral potassium supplementation was started and genetic studies were recommended.
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Affiliation(s)
- Nery Sablón-González
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | - Yanet Parodis-Lopez
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | - Maria Belen Alonso-Ortiz
- Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | - Angélica Laurin
- Centro de Atención Primaria Barrio Atlántico, Las Palmas de Gran Canaria, Spain
| | - Emmanuel Andres
- Service de Médecine Interne, Diabète et Maladies Métaboliques. Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Noel Lorenzo Villalba
- Service de Médecine Interne, Diabète et Maladies Métaboliques. Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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10
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Zulfiqar AA, Habchi H, Habchi P, Dembele IA, Andres E. Physical Activity in the Elderly and Frailty Syndrome: A Retrospective Study in Primary Care. Medicines (Basel) 2022; 9:medicines9100051. [PMID: 36286584 PMCID: PMC9611325 DOI: 10.3390/medicines9100051] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/03/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022]
Abstract
Objectives: Physical activity carries numerous therapeutic benefits, and it is more effective when applied before the onset of symptoms. The objective of this study is to compare the correlation of the evaluation of physical activity carried out using the Ricci and Gagnon test and the frailty profile measured by the mSEGA scale in a population of patients consulting in general medicine. Methods: We conducted a retrospective study within a general practitioner clinic in Chaumont and Bologne (Haute-Marne department) during a 3-month period. Patients aged 65 years and up were screened for frailty using the modified SEGA (mSEGA) assessment, and physical activity was measured using the Ricci–Gagnon questionnaire. Results: A total of 44 patients were selected, with a slightly female predominance (59.1%). Of these, 21 patients reported having worked in manual labor. Seven patients were found to be frail using the SEGAm assessment, while 10 (22.73%) patients had an inactive profile according the Ricci–Gagnon score. Malnutrition was detected in six patients (13.64%) using the MNA survey. Frailty as defined by the mSEGA scale had no statistical correlation (p = 0.68) with the Ricci–Gagnon score. A Ricci–Gagnon inactive profile showed statistical correlations with fall indicators (unipedal balance test, p = 0.014) and malnutrition scores using the MNA (p = 0.0057) as well as with the Charlson Comorbidity Index (p = 0.027). Conclusion: A systematic survey of the elderly by a general practitioner implementing a regular and suitable physical activity regimen would allow a better screening of frailty, minimizing its complications.
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Affiliation(s)
- Abrar-Ahmad Zulfiqar
- Service de Médecine Interne, Diabète et Maladies Métaboliques de la Clinique Médicale B, Hôpitaux Universitaires de Strasbourg et Equipe EA 3072 “Mitochondrie, Stress Oxydant et Protection Musculaire”, Faculté de Médecine, Université de Strasbourg, 67000 Strasbourg, France
- Correspondence:
| | - Habib Habchi
- Département de Médecine Générale, Université de Reims, 51100 Reims, France
| | - Perla Habchi
- Anesthesiology, Aman Hospital, F Ring Rd, Zone 47, Building 412, Doha P.O. Box 8199, Qatar
| | - Ibrahima Amadou Dembele
- Service de Médecine Interne, Diabète et Maladies Métaboliques de la Clinique Médicale B, Hôpitaux Universitaires de Strasbourg et Equipe EA 3072 “Mitochondrie, Stress Oxydant et Protection Musculaire”, Faculté de Médecine, Université de Strasbourg, 67000 Strasbourg, France
| | - Emmanuel Andres
- Service de Médecine Interne, Diabète et Maladies Métaboliques de la Clinique Médicale B, Hôpitaux Universitaires de Strasbourg et Equipe EA 3072 “Mitochondrie, Stress Oxydant et Protection Musculaire”, Faculté de Médecine, Université de Strasbourg, 67000 Strasbourg, France
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11
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Cordeanu EM, Jambert L, Tousch J, Mirea C, Delatte A, Younes W, Woehl B, Harter C, Frantz AS, Hamade A, Schini-Kerth V, Ohlmann P, Andres E, Stephan D. The Conundrum of Occult Cancer Screening in Venous Thromboembolism: Lessons from the REMOTEV Registry. Medicina (Kaunas) 2022; 58:medicina58070913. [PMID: 35888632 PMCID: PMC9317660 DOI: 10.3390/medicina58070913] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022]
Abstract
(1) Background and Objectives: Venous thromboembolism (VTE) is strongly associated with cancer, and may be the first event revealing occult neoplasia. Nonetheless, the reasonable extent of the etiological assessment after an unprovoked VTE event remains debated. The main objective of this study was to evaluate the incidence of occult neoplasia one year after an episode of VTE, in consecutively hospitalized patients for VTE from the REMOTEV registry. The secondary objectives were to assess the performance of the various tests used for occult cancer screening in a real-life setting and analyze the risk factors associated with the discovery of cancer and the 1-year prognosis. (2) Methods: REMOTEV is a prospective, non-interventional cohort study of patients with acute VTE. Patients included in the registry from 23 October 2013 to 28 July 2018 were analyzed after a follow-up of 12 months. Cancer detection was performed according to local practices and consisted of a limited strategy to which an abdominal ultrasound was added. In the presence of suggestive clinical manifestations, further examinations were performed on an individual basis. (3) Results: A total of 993 patients were included in the study. At 1 year, the incidence of newly diagnosed cancer was low (5.3%). Half of the detected cancers were metastatic at discovery (51%) and had a poor global prognosis (32% of mortality at 1 year). Admission pulmonary CT scans as well as (thoracic)-abdomino-pelvic CT scans (when performed) were responsible for the majority of detected cancers. Age over 65 years and the concomitant presence of an unusual site and lower-limb deep vein thrombosis were the only factors associated with occult neoplasia in this cohort. After 1-year FU, mortality was higher in cancer patients (HR 6.0 (CI 95% 3.5−10.3, p < 0.0001)), and cancer evolution was the leading cause of death in the cancer group. (4) Conclusions: In REMOTEV, VTE-revealed occult cancer prevalence was low, but similar to recent reports and associated with higher age, multiple thrombotic sites and worse prognosis.
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Affiliation(s)
- Elena-Mihaela Cordeanu
- Department of Hypertension, Vascular Disease and Clinical Pharmacology, Strasbourg Regional University Hospital, 67091 Strasbourg, France; (L.J.); (J.T.); (C.M.); (A.-S.F.); (D.S.)
- Correspondence: ; Tel.: +33-0369-551-520
| | - Lucas Jambert
- Department of Hypertension, Vascular Disease and Clinical Pharmacology, Strasbourg Regional University Hospital, 67091 Strasbourg, France; (L.J.); (J.T.); (C.M.); (A.-S.F.); (D.S.)
| | - Jonathan Tousch
- Department of Hypertension, Vascular Disease and Clinical Pharmacology, Strasbourg Regional University Hospital, 67091 Strasbourg, France; (L.J.); (J.T.); (C.M.); (A.-S.F.); (D.S.)
| | - Corina Mirea
- Department of Hypertension, Vascular Disease and Clinical Pharmacology, Strasbourg Regional University Hospital, 67091 Strasbourg, France; (L.J.); (J.T.); (C.M.); (A.-S.F.); (D.S.)
| | - Alexandre Delatte
- Department of Cardiology, Haguenau Regional Hospital, 67500 Haguenau, France;
| | - Waël Younes
- Department of Vascular Medicine, Colmar Regional Hospital, 68000 Colmar, France;
| | - Bastien Woehl
- Department of Vascular Medicine, Mulhouse Regional Hospital, 68100 Mulhouse, France; (B.W.); (A.H.)
| | - Claire Harter
- Department of Radiology, Strasbourg Regional University Hospital, 67091 Strasbourg, France;
| | - Anne-Sophie Frantz
- Department of Hypertension, Vascular Disease and Clinical Pharmacology, Strasbourg Regional University Hospital, 67091 Strasbourg, France; (L.J.); (J.T.); (C.M.); (A.-S.F.); (D.S.)
| | - Amer Hamade
- Department of Vascular Medicine, Mulhouse Regional Hospital, 68100 Mulhouse, France; (B.W.); (A.H.)
| | - Valérie Schini-Kerth
- UMR 1260 INSERM Regenerative Nanomedecine, Faculty of Pharmacy, Strasbourg University, 67400 Illkirch, France;
| | - Patrick Ohlmann
- Cardiology Department, Strasbourg Regional University Hospital, 67091 Strasbourg, France;
| | - Emmanuel Andres
- Internal Medicine Department, Strasbourg Regional University Hospital, 67091 Strasbourg, France;
| | - Dominique Stephan
- Department of Hypertension, Vascular Disease and Clinical Pharmacology, Strasbourg Regional University Hospital, 67091 Strasbourg, France; (L.J.); (J.T.); (C.M.); (A.-S.F.); (D.S.)
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12
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Tripon S, Bilbault P, Fabacher T, Lefebvre N, Lescuyer S, Andres E, Schmitt E, Garnier-KepKA S, Borgne PL, Muller J, Merdji H, Chaffraix F, Mutter D, Baumert TF, Meziani F, Doffoel M. Abnormal liver tests and non-alcoholic fatty liver disease predict disease progression and outcome of patients with COVID-19. Clin Res Hepatol Gastroenterol 2022; 46:101894. [PMID: 35227956 PMCID: PMC8873041 DOI: 10.1016/j.clinre.2022.101894] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/23/2022] [Accepted: 02/18/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Coronavirus disease 2019 (COVID-19) is a serious public health issue that became rapidly pandemic. Liver injury and comorbidities, including metabolic syndrome, are associated with severe forms of the disease. This study sought to investigate liver injury, clinical features, and risk factors in patients with mild, moderate, and severe COVID-19. METHODS We retrospectively included all consecutive patients hospitalized with laboratory-confirmed COVID-19 between February, 22 and May 15, 2020 at the emergency rooms of a French tertiary hospital. Medical history, symptoms, biological and imaging data were collected. RESULTS Among the 1381 hospitalizations for COVID-19, 719 patients underwent liver tests on admission and 496 (68.9%) patients displayed abnormal liver tests. Aspartate aminotransferase was most commonly abnormal in 57% of cases, followed by gamma-glutamyl transferase, alanine aminotransferase, albumin, alkaline phosphatase, and total bilirubin in 56.5%, 35.9%, 18.4%, 11.4%, and 5.8%. The presence of hepatocellular type more than 2xULN was associated with a higher risk of hospitalization and a worse course of severe disease (odd ratio [OR] 5.599; 95%CI: 1.27-23.86; p = 0.021; OR 3.404; 95% CI: 2.12-5.47; p < 0.001, respectively). A higher NAFLD fibrosis score was associated with a higher risk of hospitalization (OR 1.754; 95%CI: 1.27-2.43, p < 0.001). In multivariate analyses, patients with high fibrosis-4 index had a 3-fold greater risk of severe disease (p < 0.001). CONCLUSION Abnormal liver tests are common in patients with COVID-19 and could predict the outcome. Patients with non-alcoholic fatty liver disease and liver fibrosis are at higher risk of progressing to severe COVID-19.
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Affiliation(s)
- Simona Tripon
- Department of Hepatology and Gastroenterology, Service Expert de Lutte contre les Hépatites Virales d'Alsace (SELHVA), Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Institut des Maladies Virales et Hépatiques, Inserm U1110, Strasbourg, France.
| | - Pascal Bilbault
- Head of Emergency Department, Regenerative Nanomedicine, INSERM UMR 1260 Fédération de Médecine Translationelle de Strasbourg, Hôpitaux Universitaires de Strasbourg, University of Strasbourg, France
| | - Thibaut Fabacher
- Department of Public Health, Hôpitaux Universitaires de Strasbourg, France
| | - Nicolas Lefebvre
- Department of Infectious Diseases, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, France
| | - Sylvain Lescuyer
- Internal Medicine Department, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, France
| | - Emmanuel Andres
- Department of Internal Medicine, Medical Clinic B, HôpitauxUniversitaires de Strasbourg, University of Strasbourg, France
| | - Elise Schmitt
- Geriatric Department, HôpitauxUniversitaires de Strasbourg, EA-3072, University of Strasbourg, France
| | | | - Pierrick Le Borgne
- Emergency Department, Regenerative Nanomedicine, INSERM UMR 1260 Fédération de MédecineTranslationelle de Strasbourg, HôpitauxUniversitaires de Strasbourg, University of Strasbourg, France
| | - Joris Muller
- Department of Public Health, Hôpitaux Universitaires de Strasbourg, France
| | - Hamid Merdji
- Medical ICU, Médecine Intensive- Réanimation, INSERM UMR 1260, RegenerativeNanomedicine (RNM), FMTS, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France
| | - Frédéric Chaffraix
- Service Expert de Lutte contre les Hépatites Virales d'Alsace (SELHVA), Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, France
| | - Didier Mutter
- Department of General, Digestive, and Endocrine Surgery, Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, France
| | - Thomas F Baumert
- Department of Hepatology and Gastroenterology, Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Institut des Maladies Virales et Hépatiques, Inserm U1110, Institut Hopitalo-Universitaire, University of Strasbourg, France
| | - Ferhat Meziani
- Medical ICU, Médecine Intensive - Réanimation, INSERM UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France
| | - Michel Doffoel
- Faculté de Medicine, University of Strasbourg, Inserm U1110, Strasbourg, France
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13
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Zulfiqar AA, Hajjam M, Hajjam A, Andres E. GER-e-TEC Study: An Innovative Geriatric Risk Remote Monitoring Project. Digit Health 2022. [DOI: 10.36255/exon-publications-digital-health-remote-monitoring] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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14
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Sauer F, Riou M, Charles AL, Meyer A, Andres E, Geny B, Talha S. Pathophysiology of Heart Failure: A Role for Peripheral Blood Mononuclear Cells Mitochondrial Dysfunction? J Clin Med 2022; 11:jcm11030741. [PMID: 35160190 PMCID: PMC8836880 DOI: 10.3390/jcm11030741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 02/06/2023] Open
Abstract
Heart failure (HF) is a leading cause of hospitalization in patients aged more than 65 years and is associated with high mortality rates. A better comprehension of its physiopathology is still needed, and, in addition to neurohormonal systems and sodium glucose co-transporter 2 modulations, recent studies focus on the mitochondrial respiration of peripheral blood circulating cells (PBMCs). Thus, cardiovascular metabolic risk factors and cellular switch with an increased neutrophil/lymphocytes ratio might favor the decreased PBMC mitochondrial respiration observed in relation with HF severity. PBMCs are implicated in the immune system function and mitochondrial dysfunction of PBMC, potentially induced by their passage through a damaged heart and by circulating mitoDAMPs, which can lead to a vicious circle, thus sustaining negative cardiac remodeling during HF. This new approach of HF complex pathophysiology appears to be a promising field of research, and further studies on acute and chronic HF with reduced or preserved LVEF are warranted to better understand whether circulating PBMC mitochondrial function and mitoDAMPs follow-ups in HF patients might show diagnosis, prognosis or therapeutic usefulness.
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Affiliation(s)
- François Sauer
- University of Strasbourg, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France; (F.S.); (M.R.); (A.-L.C.); (A.M.); (E.A.); (S.T.)
- University Hospital of Strasbourg, Physiology and Functional Exploration Service, 1 Place de l’Hôpital, 67091 Strasbourg, France
| | - Marianne Riou
- University of Strasbourg, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France; (F.S.); (M.R.); (A.-L.C.); (A.M.); (E.A.); (S.T.)
- University Hospital of Strasbourg, Physiology and Functional Exploration Service, 1 Place de l’Hôpital, 67091 Strasbourg, France
| | - Anne-Laure Charles
- University of Strasbourg, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France; (F.S.); (M.R.); (A.-L.C.); (A.M.); (E.A.); (S.T.)
- University Hospital of Strasbourg, Physiology and Functional Exploration Service, 1 Place de l’Hôpital, 67091 Strasbourg, France
| | - Alain Meyer
- University of Strasbourg, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France; (F.S.); (M.R.); (A.-L.C.); (A.M.); (E.A.); (S.T.)
- University Hospital of Strasbourg, Physiology and Functional Exploration Service, 1 Place de l’Hôpital, 67091 Strasbourg, France
| | - Emmanuel Andres
- University of Strasbourg, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France; (F.S.); (M.R.); (A.-L.C.); (A.M.); (E.A.); (S.T.)
- Internal Medicine, Diabete and Metabolic Diseases Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, France
| | - Bernard Geny
- University of Strasbourg, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France; (F.S.); (M.R.); (A.-L.C.); (A.M.); (E.A.); (S.T.)
- University Hospital of Strasbourg, Physiology and Functional Exploration Service, 1 Place de l’Hôpital, 67091 Strasbourg, France
- Correspondence:
| | - Samy Talha
- University of Strasbourg, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France; (F.S.); (M.R.); (A.-L.C.); (A.M.); (E.A.); (S.T.)
- University Hospital of Strasbourg, Physiology and Functional Exploration Service, 1 Place de l’Hôpital, 67091 Strasbourg, France
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15
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Mariette X, Hermine O, Tharaux PL, Resche-Rigon M, Porcher R, Ravaud P, Bureau S, Dougados M, Tibi A, Azoulay E, Cadranel J, Emmerich J, Fartoukh M, Guidet B, Humbert M, Lacombe K, Mahevas M, Pene F, Pourchet-Martinez V, Schlemmer F, Yazdanpanah Y, Baron G, Perrodeau E, Vanhoye D, Kedzia C, Demerville L, Gysembergh-Houal A, Bourgoin A, Dalibey S, Raked N, Mameri L, Alary S, Hamiria S, Bariz T, Semri H, Hai DM, Benafla M, Belloul M, Vauboin P, Flamand S, Pacheco C, Walter-Petrich A, Stan E, Benarab S, Nyanou C, Montlahuc C, Biard L, Charreteur R, Dupré C, Cardet K, Lehmann B, Baghli K, Madelaine C, D'Ortenzio E, Puéchal O, Semaille C, Savale L, Harrois A, Figueiredo S, Duranteau J, Anguel N, Pavot A, Monnet X, Richard C, Teboul JL, Durand P, Tissieres P, Jevnikar M, Montani D, Bulifon S, Jaïs X, Sitbon O, Pavy S, Noel N, Lambotte O, Escaut L, Jauréguiberry S, Baudry E, Verny C, Noaillon M, Lefèvre E, Zaidan M, Le Tiec CLT, Verstuyft C, Roques AM, Grimaldi L, Molinari D, Leprun G, Fourreau A, Cylly L, Virlouvet M, Meftali R, Fabre S, Licois M, Mamoune A, Boudali Y, Georgin-Lavialle S, Senet P, Pialoux G, Soria A, Parrot A, François H, Rozensztajn N, Blin E, Choinier P, Camuset J, Rech JS, Canellas A, Rolland-Debord C, Lemarié N, Belaube N, Nadal M, Siguier M, Petit-Hoang C, Chas J, Drouet E, Lemoine M, Phibel A, Aunay L, Bertrand E, Ravato S, Vayssettes M, Adda A, Wilpotte C, Thibaut P, Fillon J, Debrix I, Fellahi S, Bastard JP, Lefèvre G, Fallet V, Gottenberg JE, Hansmann Y, Andres E, Bayer S, Becker G, Blanc F, Brin S, Castelain V, Chatelus E, Chatron E, Collange O, Danion F, De Blay F, Demonsant E, Diemunsch P, Diemunsch S, Felten R, Goichot B, Greigert V, Guffroy A, Heger B, Hutt A, Kaeuffer C, Kassegne L, Korganow AS, Le Borgne P, Lefebvre N, Martin T, Mertes PM, Metzger C, Meyer N, Nisand G, Noll E, Oberlin M, Ohlmann-Caillard S, Poindron V, Pottecher J, Ruch Y, Sublon C, Tayebi H, Weill F, Mekinian A, Abisror N, Jachiet V, Chopin D, Fain O, Garnier M, Krause le Garrec J, Morgand M, Pacanowski J, Urbina T, McAvoy C, Pereira M, Aratus G, Berard L, Simon T, Daguenel-Nguyen A, Antignac M, Leplay C, Arlet JB, Diehl JL, Bellenfant F, Blanchard A, Buffet A, Cholley B, Fayol A, Flamarion E, Godier A, Gorget T, Hamada SR, Hauw-Berlemont C, Hulot JS, Lebeaux D, Livrozet M, Michon A, Neuschwander A, Penet MA, Planquette B, Ranque B, Sanchez O, Volle G, Briois S, Cornic M, Elisee V, Jesuthasan D, Djadi-Prat J, Jouany P, Junquera R, Henriques M, Kebir A, Lehir I, Meunier J, Patin F, Paquet V, Tréhan A, Vigna V, Sabatier B, Bergerot D, Jouve C, Knosp C, Lenoir O, Mahtal N, Resmini L, Lescure FX, Ghosn J, BACHELARD A, BIRONNE T, BORIE R, BOUNHIOL A, BOUSSARD C, CHAUFFiER J, CHALAL S, CHALAL L, CHANSOMBAT M, CRESPIN P, CRESTANI B, DACONCEICAO O, DECONINCK L, DIEUDE P, DOSSIER A, DUBERT M, DUCROCQ G, FUENTES A, GERVAIS A, GILBERT M, ISERNIA V, ISMAEL S, JOLY V, JULIA Z, LARIVEN S, LE GAC S, LE PLUART D, LOUNI F, NDIAYE A, PAPO T, PARISEY M, PHUNG B, POURBAIX A, RACHLINE A, RIOUX C, SAUTEREAU A, STEG G, TARHINI H, VALAYER S, VALLOIS D, VERMES P, VOLPE T, Nguyen Y, Honsel V, Weiss E, Codorniu A, Zarrouk V, De Lastours V, Uzzan M, Olivier O, Rossi G, Gamany N, Rahli R, Louis Z, Boutboul D, Galicier L, Amara Y, Archer G, Benattia A, Bergeron A, Bondeelle L, De Castro N, Clément M, Darmont M, Denis B, Dupin C, Feredj E, Feyeux D, Joseph A, Lengliné E, Le Guen P, Liégeon G, Lorillon G, Mabrouki A, Mariotte E, Martin de Frémont G, Mirouse A, Molina JM, Peffault de Latour R, Oksenhendler E, Saussereau J, Tazi A, Tudesq JJ, Zafrani L, Brindele I, Bugnet E, Celli Lebras K, Chabert J, Djaghout L, Fauvaux C, Jegu AL, Kozaliewicz E, Meunier M, Tremorin MT, Davoine C, Madeleine I, Caillat-Zucman S, Delaugerre C, Morin F, SENE D, BURLACU R, CHOUSTERMAN B, MEGARBANE B, RICHETTE P, RIVELINE JP, FRAZIER A, VICAUT E, BERTON L, HADJAM T, VASQUEZ-IBARRA MA, JOURDAINE C, JACOB A, SMATI J, RENAUD S, MANIVET P, PERNIN C, SUAREZ L, Semerano L, ABAD S, Benainous R, Bloch Queyrat C, Bonnet N, Brahmi S, Cailhol J, Cohen Y, Comparon C, Cordel H, Dhote R, Dournon N, Duchemann B, Ebstein N, Giroux-Leprieur B, Goupil de Bouille J, Jacolot A, Nunes H, Oziel J, Rathouin V, Rigal M, Roulot D, Tantet C, Uzunhan Y, COSTEDOAT-CHALUMEAU N, Ait Hamou Z, Benghanem S, BLANCHE P, CANOUI E, CARLIER N, CHAIGNE B, CONTEJEAN A, DUNOGUE B, DUPLAND P, DUREL - MAURISSE A, GAUZIT R, JAUBERT P, Joumaa H, Jozwiak M, KERNEIS S, LACHATRE M, Lafoeste H, LEGENDRE P, LUONG NGUYEN LB, MAREY J, MORBIEU C, MOUTHON L, NGUYEN L, Palmieri LJ, REGENT A, SZWEBEL TA, TERRIER B, GUERIN C, ZERBIT J, CHEREF K, CHITOUR K, CISSE MS, CLARKE A, CLAVERE G, DUSANTER I, GAUDEFROY C, JALLOULI M, KOLTA S, LE BOURLOUT C, MARIN N, MENAGE N, MOORES A, PEIGNEY I, PIERRON C, SALEH-MGHIR S, VALLET M, MICHEL M, MELICA G, LELIEVRE JD, FOIS E, LIM P, MATIGNON M, GUILLAUD C, THIEMELE A, SCHMITZ D, BOUHRIS M, BELAZOUZ S, LANGUILLE L, MEKONTSO-DESSAPS A, SADAOUI T, Mayaux J, Cacoub P, Corvol JC, Louapre C, Sambin S, Mariani LL, Karachi C, Tubach F, Estellat C, Gimeno L, Martin K, Bah A, Keo V, Ouamri S, Messaoudi Y, Yelles N, Faye P, Cavelot S, Larcheveque C, Annonay L, Benhida J, Zahrate-Ghoul A, Hammal S, Belilita R, Lecronier M, Beurton A, Haudebourg L, Deleris R, Le Marec J, Virolle S, Nemlaghi S, Bureau C, Mora P, De Sarcus M, Clovet O, Duceau B, Grisot PH, Pari MH, Arzoine J, Clarac U, Faure M, Delemazure J, Decavele M, Morawiec E, Demoule A, Dres M, Vautier M, Allenbach Y, Benveniste O, Leroux G, Rigolet A, Guillaume-Jugnot P, Domont F, Desbois AC, Comarmond C, Champtiaux N, Toquet S, Ghembaza A, Vieira M, Maalouf G, Boleto G, Ferfar Y, Charbonnier F, AGUILAR C, ALBY-LAURENT F, ALYANAKIAN MA, BAKOUBOULA P, BROISSAND C, BURGER C, CAMPOS-VEGA C, CHAVAROT N, CHOUPEAUX L, FOURNIER B, GRANVILLE S, ISSORAT E, ROUZAUD C, VIMPERE D, Geri G, Derridj N, Sguiouar N, Meddah H, Djadel M, Chambrin-Lauvray H, Duclos-Vallée JC, Saliba F, Sacleux SC, Koumis I, Michot JM, Stoclin A, Colomba E, Pommeret F, Willekens C, Sakkal M, Da Silva R, Dejean V, Mekid Y, Ben-Mabrouk I, Pradon C, Drouard L, Camara-Clayette V, Morel A, Garcia G, Mohebbi A, Berbour F, Dehais M, Pouliquen AL, Klasen A, Soyez-Herkert L, London J, Keroumi Y, Guillot E, Grailles G, El Amine Y, Defrancq F, Fodil H, Bouras C, Dautel D, Gambier N, Dieye T, Razurel A, Bienvenu B, Lancon V, Lecomte L, Beziriganyan K, Asselate B, Allanic L, Kiouris E, Legros MH, Lemagner C, Martel P, Provitolo V, Ackermann F, Le Marchand M, Clan Hew Wai A, Fremont D, Coupez E, Adda M, Duée F, Bernard L, Gros A, Henry E, Courtin C, Pattyn A, Guinot PG, Bardou M, Maurer A, Jambon J, Cransac A, Pernot C, Mourvillier B, Servettaz A, Deslée G, Wynckel A, Benoit P, Marquis E, Roux D, Gernez C, Yelnik C, Poissy J, Nizard M, Denies F, Gros H, Mourad JJ, Sacco E, Renet S. Sarilumab in adults hospitalised with moderate-to-severe COVID-19 pneumonia (CORIMUNO-SARI-1): An open-label randomised controlled trial. The Lancet Rheumatology 2022; 4:e24-e32. [PMID: 34812424 PMCID: PMC8598187 DOI: 10.1016/s2665-9913(21)00315-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Patients with COVID-19 pneumonia can have increased inflammation and elevated cytokines, including interleukin (IL)-6, which might be deleterious. Thus, sarilumab, a high-affinity anti-IL-6 receptor antibody, might improve the outcome of patients with moderate-to-severe COVID-19 pneumonia. Methods We did a multicentric, open-label, Bayesian randomised, adaptive, phase 2/3 clinical trial, nested within the CORIMUNO-19 cohort, to test a superiority hypothesis. Patients 18 years or older hospitalised with COVID-19 in six French centres, requiring at least 3L/min of oxygen but without ventilation assistance and a WHO Clinical Progression Scale [CPS] score of 5 were enrolled. Patients were randomly assigned (1:1) via a web-based system, according to a randomisation list stratified on centre and with blocks randomly selected among 2 and 4, to receive usual care plus 400 mg of sarilumab intravenously on day 1 and on day 3 if clinically indicated (sarilumab group) or usual care alone (usual care group). Primary outcomes were the proportion of patients with WHO-CPS scores greater than 5 on the 10-point scale on day 4 and survival without invasive or non-invasive ventilation at day 14. This completed trial is closed to new participants and is registered with ClinicalTrials.gov, NCT04324073. Findings 165 patients were recruited from March 27 to April 6, 2020, and 148 patients were randomised (68 patients to the sarilumab group and 80 to the usual care group) and followed up for 90 days. Median age was 61·7 years [IQR 53·0–71·1] in the sarilumab group and 62·8 years [56·0–71·7] in the usual care group. In the sarilumab group 49 (72%) of 68 were men and in the usual care group 59 (78%) of 76 were men. Four patients in the usual care group withdrew consent and were not analysed. 18 (26%) of 68 patients in the sarilumab group had a WHO-CPS score greater than 5 at day 4 versus 20 (26%) of 76 in the usual care group (median posterior absolute risk difference 0·2%; 90% credible interval [CrI] −11·7 to 12·2), with a posterior probability of absolute risk difference greater than 0 of 48·9%. At day 14, 25 (37%) patients in the sarilumab and 26 (34%) patients in the usual care group needed ventilation or died, (median posterior hazard ratio [HR] 1·10; 90% CrI 0·69–1·74) with a posterior probability HR greater than 1 of 37·4%. Serious adverse events occurred in 27 (40%) patients in the sarilumab group and 28 (37%) patients in the usual care group (p=0·73). Interpretation Sarilumab treatment did not improve early outcomes in patients with moderate-to-severe COVID-19 pneumonia. Further studies are warranted to evaluate the effect of sarilumab on long-term survival. Funding Assistance publique—Hôpitaux de Paris
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Zulfiqar AA, Andres E, Hajjam M, Massimbo DND, Hajjam A. Heart failure risk remote monitoring program in the very elderly patients with COVID-19 disease. Transl Med Aging 2021; 5:52-53. [PMID: 34816072 PMCID: PMC8598265 DOI: 10.1016/j.tma.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Abrar-Ahmad Zulfiqar
- Service de Médecine Interne, Diabète et Maladies métaboliques de la Clinique Médicale B, Hôpitaux Universitaires de Strasbourg et Equipe EA 3072 "Mitochondrie, Stress oxydant et Protection musculaire", Faculté de Médecine, Université de Strasbourg, 67000, Strasbourg, France
| | - Emmanuel Andres
- Service de Médecine Interne, Diabète et Maladies métaboliques de la Clinique Médicale B, Hôpitaux Universitaires de Strasbourg et Equipe EA 3072 "Mitochondrie, Stress oxydant et Protection musculaire", Faculté de Médecine, Université de Strasbourg, 67000, Strasbourg, France
| | | | | | - Amir Hajjam
- Laboratoire IRTES-SeT, Université de Technologie de Belfort-Montbéliard (UTBM), Belfort-Montbéliard, Belfort, France
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Zulfiqar AA, Boulefred A, Dembélé IA, Amadou N, Traoré AK, Doucet J, Andres E. [Diabetes and frailty in the elderly. A prospective study of an outpatient population supported by general practitioners]. Rev Med Liege 2021; 76:817-823. [PMID: 34738756] [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
INTRODUCTION Elderly people with diabetes represent a large and growing part of the general practitioners patient database, but their state of frailty compared to the non-diabetic population is poorly understood. OBJECTIVE To study the relationship between diabetes and frailty in people aged 65 and over in primary care. METHOD Frailty syndrome was assessed by the Fried Scale and compared between populations of diabetic and non-diabetic patients; 268 patients were studied, including 129 diabetic patients. RESULTS Frailty was found in 27.9 % of older diabetic patients. The observed mean Fried score was 1.76 in people with diabetes versus 1.39 in non-diabetics, with more frail diabetic subjects (p = 0.007). In this study, HbA1c levels showed no significant association to frailty. CONCLUSION Larger studies in several general practice clinics should be performed on subjects over 65 years of age with or without diabetes.
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Affiliation(s)
- A A Zulfiqar
- Département de Médecine interne, Clinique médicale B, Hôpitaux Universitaires de Strasbourg, France
| | - A Boulefred
- Médecine générale, Département de Médecine générale, Université de Médecine Générale de Reims, France
| | - I A Dembélé
- Département de Médecine interne, Clinique médicale B, Hôpitaux Universitaires de Strasbourg, France
| | - N Amadou
- Département de Médecine interne, Clinique médicale B, Hôpitaux Universitaires de Strasbourg, France
| | - A K Traoré
- Département de Médecine interne, CHU Point G, Bamako, Mali
| | - J Doucet
- Service de Médecine interne polyvalente et thérapeutique, Hôpital Saint-Julien, CHU Rouen, France
| | - E Andres
- Département de Médecine interne, Clinique médicale B, Hôpitaux Universitaires de Strasbourg, France
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Méndez-Bailón M, Iguarán-Bermúdez R, López-García L, Sánchez-Sauce B, Pérez-Mateos P, Barrado-Cuchillo J, Villar-Martínez M, Fernández-Castelao S, García-Klepzig JL, Fuentes-Ferrer ME, García-García A, Vilacosta I, de Miguel-Yanes JM, Casas-Rojo JM, Calvo-Manuel E, Andres E, Lorenzo-Villalba N. Prognostic Value of the PROFUND Index for 30-Day Mortality in Acute Heart Failure. Medicina (Kaunas) 2021; 57:medicina57111150. [PMID: 34833368 PMCID: PMC8618627 DOI: 10.3390/medicina57111150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 12/13/2022]
Abstract
Background and Objectives: The prevalence and incidence of heart failure (HF) have been increasing in recent years as the population ages. These patients show a distinct profile of comorbidity, which makes their care more complex. In recent years, the PROFUND index, a specific tool for estimating the mortality rate at one year in pluripathology patients, has been developed. The aim of this study was to evaluate the prognostic value of the PROFUND index and of in-hospital and 30-day mortality after discharge of patients admitted for acute heart failure (AHF). Materials and Methods: A prospective multicenter longitudinal study was performed that included patients admitted with AHF and ≥2 comorbid conditions. Clinical, analytical, and prognostic variables were collected. The PROFUND index was collected in all patients and rates of in-hospital and 30-day mortality after discharge were analyzed. A bivariate analysis was performed with quantitative variables between patients who died and those who survived at the 30-day follow-up. A logistic regression analysis was performed with the variables that obtained statistical significance in the bivariate analysis between deceased and surviving subjects. Results: A total of 128 patients were included. Mean age was 80.5 +/− 9.98 years, and women represented 51.6%. The mean PROFUND index was 5.26 +/− 4.5. The mortality rate was 8.6% in-hospital and 20.3% at 30 days. Preserved left ventricular ejection fraction was found in 60.9%. In the sample studied, there were patients with a PROFUND score < 7 predominated (89 patients (70%) versus 39 patients (31%) with a PROFUND score ≥ 7). Thirteen patients (15%) with a PROFUND score < 7 died versus the 13 (33%) with a PROFUND score ≥ 7, p = 0.03. Twelve patients (15%) with a PROFUND score < 7 required readmission versus 12 patients (35%) with a PROFUND score ≥ 7, p = 0.02. The ROC curve of the PROFUND index for in-hospital mortality and 30-day follow-up in patients with AHF showed AUC 0.63, CI: 95% (0.508–0.764), p <0.033. Conclusions: The PROFUND index is a clinical tool that may be useful for predicting short-term mortality in elderly patients with AHF. Further studies with larger simple sizes are required to validate these results.
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Affiliation(s)
- Manuel Méndez-Bailón
- Servicios de Medicina Interna, Hospital Clínico San Carlos, Instituto de Investigación San Carlos (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.M.-B.); (R.I.-B.); (P.P.-M.); (J.B.-C.); (M.V.-M.); (S.F.-C.); (J.L.G.-K.); (E.C.-M.)
| | - Rosario Iguarán-Bermúdez
- Servicios de Medicina Interna, Hospital Clínico San Carlos, Instituto de Investigación San Carlos (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.M.-B.); (R.I.-B.); (P.P.-M.); (J.B.-C.); (M.V.-M.); (S.F.-C.); (J.L.G.-K.); (E.C.-M.)
| | - Lidia López-García
- Servicio de Cardiología, Hospital Clínico San Carlos, 28040 Madrid, Spain; (L.L.-G.); (I.V.)
| | - Beatriz Sánchez-Sauce
- Servicio de Medicina Interna, Fundación Hospital Alcorcón Alcorcón, 28922 Madrid, Spain;
| | - Pablo Pérez-Mateos
- Servicios de Medicina Interna, Hospital Clínico San Carlos, Instituto de Investigación San Carlos (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.M.-B.); (R.I.-B.); (P.P.-M.); (J.B.-C.); (M.V.-M.); (S.F.-C.); (J.L.G.-K.); (E.C.-M.)
| | - Julia Barrado-Cuchillo
- Servicios de Medicina Interna, Hospital Clínico San Carlos, Instituto de Investigación San Carlos (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.M.-B.); (R.I.-B.); (P.P.-M.); (J.B.-C.); (M.V.-M.); (S.F.-C.); (J.L.G.-K.); (E.C.-M.)
| | - Miguel Villar-Martínez
- Servicios de Medicina Interna, Hospital Clínico San Carlos, Instituto de Investigación San Carlos (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.M.-B.); (R.I.-B.); (P.P.-M.); (J.B.-C.); (M.V.-M.); (S.F.-C.); (J.L.G.-K.); (E.C.-M.)
| | - Santiago Fernández-Castelao
- Servicios de Medicina Interna, Hospital Clínico San Carlos, Instituto de Investigación San Carlos (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.M.-B.); (R.I.-B.); (P.P.-M.); (J.B.-C.); (M.V.-M.); (S.F.-C.); (J.L.G.-K.); (E.C.-M.)
| | - Jose Luis García-Klepzig
- Servicios de Medicina Interna, Hospital Clínico San Carlos, Instituto de Investigación San Carlos (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.M.-B.); (R.I.-B.); (P.P.-M.); (J.B.-C.); (M.V.-M.); (S.F.-C.); (J.L.G.-K.); (E.C.-M.)
| | - Manuel Enrique Fuentes-Ferrer
- Servicio de Medicina Preventiva, Instituto de Investigación San Carlos (IdISSC), Hospital Clínico San Carlos, 28040 Madrid, Spain;
| | - Alejandra García-García
- Servicio de Medicina Interna, Hospital Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.G.-G.); (J.M.d.M.-Y.)
| | - Isidre Vilacosta
- Servicio de Cardiología, Hospital Clínico San Carlos, 28040 Madrid, Spain; (L.L.-G.); (I.V.)
| | - José María de Miguel-Yanes
- Servicio de Medicina Interna, Hospital Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.G.-G.); (J.M.d.M.-Y.)
| | | | - Elpidio Calvo-Manuel
- Servicios de Medicina Interna, Hospital Clínico San Carlos, Instituto de Investigación San Carlos (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.M.-B.); (R.I.-B.); (P.P.-M.); (J.B.-C.); (M.V.-M.); (S.F.-C.); (J.L.G.-K.); (E.C.-M.)
| | - Emmanuel Andres
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France;
| | - Noel Lorenzo-Villalba
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France;
- Correspondence:
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Zulfiqar AA, Dembele IA, Amadou N, Doucet J, Andres E. [Type 2 diabetes and the elderly : a real problem]. Rev Med Liege 2021; 76:752-755. [PMID: 34632745] [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
Type 2 diabetes in the elderly remains a major concern for all healthcare professionals, this disease being considered a real global «pandemic». Its prevalence is high and will continue to increase in the years to come, becoming significant in the elderly and the very old. We offer you a general summary and a focus on diabetes in the elderly with the GERODIAB study.
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Affiliation(s)
- A A Zulfiqar
- Département de Médecine interne, Clinique Médicale B, Hôpitaux Universitaires de Strasbourg, France
| | - I A Dembele
- Département de Médecine interne, Clinique Médicale B, Hôpitaux Universitaires de Strasbourg, France
| | - N Amadou
- Département de Médecine interne, Clinique Médicale B, Hôpitaux Universitaires de Strasbourg, France
| | - J Doucet
- Service de Médecine interne polyvalente, Hôpital Saint-Julien, CHU, Rouen, France
| | - E Andres
- Département de Médecine interne, Clinique Médicale B, Hôpitaux Universitaires de Strasbourg, France
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Lorenzo-Villalba N, Andres E, Guerrero-Niño J, Nasco E, Cattelan J, Jannot X, Ledoux MP. Frostbite and Cold Agglutinin Disease: Coexistence of Two Entities Leading to Poor Clinical Outcomes. ACTA ACUST UNITED AC 2021; 57:medicina57060592. [PMID: 34201186 PMCID: PMC8230137 DOI: 10.3390/medicina57060592] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/28/2021] [Accepted: 06/07/2021] [Indexed: 11/24/2022]
Abstract
An 83-year-old woman was admitted to the emergency department for a 7-day history of fatigue and progressive cyanosis in the feet and hands after cold exposure despite physical protective measures. Upon arrival, the patient presented with necrotic cutaneous lesions in both hands and distal lower extremities. Upon admission, hemoglobin was 7.6 g/dL and laboratory tests were consistent with cold agglutinin disease (CAD), the presence of monoclonal IgM, and flow cytometry consistent with lymphoplasmacytic lymphoma, but MYD88 L265P mutation was negative. The patient required blood transfusion, resulting in stabilized hemoglobin and a decrease in markers of hemolysis. Treatment with aspirin 250 mg daily and intravenous iloprost 0.5 mL/h was initiated with a poor clinical response at day 4. Amputation was required. Plasma exchange was performed and chemotherapy with rituximab and bendamustine was initiated. The clinical course was marked by further necrosis, prompting discussions regarding an additional amputation that was not performed considering the high surgical risk and refusal by the patient. Supportive treatment was initiated, and the patient expired one month after hospital admission.
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Affiliation(s)
- Noel Lorenzo-Villalba
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (E.A.); (E.N.); (J.C.); (X.J.)
- Correspondence:
| | - Emmanuel Andres
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (E.A.); (E.N.); (J.C.); (X.J.)
| | - Javier Guerrero-Niño
- Service des Urgences, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France;
| | - Edward Nasco
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (E.A.); (E.N.); (J.C.); (X.J.)
| | - Jessy Cattelan
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (E.A.); (E.N.); (J.C.); (X.J.)
| | - Xavier Jannot
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (E.A.); (E.N.); (J.C.); (X.J.)
| | - Marie-Pierre Ledoux
- Service d’Hématologie, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France;
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21
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Greuez C, Argemi X, Giorgiutti S, Goichot B, Hannedouche T, Kaltenbach G, Lefebvre N, Lenormand C, Lescuyer S, Moulin B, Rondeau-Lutz M, Schmitt E, Sibilia J, Imperiale A, Andres E. Fièvre et syndrome inflammatoire inexpliqué chez le sujet âgé, impact thérapeutique de la TEP-TDM au 18F-FDG. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Giorgiutti S, Dieudonne Y, Hinschberger O, Nespola B, Campagne J, Rakotoarivelo HN, Hannedouche T, Moulin B, Blaison G, Weber JC, Dalmas MC, De Blay F, Lipsker D, Chantrel F, Gottenberg JE, Dimitrov Y, Imhoff O, Gavand PE, Andres E, Debry C, Hansmann Y, Klein A, Lohmann C, Mathiaux F, Guffroy A, Poindron V, Martin T, Korganow AS, Arnaud L. Prevalence of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis and spatial association with quarries in a French Northeast region. Arthritis Rheumatol 2021; 73:2078-2085. [PMID: 33881225 DOI: 10.1002/art.41767] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/08/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Silica is one of the strongest environmental substances linked with autoimmunity. The aim of this study was to assess the prevalence of granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and renal limited vasculitis (RLV) in a French northeast region, and their geospatial association with quarries. METHODS Potential ANCA-Associated Vasculitis (AAV) cases were identified using three sources: hospital records, immunology laboratories and the National Health Insurance System. Patients who resided in Alsace on January 1, 2016 and fulfilled ACR AAV criteria or Chapel Hill Consensus Conference 2012 definition were included. Incomplete case ascertainment was corrected using capture-recapture analysis. The spatial association between the number of cases and quarries in each administrative entity was assessed using geographical weighted regression (GWR). RESULTS From 910 potential AAV cases, we identified 185 patients meeting inclusion criteria: 120 GPA, 35 MPA, 30 RLV. The number of cases missed by any source was 6.4 (95%CI 3.6-11.5). Accordingly, the 2016 estimated prevalence in Alsace was 65.5 cases per million inhabitants (95%CI 47.3-93.0) for GPA, 19.1 (95%CI 11.3-34.3) for MPA, and 16.8 (95%CI 8.7-35.2) for RLV. The risk of AAV was significantly increased in communes with quarries (OR: 2.51 [95%CI: 1.66-3.80]) and GWR revealed a significant spatial association between quarries and GPA cases (p = 0.039), and, regarding ANCA serotype, between quarries and both PR3-AAV (p = 0.04) and MPO-AAV (p = 0.03)." CONCLUSION In a region with a high density of quarries, the spatial association of AAV with quarries supports the role of silica as a specific environmental factor.
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Affiliation(s)
- Stéphane Giorgiutti
- Department of Clinical Immunology and Internal Medicine, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Tertiary Center for Primary Immunodeficiency, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France
| | - Yannick Dieudonne
- Department of Clinical Immunology and Internal Medicine, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Tertiary Center for Primary Immunodeficiency, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France.,Université de Strasbourg, INSERM UMR - S1109, F-67000, Strasbourg, France
| | - Olivier Hinschberger
- Department of Internal Medicine, Hôpital Emile Muller, groupe hospitalier de la région de Mulhouse et Sud Alsace, F-68070, Mulhouse, France
| | - Benoît Nespola
- Laboratory of Immunology, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France
| | - Julien Campagne
- Department of Internal Medicine, Hôpitaux Privés de Metz, F-57000, Metz, France
| | | | - Thierry Hannedouche
- Department of Nephrology and Dialysis, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France
| | - Bruno Moulin
- Department of Nephrology and Transplantation, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France
| | - Gilles Blaison
- Department of Internal Medicine, Hôpitaux Civils de Colmar, F-68024, Colmar, France
| | - Jean-Christophe Weber
- Department of Internal Medicine, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France
| | - Marie-Caroline Dalmas
- Department of Internal Medicine, Endocrinology and Nutrition, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France
| | - Frédéric De Blay
- Department of Pneumology, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France
| | - Dan Lipsker
- Department of Dermatology, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France
| | - François Chantrel
- Department of Nephrology, Hôpital Emile Muller, groupe hospitalier de la région de Mulhouse et Sud Alsace, F-68070, Mulhouse, France
| | - Jacques-Eric Gottenberg
- Department of Rheumatology, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France
| | - Yves Dimitrov
- Department of Nephrology, Centre Hospitalier de Haguenau, F-67500, Haguenau, France
| | - Olivier Imhoff
- Department of Nephrology, Clinique Saint-Anne, F-67000, Strasbourg, France
| | | | - Emmanuel Andres
- Department of Internal Medicine, Diabetology and Metabolic Diseases, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France
| | - Christian Debry
- Department of Otorhinolaryngology, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France
| | - Yves Hansmann
- Department of Infectious Diseases, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France
| | - Alexandre Klein
- Department of Nephrology, Hôpitaux Civils de Colmar, F-68024, Colmar, France
| | - Caroline Lohmann
- Department of Microbiology, Hôpital Emile Muller, groupe hospitalier de la région de Mulhouse et Sud Alsace, F-68070, Mulhouse, France
| | - François Mathiaux
- Department of Biochemistry, Hôpitaux Civils de Colmar, F-68024, Colmar, France
| | - Aurélien Guffroy
- Department of Clinical Immunology and Internal Medicine, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Tertiary Center for Primary Immunodeficiency, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France.,Université de Strasbourg, INSERM UMR - S1109, F-67000, Strasbourg, France
| | - Vincent Poindron
- Department of Clinical Immunology and Internal Medicine, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Tertiary Center for Primary Immunodeficiency, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France.,Université de Strasbourg, INSERM UMR - S1109, F-67000, Strasbourg, France
| | - Thierry Martin
- Department of Clinical Immunology and Internal Medicine, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Tertiary Center for Primary Immunodeficiency, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France.,Université de Strasbourg, INSERM UMR - S1109, F-67000, Strasbourg, France
| | - Anne-Sophie Korganow
- Department of Clinical Immunology and Internal Medicine, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Tertiary Center for Primary Immunodeficiency, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France.,Université de Strasbourg, INSERM UMR - S1109, F-67000, Strasbourg, France
| | - Laurent Arnaud
- Department of Rheumatology, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France
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23
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Felten R, Devauchelle-Pensec V, Seror R, Duffau P, Saadoun D, Hachulla E, Pierre Yves H, Salliot C, Perdriger A, Morel J, Mékinian A, Vittecoq O, Berthelot JM, Dernis E, Le Guern V, Dieudé P, Larroche C, Richez C, Martin T, Zarnitsky C, Blaison G, Kieffer P, Maurier F, Dellal A, Rist S, Andres E, Contis A, Chatelus E, Sordet C, Sibilia J, Arnold C, Tawk MY, Aberkane O, Holterbach L, Cacoub P, Saraux A, Mariette X, Meyer N, Gottenberg JE. Interleukin 6 receptor inhibition in primary Sjögren syndrome: a multicentre double-blind randomised placebo-controlled trial. Ann Rheum Dis 2021; 80:329-338. [PMID: 33208345 DOI: 10.1136/annrheumdis-2020-218467] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [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: 06/30/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES No immunomodulatory drug has been approved for primary Sjögren's syndrome, a systemic autoimmune disease affecting 0.1% of the population. To demonstrate the efficacy of targeting interleukin 6 receptor in patients with Sjögren's syndrome-related systemic complications. METHODS Multicentre double-blind randomised placebo-controlled trial between 24 July 2013 and 16 July 2018, with a follow-up of 44 weeks, involving 17 referral centres. Inclusion criteria were primary Sjögren's syndrome according to American European Consensus Group criteria and score ≥5 for the EULAR Sjögren's Syndrome Disease activity Index (ESSDAI, score of systemic complications). Patients were randomised to receive either 6 monthly infusions of tocilizumab or placebo. The primary endpoint was response to treatment at week 24. Response to treatment was defined by the combination of (1) a decrease of at least 3 points in the ESSDAI, (2) no occurrence of moderate or severe activity in any new domain of the ESSDAI and (3) lack of worsening in physician's global assessment on a Visual Numeric Scale ≥1/10, all as compared with enrolment. RESULTS 110 patients were randomised, 55 patients to tocilizumab (mean (SD) age: 50.9 (12.4) years; women: 98.2%) and 55 patients to placebo (54.8 (10.7) years; 90.9%). At 24 weeks, the proportion of patients meeting the primary endpoint was 52.7% (29/55) in the tocilizumab group and 63.6% (35/55) in the placebo group, for a difference of -11.4% (95% credible interval -30.6 to 9.0) (Pr[Toc >Pla]=0.14). CONCLUSION Among patients with primary Sjögren's syndrome, the use of tocilizumab did not improve systemic involvement and symptoms over 24 weeks of treatment compared with placebo. TRIAL REGISTRATION NUMBER NCT01782235.
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Affiliation(s)
- Renaud Felten
- Rheumatology, CHU Strasbourg, Centre National de Référence des maladies auto-immunes et systémiques rares Est/Sud-Ouest (RESO), Strasbourg, Alsace, France
| | | | - Raphaèle Seror
- Rheumatology, Université Paris-Sud BU Kremlin-Bicêtre, Le Kremlin-Bicetre, Île-de-France, France
| | - Pierre Duffau
- Internal Medicine, CHU de Bordeaux, Bordeaux, Aquitaine, France
| | - David Saadoun
- University Hospital Pitié Salpêtrière, Paris, Île-de-France, France
| | - Eric Hachulla
- Internal Medicine, Regional and University Hospital Centre Lille Internal Medicine Service, Lille, Hauts-de-France, France
| | - Hatron Pierre Yves
- Internal Medicine, Regional and University Hospital Centre Lille Internal Medicine Service, Lille, Hauts-de-France, France
| | - Carine Salliot
- Rheumatology, Regional Hospital Centre Orleans La Source Hospital, Orleans, Centre, France
| | - Aleth Perdriger
- Rheumatology, University Hospital Centre Rennes, Rennes, Bretagne, France
| | - Jacques Morel
- CHU Lapeyronie, Montpellier, Languedoc-Roussillon, France
| | - Arsène Mékinian
- Internal Medicine, Hospital Saint-Antoine, Paris, Île-de-France, France
| | - Olivier Vittecoq
- Rheumatology, University Hospital Centre Rouen, Rouen, Normandie, France
| | | | | | | | - Philippe Dieudé
- Rheumatology, Hôpital Bichat Claude-Bernard, Paris, Île-de-France, France
| | - Claire Larroche
- Internal Medicine, Hospital Avicenne, Bobigny, Île-de-France, France
| | - Christophe Richez
- Rheumatology, CHU Bordeaux GH Pellegrin, Bordeaux, Aquitaine, France
| | - Thierry Martin
- Internal Medicine, CHU Strasbourg, Strasbourg, Alsace, France
| | - Charles Zarnitsky
- Rheumatology, Hôpital Jacques Monod, Montivilliers, Normandy, France
| | | | - Pierre Kieffer
- Internal Medicine, CH Mulhouse, Mulhouse, Grand Est, France
| | - François Maurier
- Internal Medicine, Sainte Blandine Hospital, Metz, Lorraine, France
| | - Azeddine Dellal
- Rheumatology, GHI Le Raincy-Montfermeil, Montfermeil, Île-de-France, France
| | - Stephanie Rist
- Rheumatology, Regional Hospital Centre Orleans La Source Hospital, Orleans, Centre, France
| | - Emmanuel Andres
- Internal Medicine, CHU Strasbourg, Strasbourg, Alsace, France
| | - Anne Contis
- Internal Medicine, CHU de Bordeaux, Bordeaux, Aquitaine, France
| | - Emmanuel Chatelus
- Rheumatology, CHU Strasbourg, Centre National de Référence des maladies auto-immunes et systémiques rares Est/Sud-Ouest (RESO), Strasbourg, Alsace, France
| | - Christelle Sordet
- Rheumatology, CHU Strasbourg, Centre National de Référence des maladies auto-immunes et systémiques rares Est/Sud-Ouest (RESO), Strasbourg, Alsace, France
| | - Jean Sibilia
- Rheumatology, CHU Strasbourg, Centre National de Référence des maladies auto-immunes et systémiques rares Est/Sud-Ouest (RESO), Strasbourg, Alsace, France
| | | | - Mira Y Tawk
- DRCI, CHU Strasbourg, Strasbourg, Alsace, France
| | | | - Lise Holterbach
- Public Health, Methods in Clinical Research Team, Hopitaux universitaires de Strasbourg, Strasbourg, Alsace, France
| | - Patrice Cacoub
- University Hospital Pitié Salpêtrière, Paris, Île-de-France, France
| | - Alain Saraux
- Rheumatology, Hospital Cavale-Blanche, Brest, Bretagne, France
| | - Xavier Mariette
- Rheumatology, Université Paris-Sud BU Kremlin-Bicêtre, Le Kremlin-Bicetre, Île-de-France, France
| | - Nicolas Meyer
- Public Health, Methods in Clinical Research Team, Hopitaux universitaires de Strasbourg, Strasbourg, Alsace, France
| | - Jacques-Eric Gottenberg
- Rheumatology, CHU Strasbourg, Centre National de Référence des maladies auto-immunes et systémiques rares Est/Sud-Ouest (RESO), Strasbourg, Alsace, France
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Zulfiqar AA, Courtois T, Doucet J, Andres E. [Prescribing inappropriate medication in the elderly: review of the main therapeutic scales]. Soins Gerontol 2021; 26:40-43. [PMID: 33894914 DOI: 10.1016/j.sger.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Abrar-Ahmad Zulfiqar
- Département de médecine interne, hôpital civil, centre hospitalier régional universitaire de Strasbourg, 1 place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France.
| | - Thibault Courtois
- Département de médecine générale, centre hospitalier universitaire de Rouen, 37 boulevard Gambetta, 76000 Rouen, France
| | - Jean Doucet
- Département de médecine interne polyvalente, hôpital Saint-Julien, centre hospitalier universitaire Rouen, 2 rue Guillaume-Lecointe, 76140 Le Petit-Quevilly, France
| | - Emmanuel Andres
- Département de médecine interne, hôpital civil, centre hospitalier régional universitaire de Strasbourg, 1 place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
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Cordeanu E, Jambert L, Lambach H, Tousch J, Heitz M, Mirea C, Frantz A, Younes W, Delatte A, Woehl B, Bilbault P, Ohlmann P, Meziani F, Andres E, Stephan D. Outcomes of hospitalized patients with SARS-CoV-2 infection previously treated with renin-angiotensin system inhibitors. Archives of Cardiovascular Diseases Supplements 2021. [PMCID: PMC7803093 DOI: 10.1016/j.acvdsp.2020.10.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Renin angiotensin system inhibitors (RASi) are largely prescribed in hypertensive patients. As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) penetrates respiratory epithelium through angiotensin converting enzyme 2 (ACE2) binding, the association between RASi and poorer outcomes has been questioned. Purpose This study aimed to provide insight on the impact of RASi on SARS-CoV-2 outcomes in a population of patients hospitalized for COVID-19. Methods This is a retrospective analysis of consecutively hospitalized adult patients with SARS-CoV-2 infection (positive rtPCR) admitted to the University Hospital of Strasbourg from the 25th Feb, 2020 to the 1st Apr, 2020. Patients hospitalized for less than 24 h were excluded and the observation period ended at hospital discharge. Results During the study period, 943 COVID-19 patients were hospitalized in our institution, of whom 772 were included in this analysis. Among them, 431 patients had previously known hypertension. The median age was 68 (56–79). The cohort was divided into two subgroups based on RASi treatment on admission: “RASi” (n = 282) and “RASi-free” (n = 490). Both groups had similar clinical presentations and equivalent recourse to endotracheal intubation, high flow nasal oxygen (HFNO) or non-invasive ventilation (NIV). Overall, 220 patients were placed under mechanical ventilation of whom 30% died. Severe pneumonia (defined as either leading to death, and/or requiring intubation, HFNO, NIV and/or requiring an oxygen rate flow ≥ 5l/min) and death occurred more frequently in RASi treated patients (63% vs. 53% and respectively 27.3% versus 18.2%). In a multivariate logistic-regression model, neither severe pneumonia nor death were associated with RASi treatment. Conclusion Our study showed no correlation between RASi treatment and death or severe COVID-19 pneumonia.
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Cordeanu E, Lambach H, Tousch J, Jambert L, Mirea C, Heitz M, Frantz A, Delatte A, Younes W, Woehl B, Bilbault P, Ohlmann P, Andres E, Meziani F, Stephan D. Venous thromboembolism frequency in patients hospitalized for SARS-CoV-2 infection. Archives of Cardiovascular Diseases Supplements 2021. [PMCID: PMC8719937 DOI: 10.1016/j.acvdsp.2020.10.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background SARS-CoV-2 infection was associated with a higher thrombotic risk, partially explained by intense systemic inflammatory reaction, longer hospitalizations and intubations as well as central catheters and extracorporeal membrane oxygenation devices. Intrinsic thrombotic potential is questioned as certain patients had plasma lupus anticoagulant (LAC). Purpose This study aimed to evaluate the frequency of venous thromboembolism (VTE) among adult patients hospitalized for COVID-19. Methods This is a retrospective analysis of consecutively hospitalized adult patients with SARS-CoV-2 infection (positive rtPCR) admitted to the University Hospital of Strasbourg from the 25th Feb, 2020 to the 1st Apr, 2020. Patients hospitalized for less than 24 h were excluded and the observation period ended at hospital discharge. Results During the study period, 943 COVID-19 patients were hospitalized in our institution, of whom 772 were included in this analysis. The median age was 68 (56–79) years old and 58 patients had previously known VTE. Overall, VTE occurred in 60 patients (7.8%): 43 pulmonary embolisms (PE), 15 isolated deep vein thrombosis and 2 superficial vein thrombosis. Of note, 81% of patients had been prescribed an anticoagulant treatment on admission. VTE incidence was higher in patients with more severe forms of pneumonia defined as either leading to death, and/or requiring intubation/high flow nasal oxygen/non-invasive ventilation (21% versus 2%, P < 0.001). Overall mortality was 21% and death rate was higher in patients that presented a VTE event (35% versus 20%, P = 0.012). Among VTE patients, a search for LAC was performed in 72% of them and came back positive in 88% of cases. Overall, 33 major bleeding complications (4.3%) were observed of which 42% were intracranial. Conclusion Our study showed that in-hospital VTE occurred more frequently in case of severe COVID-19 pneumonia and was associated with higher death rates.
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Le Borgne P, Colin J, Bilbault P, Andres E, Lorenzo-Villalba N. [Cervical myelopathy secondary to recreational nitrous oxide use: an emergent pathology]. Medicina (B Aires) 2021; 81:840-842. [PMID: 34633959] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
We describe the case of a 27-year-old female patient who presented to the emergency ward with hypoesthesia and paresthesia developing over the last two months, initially in both feet and progressing to the knees in a few days without associated gait disorders. Dystonia in the thumb and index finger of both hands was noted. Blood tests including toxic drugs were negative. The spinal magnetic resonance imaging was consistent with (C3-C5) myelopathy or myelitis without other abnormalities suggestive of systemic diseases. The biochemical and bacteriological analysis of the cerebrospinal fluid was normal. Because of these findings, the patient was re-interviewed to determine the consumption of unusual drugs, and nitrous oxide consumption was referred. The patient was admitted for further studies, which confirmed the diagnosis.
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Affiliation(s)
| | - Jules Colin
- Service des Urgences, Hôpitaux Universitaires de Strasbourg, Francia
| | - Pascal Bilbault
- Service des Urgences, Hôpitaux Universitaires de Strasbourg, Francia
| | - Emmanuel Andres
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, Francia
| | - Noel Lorenzo-Villalba
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, Francia. E-mail:
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Trimaille A, Curtiaud A, Marchandot B, Matsushita K, Sato C, Leonard-Lorant I, Sattler L, Grunebaum L, Ohana M, Von Hunolstein J, Andres E, Goichot B, Danion F, Kaeuffer C, Poindron V, Ohlmann P, Jesel L, Morel O. Venous thromboembolism in non-critically ill patients with COVID-19 infection. Archives of Cardiovascular Diseases Supplements 2021. [PMCID: PMC7803092 DOI: 10.1016/j.acvdsp.2020.10.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Systemic coagulation activation and thrombotic complications are frequent among critically ill patients with COVID-19. Limited data are available in non-intensive care unit (ICU) patients. Purpose To determine the incidence, risk factors and prognosis of venous thromboembolism (VTE) in non-ICU COVID-19 patients. Methods We studied consecutive COVID-19 patients admitted to general ward at Strasbourg Hospital, France (25.02.2020–19.04.2020). The primary outcome was any VTE complication. The secondary outcome was the composite of death or transfer to ICU. Results Among the 289 patients included (62.2 ± 17.0 years, 59.2% male), VTE occurred in 49 (17.0%). Padua prediction score for VTE was similar between VTE and non-VTE patients. VTE imaging tests were performed in 100 (34.6%) patients and VTE diagnosed in median 7 (3–11) days after admission. On-admission, time from symptom onset to admission (OR 1.07, CI 95% [1.00–1.16], P = 0.045), Improve score (OR 1.37, [1.02–1.83], P = 0.032), leukocyte count (OR 1.16, [1.06–1.27], P = 0.001) and lack of thromboprophylaxis (OR 27.85, CI 95% [9.35–82.95], P < 0.001) were independent predictors of VTE. The incidence of the composite of death or ICU transfer was 31.0% and more frequent among patients with VTE (47.9% vs. 27.9%, P = 0.01). Fever (OR 5.37, CI 95% [1.44–19.97], P = 0.012), VTE (OR 3.44, CI 95% [1.63–7.25], P = 0.001), lymphopenia (OR 0.32, 95% CI [0.15–0.71]; P = 0.005) and extent of COVID-19 evaluated by chest CT severity (OR 1.56, 95% CI [1.12–2.16]; P = 0.007) were independently associated with in-hospital death or transfer to ICU (Table 1, Fig. 1). Conclusions The 17.0% incidence of VTE in non-ICU patients with COVID-19 was associated with worse outcomes. Given the high incidence of VTE in ward patients, there is an urgent need to investigate the optimal anticoagulation regimen.
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Villalba NL, Zulfiqar AA, Alonso Ortiz MB, Jannot X, Syrovatkova A, Andres E. [Acquired hemophilia as the initial manifestation of colorectal cancer's recurrence]. Medicina (B Aires) 2021; 81:286-288. [PMID: 33906149] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
We report the case of an 86-year-old man presenting with a spontaneous hematoma in the left iliac muscle and previous diagnosis of colon cancer in 1998 (stage pT3N0M0) treated with transverse colectomy and considered in complete remission. After a complete study, it was possible to identify the presence of Factor VIII inhibitors antibodies that confirmed the presence of acquired hemophilia. During hospitalization the patient presented a lower gastrointestinal bleeding leading to the diagnosis of recurrence of a previously treated colorectal adenocarcinoma. He responded to initial therapy with systemic corticoids and anti-inhibitory coagulant complex which includes activated VII Factor [FEIBA].
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Affiliation(s)
- Noel Lorenzo Villalba
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, Francia. E-mail:
| | - Abrar-Ahmad Zulfiqar
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, Francia
| | - Maria Belén Alonso Ortiz
- Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España
| | - Xavier Jannot
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, Francia
| | - Anezka Syrovatkova
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, Francia
| | - Emmanuel Andres
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, Francia
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Zulfiqar A, Lorenzo N, Mourot-Cottet R, Goichot B, Maloisel F, Tebacher M, Andres E. Neutropénie sévère et agranulocytose induites par les antithyroïdiens de synthèse : à propos de 30 cas issus d’un centre de référence. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Chahbazian J, Lorenzo N, Ben Malek H, Vogel T, Bourgarit A, Andres E, Zulfiqar A. Sémiologie clinique de l’anémie chez des patients âgés de plus de 75 ans : une étude prospective menée par le groupe SiFMI. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Delforge J, Sovaila S, Alix L, Didon A, Steichen O, Ranque B, Froissart A, Amadou K, Hanslik T, Cador B, Bergmann JF, Mekininan A, Goujard C, Gayet S, Cathebras P, Fantin B, Raigniac D, Weber JC, Rosenthal E, Hery L, Andres E, Benhamou Y, Bourgarit A. [Characteristics of patients admitted from emergency units in 18 internal medicine departments and organisation of these departments: A cross sectional study from SNFMI (SiFMI study group) in 2015]. Rev Med Interne 2020; 42:79-85. [PMID: 33160706 DOI: 10.1016/j.revmed.2020.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/23/2019] [Revised: 08/04/2020] [Accepted: 09/13/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Patients admitted from emergency units represent a large portion of the population in internal medicine departments. The aim of this study is to identify characteristics of patients and organization of these departments. METHODS Between June 29th and July 26th 2015, voluntary internal medicine departments from the SiFMI group prospectively filled anonymized internet forms to collect data of each patients admitted in their ward from emergency units, during seven consecutive days. RESULTS Three hundred and sixty-five patients from emergency departments were admitted in 18 internal medicine inpatients departments, totalling 1100 beds and 33,530 annual stays, 56% of them for emergency units inpatients. Mean age was 68 years, 54% were women, mean Charlson score was 2.6 and 44% of the patients took at least three drugs. Main causes of hospitalization were infectious (29%) and neurological (17%) diseases. Mean length of stay was 9.2 days. The medical team was composed by a median value of 4,5 [2,75-6,25] senior full-time equivalents, 86% were internists. Each department except one received residents, two third of them were from general medicine. CONCLUSION This study highlights a high organizational variability among internal medicine departments and patients, and sets internal medicine as a specialty with a great capacity to achieve an integrative/comprehensive management of patients and to offer a comprehensive basis for physicians in training.
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Affiliation(s)
- J Delforge
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - S Sovaila
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - L Alix
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France.
| | - A Didon
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - O Steichen
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - B Ranque
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - A Froissart
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - K Amadou
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - T Hanslik
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - B Cador
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - J F Bergmann
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - A Mekininan
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - C Goujard
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - S Gayet
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - P Cathebras
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - B Fantin
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - D Raigniac
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - J C Weber
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - E Rosenthal
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - L Hery
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - E Andres
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - Y Benhamou
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
| | - A Bourgarit
- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
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- Service de médecine interne et immunologie clinique, CHU de Rennes, 2 rue Henri-Le-Guilloux, 35000 Rennes, France
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Zulfiqar AA, Lorenzo Villalba N, Andres E. [Anaemia: What is its relationship with the frailty syndrome in elderly patients?]. Rev Esp Geriatr Gerontol 2020; 55:350-353. [PMID: 32247637 DOI: 10.1016/j.regg.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/15/2019] [Accepted: 11/19/2019] [Indexed: 06/11/2023]
Abstract
Anaemia is often unexpectedly found, or in a context of investigations into a chest pain, dyspnoea, or weakness. This disorder can be considered an indicator of health status in elderly patients, and has been related to the frailty syndrome. A systematic review was conducted on the studies published in PubMed and Google Scholar databases in the period from January 1999 to May 2019. The search was limited to those studies published regarding anaemia and its relationship to the frailty syndrome. Anaemia seems to be part of the immunosenescence process that can explain frailty syndrome in association with other metabolism, endocrine, and inflammatory disorders. It was unable to be determined if anaemia is responsible for frailty or a result of it.
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Affiliation(s)
- Abrar-Ahmad Zulfiqar
- Servicio de Medicina Interna, Diabetes y Enfermedades Metabólicas, Hospital Universitario de Estrasburgo, Estrasburgo, Francia
| | - Noel Lorenzo Villalba
- Servicio de Medicina Interna, Diabetes y Enfermedades Metabólicas, Hospital Universitario de Estrasburgo, Estrasburgo, Francia.
| | - Emmanuel Andres
- Servicio de Medicina Interna, Diabetes y Enfermedades Metabólicas, Hospital Universitario de Estrasburgo, Estrasburgo, Francia
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Cordeanu EM, Jambert L, Severac F, Lambach H, Tousch J, Heitz M, Mirea C, Hamadé A, Younes W, Frantz AS, Merdji H, Schini-Kerth V, Bilbault P, Meziani F, Ohlmann P, Andres E, Stephan D. Outcomes of COVID-19 Hospitalized Patients Previously Treated with Renin-Angiotensin System Inhibitors. J Clin Med 2020; 9:E3472. [PMID: 33126565 PMCID: PMC7692895 DOI: 10.3390/jcm9113472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 09/15/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 01/08/2023] Open
Abstract
(1) Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) penetrates respiratory epithelium through angiotensin-converting enzyme-2 binding, raising concerns about the potentially harmful effects of renin-angiotensin system inhibitors (RASi) on Human Coronavirus Disease 2019 (COVID-19) evolution. This study aimed to provide insight into the impact of RASi on SARS-CoV-2 outcomes in patients hospitalized for COVID-19. (2) Methods: This was a retrospective analysis of hospitalized adult patients with SARS-CoV-2 infection admitted to a university hospital in France. The observation period ended at hospital discharge. (3) Results: During the study period, 943 COVID-19 patients were admitted to our institution, of whom 772 were included in this analysis. Among them, 431 (55.8%) had previously known hypertension. The median age was 68 (56-79) years. Overall, 220 (28.5%) patients were placed under mechanical ventilation and 173 (22.4%) died. According to previous exposure to RASi, we defined two groups, namely, "RASi" (n = 282) and "RASi-free" (n = 490). Severe pneumonia (defined as leading to death and/or requiring intubation, high-flow nasal oxygen, noninvasive ventilation, and/or oxygen flow at a rate of ≥5 L/min) and death occurred more frequently in RASi-treated patients (64% versus 53% and 29% versus 19%, respectively). However, in a propensity score-matched cohort derived from the overall population, neither death (hazard ratio (HR) 0.93 (95% confidence interval (CI) 0.57-1.50), p = 0.76) nor severe pneumonia (HR 1.03 (95%CI 0.73-1.44), p = 0.85) were associated with RASi therapy. (4) Conclusion: Our study showed no correlation between previous RASi treatment and death or severe COVID-19 pneumonia after adjustment for confounders.
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Affiliation(s)
- Elena-Mihaela Cordeanu
- Department of Hypertension, Vascular Disease and Clinical Pharmacology, Strasbourg Regional University Hospital, 67091 Strasbourg, France; (H.L.); (J.T.); (M.H.); (C.M.); (A.-S.F.); (D.S.)
| | - Lucas Jambert
- Department of Vascular Medicine, Mulhouse Regional Hospital, 68100 Mulhouse, France; (L.J.); (A.H.)
| | - Francois Severac
- Division of Public Health, Methodology and Biostatistics, University Hospitals of Strasbourg, 67091 Strasbourg, France;
| | - Hélène Lambach
- Department of Hypertension, Vascular Disease and Clinical Pharmacology, Strasbourg Regional University Hospital, 67091 Strasbourg, France; (H.L.); (J.T.); (M.H.); (C.M.); (A.-S.F.); (D.S.)
| | - Jonathan Tousch
- Department of Hypertension, Vascular Disease and Clinical Pharmacology, Strasbourg Regional University Hospital, 67091 Strasbourg, France; (H.L.); (J.T.); (M.H.); (C.M.); (A.-S.F.); (D.S.)
| | - Marie Heitz
- Department of Hypertension, Vascular Disease and Clinical Pharmacology, Strasbourg Regional University Hospital, 67091 Strasbourg, France; (H.L.); (J.T.); (M.H.); (C.M.); (A.-S.F.); (D.S.)
| | - Corina Mirea
- Department of Hypertension, Vascular Disease and Clinical Pharmacology, Strasbourg Regional University Hospital, 67091 Strasbourg, France; (H.L.); (J.T.); (M.H.); (C.M.); (A.-S.F.); (D.S.)
| | - Amer Hamadé
- Department of Vascular Medicine, Mulhouse Regional Hospital, 68100 Mulhouse, France; (L.J.); (A.H.)
| | - Waël Younes
- Department of Vascular Medicine, Colmar Regional Hospital, 68000 Colmar, France;
| | - Anne-Sophie Frantz
- Department of Hypertension, Vascular Disease and Clinical Pharmacology, Strasbourg Regional University Hospital, 67091 Strasbourg, France; (H.L.); (J.T.); (M.H.); (C.M.); (A.-S.F.); (D.S.)
| | - Hamid Merdji
- Intensive care and Reanimation Department, Strasbourg Regional University Hospital, 67091 Strasbourg, France; (H.M.); (F.M.)
| | - Valérie Schini-Kerth
- UMR 1260 INSERM Regenerative Nanomedecine, Faculty of Pharmacy, Strasbourg University, 67400 Illkirch, France;
| | - Pascal Bilbault
- Emergency Department, Strasbourg Regional University Hospital, 67091 Strasbourg, France;
| | - Ferhat Meziani
- Intensive care and Reanimation Department, Strasbourg Regional University Hospital, 67091 Strasbourg, France; (H.M.); (F.M.)
| | - Patrick Ohlmann
- Cardiology Department, Strasbourg Regional University Hospital, 67091 Strasbourg, France;
| | - Emmanuel Andres
- Internal Medicine Department, Strasbourg Regional University Hospital, 67091 Strasbourg, France;
| | - Dominique Stephan
- Department of Hypertension, Vascular Disease and Clinical Pharmacology, Strasbourg Regional University Hospital, 67091 Strasbourg, France; (H.L.); (J.T.); (M.H.); (C.M.); (A.-S.F.); (D.S.)
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Mahévas M, Moulis G, Andres E, Riviere E, Garzaro M, Crickx E, Guillotin V, Malphettes M, Galicier L, Noel N, Darnige L, Terriou L, Guerveno C, Sanchis-Borja M, Moulinet T, Meunier B, Ebbo M, Michel M, Godeau B. Clinical characteristics, management and outcome of COVID-19-associated immune thrombocytopenia: a French multicentre series. Br J Haematol 2020; 190:e224-e229. [PMID: 32678953 PMCID: PMC7404899 DOI: 10.1111/bjh.17024] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Matthieu Mahévas
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Guillaume Moulis
- Department of Internal Medicine, Toulouse University Hospital (CHU de Toulouse), Toulouse, France.,CIC 1436, Toulouse University Hospital (CHU de Toulouse), Toulouse, France.,UMR 1027 Inserm, University of Toulouse, Toulouse, France
| | - Emmanuel Andres
- Department of Internal Medicine, University Hospital of Strasbourg, Research Team EA, 3072 "Mitochondrie, Stress oxydant et Protection musculaire", University of Strasbourg, Strasbourg, France
| | - Etienne Riviere
- Department of Internal Medicine, Bordeaux University Hospital (CHU de Bordeaux), Bordeaux, France.,Inserm U1034-University of Bordeaux, Bordeaux, France
| | - Margaux Garzaro
- Department of Clinical Immunology, Saint Louis University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Etienne Crickx
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Vivien Guillotin
- Department of Internal Medicine, University Hospital of Strasbourg, Research Team EA, 3072 "Mitochondrie, Stress oxydant et Protection musculaire", University of Strasbourg, Strasbourg, France
| | - Marion Malphettes
- Department of Clinical Immunology, Saint Louis University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Lionel Galicier
- Department of Clinical Immunology, Saint Louis University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Nicolas Noel
- Department of internal medicine, Kremlin-Bicêtre, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Luc Darnige
- Inserm UMR-S 1140, Service d'Hématologie Biologique, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Louis Terriou
- Department of Internal Medicine and Immunology, Claude-Huriez University Hospital, Université Lille Nord de France, Lille, France
| | - Claire Guerveno
- Department of Internal Medicine, Albi Hospital, Albi, France
| | - Mateo Sanchis-Borja
- Department of pneumology, Hôpital européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Thomas Moulinet
- Department of internal medicine, Nancy University Hospital (CHU de Nancy), University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Benoit Meunier
- Department of internal medicine, Hôpital la Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Mikael Ebbo
- Department of internal medicine, Hôpital la Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Marc Michel
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Bertrand Godeau
- Department of Internal Medicine, National Referral Center for Adult's Immune Cytopenias Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
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Zulfiqar AA, Lorenzo-Villalba N, Zulfiqar OA, Hajjam M, Courbon Q, Esteoulle L, Geny B, Talha S, Letourneau D, Hajjam J, Erve S, Hajjam El Hassani A, Andres E. e-Health: A Future Solution for Optimized Management of Elderly Patients. GER-e-TEC™ Project. Medicines (Basel) 2020; 7:E41. [PMID: 32717937 PMCID: PMC7459723 DOI: 10.3390/medicines7080041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 11/17/2022]
Abstract
Background: Elderly residents in nursing homes have multiple comorbidities (including cognitive and psycho-behavioral pathologies, malnutrition, heart failure, diabetes, chronic obstructive pulmonary disease, and renal failure) and use multiple medications. Methods: The GER-e-TEC project aims to provide these fragile and complex patients with telemedicine tools, more specifically telemonitoring, backed by a well-defined and personalized protocol. Results: Medically, this implies the need for regular monitoring and a high level of medical and multidisciplinary expertise for the healthcare team. The tools use non-invasive communicating sensors and artificial intelligence techniques, allowing daily monitoring with the ability to detect any abnormal changes in the patient's condition early. Conclusions: The GER-e-TEC project specifically considers the challenges of aging residents and significant challenges in nursing homes, with the main geriatric syndromes (falls, malnutrition, cognitive-behavioral disorders, and iatrogenic conditions).
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Affiliation(s)
- Abrar-Ahmad Zulfiqar
- Diabètes et Maladies Métaboliques, Service de Médecine Interne, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (N.L.-V.); (E.A.)
| | - Noël Lorenzo-Villalba
- Diabètes et Maladies Métaboliques, Service de Médecine Interne, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (N.L.-V.); (E.A.)
| | | | - Mohamed Hajjam
- Predimed Technology, 67300 Schiltigheim, France; (M.H.); (Q.C.); (L.E.)
| | - Quentin Courbon
- Predimed Technology, 67300 Schiltigheim, France; (M.H.); (Q.C.); (L.E.)
| | - Lucie Esteoulle
- Predimed Technology, 67300 Schiltigheim, France; (M.H.); (Q.C.); (L.E.)
| | - Bernard Geny
- Service de Physiologie et Laboratoire d’Explorations Fonctionnelles, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (B.G.); (S.T.)
- Equipe de recherche EA 3072 “Mitochondrie, Stress oxydant et Protection musculaire”, Faculté de Médecine de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France
| | - Samy Talha
- Service de Physiologie et Laboratoire d’Explorations Fonctionnelles, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (B.G.); (S.T.)
- Equipe de recherche EA 3072 “Mitochondrie, Stress oxydant et Protection musculaire”, Faculté de Médecine de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France
| | - Dominique Letourneau
- Fondation de l’Avenir pour la Recherche Médicale Appliquée, 75015 Paris, France;
| | - Jawad Hajjam
- Centre d’Expertise des TIC pour l’autonomie (CenTich) et Mutualité Française Anjou-Mayenne (MFAM)–Angers, 49000 Angers, France; (J.H.); (S.E.)
| | - Sylvie Erve
- Centre d’Expertise des TIC pour l’autonomie (CenTich) et Mutualité Française Anjou-Mayenne (MFAM)–Angers, 49000 Angers, France; (J.H.); (S.E.)
| | - Amir Hajjam El Hassani
- Laboratoire IRTES-SeT, Université de Technologie de Belfort-Montbéliard (UTBM), Belfort-Montbéliard, 90000 Belfort, France;
| | - Emmanuel Andres
- Diabètes et Maladies Métaboliques, Service de Médecine Interne, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (N.L.-V.); (E.A.)
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Trimaille A, Curtiaud A, Marchandot B, Matsushita K, Sato C, Leonard-Lorant I, Sattler L, Grunebaum L, Ohana M, Von Hunolstein JJ, Andres E, Goichot B, Danion F, Kaeuffer C, Poindron V, Ohlmann P, Jesel L, Morel O. Venous thromboembolism in non-critically ill patients with COVID-19 infection. Thromb Res 2020; 193:166-169. [PMID: 32707275 PMCID: PMC7367026 DOI: 10.1016/j.thromres.2020.07.033] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/11/2020] [Accepted: 07/15/2020] [Indexed: 01/30/2023]
Abstract
Venous thromboembolism (VTE) is a frequent complication in COVID-19 patients. Single-center study of COVID-19 patients admitted to general ward. 17.0% of patients with VTE Lack of thromboprophylaxis and leukocytosis were independent risk factors of VTE. VTE is independently associated with worse in-hospital outcomes.
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Affiliation(s)
- Antonin Trimaille
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France; INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
| | - Anaïs Curtiaud
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Benjamin Marchandot
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Kensuke Matsushita
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France; INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
| | - Chisato Sato
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France; INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
| | - Ian Leonard-Lorant
- Radiology Department, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Laurent Sattler
- Department Laboratory Haematology, Center for Thrombosis and Haemostasis, Nouvel Hôpital Civil Strasbourg University Hospital, Strasbourg, France
| | - Lelia Grunebaum
- Department Laboratory Haematology, Center for Thrombosis and Haemostasis, Nouvel Hôpital Civil Strasbourg University Hospital, Strasbourg, France
| | - Mickaël Ohana
- Radiology Department, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Jean-Jacques Von Hunolstein
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Emmanuel Andres
- Department of Internal Medicine, Médicale B, Strasbourg University Hospital, Strasbourg, France
| | - Bernard Goichot
- Department of Internal Medicine, Diabetes and Metabolic Disorders, Strasbourg University Hospital, Strasbourg, France
| | - François Danion
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France
| | - Charlotte Kaeuffer
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France
| | - Vincent Poindron
- National Referral Center for Systemic Autoimmune Diseases, Clinical Immunology Department, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Patrick Ohlmann
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Laurence Jesel
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France; INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
| | - Olivier Morel
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France; INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France.
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Lorenzo Villalba N, Zulfiqar AA, Maouche Y, Cordoba Sosa Z, Alonso Ortiz MB, Andres E. Idiopathic CD4+ T-cell Lymphocytopenia: Report of a Case 11 Years after Diagnosis. Eur J Case Rep Intern Med 2020; 7:001589. [PMID: 32399448 PMCID: PMC7213825 DOI: 10.12890/2020_001589] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/03/2020] [Indexed: 11/17/2022] Open
Abstract
We report the case of a 23-year-old woman evaluated for asthenia and lymphocytopenia. Clinical examination was unremarkable but laboratory tests showed the presence of CD4 lymphocytopenia. Secondary causes of CD4 lymphocytopenia were ruled out and a previous diagnosis of idiopathic CD4+ T-cell lymphocytopenia was retained. CD4 lymphocytopenia has persisted for 11 years now but the patient has been clinically asymptomatic.
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Affiliation(s)
- Noel Lorenzo Villalba
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, France
| | - Abrar-Ahmad Zulfiqar
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, France
| | - Yasmine Maouche
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, France
| | - Zaida Cordoba Sosa
- Internal Medicine Department, Fuerteventura General Hospital, Fuerteventura, Spain
| | | | - Emmanuel Andres
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, France
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Lorenzo-Villalba N, Zulfiqar AA, Auburtin M, Schuhmacher MH, Meyer A, Maouche Y, Keller O, Andres E. Thrombocytopenia in the Course of COVID-19 Infection. Eur J Case Rep Intern Med 2020; 7:001702. [PMID: 32523922 PMCID: PMC7279909 DOI: 10.12890/2020_001702] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 12/27/2022] Open
Abstract
We report three cases of severe thrombocytopenia during COVID-19 infection associated with either cutaneous purpura or mucosal bleeding. The initial investigations ruled out other causes of thrombocytopenia. Two of the patients were treated with intravenous immunoglobulins and eltrombopag, while the third recovered spontaneously. A good clinical and biological response was achieved in all patients leading to hospital discharge.
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Affiliation(s)
- Noel Lorenzo-Villalba
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasboug, Strasbourg France
| | - Abrar-Ahmad Zulfiqar
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasboug, Strasbourg France
| | - Marc Auburtin
- Service de Médecine Interne, Centre Hospitalier d'Epinal, Epinal, France
| | | | - Alain Meyer
- Service de Rhumatologie, Hôpitaux Universitaires de Strasboug, Strasbourg, France
| | - Yasmine Maouche
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasboug, Strasbourg France
| | - Olivier Keller
- Service de Médecine Interne, Centre Hospitalier de Haguenau, Haguenau, France
| | - Emmanuel Andres
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasboug, Strasbourg France
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Lorenzo Villalba N, Maouche Y, Alonso Ortiz MB, Cordoba Sosa Z, Chahbazian JB, Syrovatkova A, Pertoldi P, Andres E, Zulfiqar AA. Anosmia and Dysgeusia in the Absence of Other Respiratory Diseases: Should COVID-19 Infection Be Considered? Eur J Case Rep Intern Med 2020; 7:001641. [PMID: 32309267 PMCID: PMC7162576 DOI: 10.12890/2020_001641] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 01/22/2023] Open
Abstract
We describe two elderly patients evaluated at emergency departments for anosmia/dysgeusia in the absence of any other respiratory symptoms prior to or upon admission. In the current epidemiological context, clinical and biological work-up led to a diagnosis of COVID-19 infection. Unfortunately, one of the patients died during hospitalization, but the other recovered and was discharged. LEARNING POINTS In the current epidemiological situation, anosmia and dysgeusia in the absence of other respiratory conditions should be carefully evaluated.Special attention should be given to patients with non-classic COVID-19 symptoms in order to reduce transmission and protect health providers.
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Affiliation(s)
- Noel Lorenzo Villalba
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, France
| | - Yasmine Maouche
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, France
| | | | - Zaida Cordoba Sosa
- Internal Medicine Department, Fuerteventura General Hospital, Fuerteventura, Spain
| | - Jean Baptiste Chahbazian
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, France
| | - Aneska Syrovatkova
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, France
| | - Pierre Pertoldi
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, France
| | - Emmanuel Andres
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, France
| | - Abrar-Ahmad Zulfiqar
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, France
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Riou M, Pizzimenti M, Enache I, Charloux A, Canuet M, Andres E, Talha S, Meyer A, Geny B. Skeletal and Respiratory Muscle Dysfunctions in Pulmonary Arterial Hypertension. J Clin Med 2020; 9:jcm9020410. [PMID: 32028638 PMCID: PMC7073630 DOI: 10.3390/jcm9020410] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 12/15/2019] [Revised: 01/20/2020] [Accepted: 01/28/2020] [Indexed: 12/18/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a rare disease, which leads to the progressive loss and remodeling of the pulmonary vessels, right heart failure, and death. Different clinical presentations can be responsible for such a bad prognosis disease and the underlying mechanisms still need to be further examined. Importantly, skeletal and respiratory muscle abnormalities largely contribute to the decreased quality of life and exercise intolerance observed in patients with PAH. At the systemic level, impaired oxygen supply through reduced cardiac output and respiratory muscle dysfunctions, which potentially result in hypoxemia, is associated with altered muscles vascularization, inflammation, enhanced catabolic pathways, and impaired oxygen use through mitochondrial dysfunctions that are likely participate in PAH-related myopathy. Sharing new insights into the pathological mechanisms of PAH might help stimulate specific research areas, improving the treatment and quality of life of PAH patients. Indeed, many of these muscular impairments are reversible, strongly supporting the development of effective preventive and/or therapeutic approaches, including mitochondrial protection and exercise training.
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Affiliation(s)
- Marianne Riou
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France
- Pulmonology Service, University Hospital of Strasbourg, 1 place de l’Hôpital, 67091 Strasbourg CEDEX, France
| | - Mégane Pizzimenti
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France
| | - Irina Enache
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France
| | - Anne Charloux
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France
| | - Mathieu Canuet
- Pulmonology Service, University Hospital of Strasbourg, 1 place de l’Hôpital, 67091 Strasbourg CEDEX, France
| | - Emmanuel Andres
- Internal Medicine, Diabete and Metabolic Diseases Service, University Hospital of Strasbourg, 1 place de l’Hôpital, 67091 Strasbourg CEDEX, France;
| | - Samy Talha
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France
| | - Alain Meyer
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France
| | - Bernard Geny
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France
- Correspondence:
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Habchi H, Lorenzo-Villalba N, Andres E, Zulfiqar AA. [Physical activity among seniors : what benefits on geriatric criteria ?]. Rev Med Liege 2020; 75:89-93. [PMID: 32030932] [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 elderly population is growing in our societies. Prevention policies are strongly supported by public authorities and one of them is the promotion of physical activity. We propose to detail, through a literature review, the impact of physical activity on the main geriatric criteria.
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Affiliation(s)
- H Habchi
- Département de Médecine générale, CHU Reims, France
| | | | - E Andres
- Département de Médecine interne, CHRU Strasbourg, France
| | - A A Zulfiqar
- Département de Médecine interne, CHRU Strasbourg, France
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Sovaila S, Purcarea A, Froissart A, Ranque B, Kieffer P, Andres E, Goujard C, Weber JC, Bergmann JF, Gayet S, Granel B, Bourgarit A. Contribution of an Early Internal Medicine Rotation to the Clinical Reasoning Learning for Young Residents. J Med Life 2020; 13:183-186. [PMID: 32742511 PMCID: PMC7378354 DOI: 10.25122/jml-2020-1003] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Clinical reasoning is the cornerstone of medical practice, and achieving this competence depends on a large number of factors. Internal medicine departments provide junior doctors with plentiful and varied patients, offering a comprehensive basis for learning clinical reasoning. In order to evaluate the usefulness of an early rotation at internal medicine departments, we compared, via script concordance tests, the evolution of residents' clinical reasoning after an initial internal medicine rotation compared to rotations through other medical specialties. Twenty-two residents were tested after six months of their internal medicine rotation and compared to twenty-five residents that had the first rotation in another specialty (control). We showed a significant difference in the improvement of the script concordance tests scores (p=0.015) between the beginning and the end of their first rotation between the internal medicine and the control groups, and this implies the lower improvement of clinical reasoning skills and spontaneous learning slope of the junior doctors in other departments.
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Affiliation(s)
- Silvia Sovaila
- Internal Medicine Department, Civil Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Adrian Purcarea
- Internal Medicine Department, University Hospital Strasbourg, Strasbourg, France
| | - Antoine Froissart
- Internal Medicine Department, Créteil, Assistance Publique – Hôpitaux de Paris, France
| | - Brigitte Ranque
- Vascular Medicine Department and Reference Center for Rare Vascular Diseases, Hôpital Européen Georges Pompidou, Assistance Publique – Hôpitaux de Paris, France
| | - Pierre Kieffer
- Internal Medicine Department, Mulhouse hospital, Mulhouse
| | - Emmanuel Andres
- Internal Medicine Department, University Hospital Strasbourg, Strasbourg, France
| | - Cecile Goujard
- Internal Medicine Department, Bicêtre Hospital, Assistance Publique – Hôpitaux de Paris, France
| | - Jean-Christophe Weber
- Internal Medicine Department, Civil Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Jean-François Bergmann
- Internal Medicine Department, Hôpital Lariboisiere, Assistance Publique – Hôpitaux de Paris, France
| | - Stephane Gayet
- Internal Medicine Department, Hôpital Timone, Marseille, France
| | - Brigitte Granel
- Internal Medicine Department, Marseille University Hospitals, Marseille, France
| | - Anne Bourgarit
- Internal Medicine Department, University Hospital Strasbourg, Strasbourg, France
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Pizzimenti M, Riou M, Charles AL, Talha S, Meyer A, Andres E, Chakfé N, Lejay A, Geny B. The Rise of Mitochondria in Peripheral Arterial Disease Physiopathology: Experimental and Clinical Data. J Clin Med 2019; 8:jcm8122125. [PMID: 31810355 PMCID: PMC6947197 DOI: 10.3390/jcm8122125] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 11/10/2019] [Revised: 11/27/2019] [Accepted: 11/29/2019] [Indexed: 12/21/2022] Open
Abstract
Peripheral arterial disease (PAD) is a frequent and serious condition, potentially life-threatening and leading to lower-limb amputation. Its pathophysiology is generally related to ischemia-reperfusion cycles, secondary to reduction or interruption of the arterial blood flow followed by reperfusion episodes that are necessary but also—per se—deleterious. Skeletal muscles alterations significantly participate in PAD injuries, and interestingly, muscle mitochondrial dysfunctions have been demonstrated to be key events and to have a prognosis value. Decreased oxidative capacity due to mitochondrial respiratory chain impairment is associated with increased release of reactive oxygen species and reduction of calcium retention capacity leading thus to enhanced apoptosis. Therefore, targeting mitochondria might be a promising therapeutic approach in PAD.
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Affiliation(s)
- Mégane Pizzimenti
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 «Mitochondria, Oxidative Stress and Muscle Protection», 11 Rue Humann, 67000 Strasbourg, France; (M.P.); (M.R.); (A.-L.C.); (S.T.); (A.M.); (A.L.)
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France
| | - Marianne Riou
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 «Mitochondria, Oxidative Stress and Muscle Protection», 11 Rue Humann, 67000 Strasbourg, France; (M.P.); (M.R.); (A.-L.C.); (S.T.); (A.M.); (A.L.)
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France
| | - Anne-Laure Charles
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 «Mitochondria, Oxidative Stress and Muscle Protection», 11 Rue Humann, 67000 Strasbourg, France; (M.P.); (M.R.); (A.-L.C.); (S.T.); (A.M.); (A.L.)
| | - Samy Talha
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 «Mitochondria, Oxidative Stress and Muscle Protection», 11 Rue Humann, 67000 Strasbourg, France; (M.P.); (M.R.); (A.-L.C.); (S.T.); (A.M.); (A.L.)
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France
| | - Alain Meyer
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 «Mitochondria, Oxidative Stress and Muscle Protection», 11 Rue Humann, 67000 Strasbourg, France; (M.P.); (M.R.); (A.-L.C.); (S.T.); (A.M.); (A.L.)
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France
| | - Emmanuel Andres
- Internal Medicine, Diabete and Metabolic Diseases Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France;
| | - Nabil Chakfé
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 «Mitochondria, Oxidative Stress and Muscle Protection», 11 Rue Humann, 67000 Strasbourg, France; (M.P.); (M.R.); (A.-L.C.); (S.T.); (A.M.); (A.L.)
- Vascular Surgery and Kidney Transplantation Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France
| | - Anne Lejay
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 «Mitochondria, Oxidative Stress and Muscle Protection», 11 Rue Humann, 67000 Strasbourg, France; (M.P.); (M.R.); (A.-L.C.); (S.T.); (A.M.); (A.L.)
- Vascular Surgery and Kidney Transplantation Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France
| | - Bernard Geny
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 «Mitochondria, Oxidative Stress and Muscle Protection», 11 Rue Humann, 67000 Strasbourg, France; (M.P.); (M.R.); (A.-L.C.); (S.T.); (A.M.); (A.L.)
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France
- Correspondence:
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Zulfiqar AA, Lorenzo Villalba N, Ben Malek H, Vogel T, Andres E, SiFMI G. [Clinical semiology of anemia in patients over 75 years: a prospective study conducted in France by the SiFMI group]. Rev Med Liege 2019; 74:667-671. [PMID: 31833278] [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
INTRODUCTION Anemia remains one of the main concerns of the day-today life of Internist since it ranks third among the pathologies seen in Internal Medicine Departments. OBJECTIVE it seemed appropriate for the SiFMI Group (Common Situations in Internal Medicine of the SNFMI) to carry out a study of anemia evaluating the contribution to the diagnosis of the «classical» semiology of the anemic syndrome. This work reports the results from the study of 204 patients aged 75 years and more. METHOD A prospective, non interventional multicenter study was carried out in Internal and Geriatric Departments in the period September 2015-September 2017. Clinical and biological variables were collected. RESULTS 204 patients from 10 Internal or Geriatric Departments were included in the period September 2015-September 2017. They were assigned into two groups with and without anemia. According to this study, it seems that the following parameters : asthenia, dyspnea (NYHA stages III and IV), palpitations, chest pain, tachycardia, hypotension as well as confusion, falls, depression and MMSE showed no significant statistical difference between both groups in contrast to pallor, edema, albumin and ECG. CONCLUSION Clinical diagnosis of anemia in elderly individuals remains a challenge. It is difficult to establish a diagnostic protocol in this population.
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Affiliation(s)
- A A Zulfiqar
- Service de Médecine interne, Diabète et Maladies métaboliques, Hôpitaux Universitaires de Strasbourg, France
| | - N Lorenzo Villalba
- Service de Médecine interne, Diabète et Maladies métaboliques, Hôpitaux Universitaires de Strasbourg, France
| | - H Ben Malek
- Service de Médecine interne, Diabète et Maladies métaboliques, Hôpitaux Universitaires de Strasbourg, France
| | - T Vogel
- Service de Gériatrie et Médecine interne, CHU Strasbourg, France
| | - E Andres
- Service de Médecine interne, Diabète et Maladies métaboliques, Hôpitaux Universitaires de Strasbourg, France
| | - Group SiFMI
- Société Nationale Française de Médecine Interne
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Ederlé C, Charles AL, Khayath N, Poirot A, Meyer A, Clere-Jehl R, Andres E, De Blay F, Geny B. Mitochondrial Function in Peripheral Blood Mononuclear Cells (PBMC) Is Enhanced, Together with Increased Reactive Oxygen Species, in Severe Asthmatic Patients in Exacerbation. J Clin Med 2019; 8:jcm8101613. [PMID: 31623409 PMCID: PMC6833034 DOI: 10.3390/jcm8101613] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 08/30/2019] [Revised: 09/24/2019] [Accepted: 09/27/2019] [Indexed: 12/11/2022] Open
Abstract
Asthma is a chronic inflammatory lung syndrome with an increasing prevalence and a rare but significant risk of death. Its pathophysiology is complex, and therefore we investigated at the systemic level a potential implication of oxidative stress and of peripheral blood mononuclear cells’ (PBMC) mitochondrial function. Twenty severe asthmatic patients with severe exacerbation (GINA 4–5) and 20 healthy volunteers participated at the study. Mitochondrial respiratory chain complexes activities using different substrates and reactive oxygen species (ROS) production were determined in both groups by high-resolution respirometry and electronic paramagnetic resonance, respectively. Healthy PBMC were also incubated with a pool of plasma of severe asthmatics or healthy controls. Mitochondrial respiratory chain complexes activity (+52.45%, p = 0.015 for VADP) and ROS production (+34.3%, p = 0.02) were increased in asthmatic patients. Increased ROS did not originate mainly from mitochondria. Plasma of severe asthmatics significantly increased healthy PBMC mitochondrial dioxygen consumption (+56.8%, p = 0.031). In conclusion, such asthma endotype, characterized by increased PMBCs mitochondrial oxidative capacity and ROS production likely related to a plasma constituent, may reflect activation of the immune system. Further studies are needed to determine whether increased PBMC mitochondrial respiration might have protective effects, opening thus new therapeutic approaches.
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Affiliation(s)
- Carole Ederlé
- Pôle de Pathologie Thoracique, Service de Pneumologie, Nouvel Hôpital Civil, 1, Place de l'Hôpital, FHU OMICARE Université de Strasbourg, 67000 Strasbourg, France.
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Equipe d'Accueil 3072, «Mitochondrie, Stress Oxydant, et Protection Musculaire», 11 Rue Humann, Université de Strasbourg, 67000 Strasbourg, France.
| | - Anne-Laure Charles
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Equipe d'Accueil 3072, «Mitochondrie, Stress Oxydant, et Protection Musculaire», 11 Rue Humann, Université de Strasbourg, 67000 Strasbourg, France.
| | - Naji Khayath
- Pôle de Pathologie Thoracique, Service de Pneumologie, Nouvel Hôpital Civil, 1, Place de l'Hôpital, FHU OMICARE Université de Strasbourg, 67000 Strasbourg, France.
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Equipe d'Accueil 3072, «Mitochondrie, Stress Oxydant, et Protection Musculaire», 11 Rue Humann, Université de Strasbourg, 67000 Strasbourg, France.
| | - Anh Poirot
- Pôle de Pathologie Thoracique, Service de Pneumologie, Nouvel Hôpital Civil, 1, Place de l'Hôpital, FHU OMICARE Université de Strasbourg, 67000 Strasbourg, France.
| | - Alain Meyer
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Equipe d'Accueil 3072, «Mitochondrie, Stress Oxydant, et Protection Musculaire», 11 Rue Humann, Université de Strasbourg, 67000 Strasbourg, France.
- Service de Physiologie et d'Explorations Fonctionnelles, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, 1 Place de l'Hôpital, 67091 Strasbourg CEDEX, France.
| | - Raphaël Clere-Jehl
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Equipe d'Accueil 3072, «Mitochondrie, Stress Oxydant, et Protection Musculaire», 11 Rue Humann, Université de Strasbourg, 67000 Strasbourg, France.
| | - Emmanuel Andres
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Pôle M.I.R.N.E.D., Hôpitaux Universitaires, 67000 CHRU Strasbourg CEDEX, France.
| | - Frédéric De Blay
- Pôle de Pathologie Thoracique, Service de Pneumologie, Nouvel Hôpital Civil, 1, Place de l'Hôpital, FHU OMICARE Université de Strasbourg, 67000 Strasbourg, France.
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Equipe d'Accueil 3072, «Mitochondrie, Stress Oxydant, et Protection Musculaire», 11 Rue Humann, Université de Strasbourg, 67000 Strasbourg, France.
| | - Bernard Geny
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Equipe d'Accueil 3072, «Mitochondrie, Stress Oxydant, et Protection Musculaire», 11 Rue Humann, Université de Strasbourg, 67000 Strasbourg, France.
- Service de Physiologie et d'Explorations Fonctionnelles, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, 1 Place de l'Hôpital, 67091 Strasbourg CEDEX, France.
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Gárate-Escamilla AK, El Hassani AH, Andres E. Big data execution time based on Spark Machine Learning Libraries. Proceedings of the 2019 3rd International Conference on Cloud and Big Data Computing 2019. [DOI: 10.1145/3358505.3358519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
| | | | - Emmanuel Andres
- Service de Médecine Interne, Diabète et Maladies métaboliques de la Clinique Médicale B, CHRU de Strasbourg, Strasbourg
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Ruch Y, Labidi A, Martin A, Weingertner N, Hansmann Y, Lefebvre N, Andres E, Argemi X, Dieudonné Y. Le syndrome de cavitation ganglionnaire mésentérique, complication rare de la maladie cœliaque de l’adulte : à propos de quatre cas et revue de la littérature. Rev Med Interne 2019; 40:536-544. [DOI: 10.1016/j.revmed.2019.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 11/28/2022]
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Andres E, Meyer L, Talha S, Hajjam A, Hajjam M, Jeandidier N. Télésurveillance du patient diabétique de type 2 et/ou insuffisant cardiaque : l’expérience Strasbourgeoise. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.03.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Spielmann L, Nespola B, Séverac F, Andres E, Kessler R, Guffroy A, Poindron V, Martin T, Geny B, Sibilia J, Meyer A. Anti-Ku syndrome with elevated CK and anti-Ku syndrome with anti-dsDNA are two distinct entities with different outcomes. Ann Rheum Dis 2019; 78:1101-1106. [PMID: 31126956 DOI: 10.1136/annrheumdis-2018-214439] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [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: 09/13/2018] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To refine the spectrum of anti-Ku-associated disease, a condition that is equivocally described by current diagnostic criteria for connective tissue diseases. METHODS Among 42 consecutive patients harbouring anti-Ku antibodies, subgroups with similar phenotypes and prognosis were delineated without an a priori diagnosis using hierarchical clustering analysis of the cumulative clinico-biological features recorded during the follow-up. Features present at baseline that most efficiently predicted the outcomes were then identified using a sensitivity-specificity sum maximisation approach. RESULTS Clinico-biological features were clustered into three groups. Glomerulonephritis and ILD, the two fatal complications in this cohort, were unequally distributed between the three clusters that additionally differed on six clinico-biological features.Among features present at baseline, elevated serum level of creatine kinase (CK) and anti-dsDNA antibodies were generally mutually exclusive and most efficiently predicted the cluster belonging at last follow-up. Anti-Ku patients with elevated CK had a 22-fold higher risk of ILD while anti-Ku patients with anti-dsDNA antibodies had a 13-fold higher risk of glomerulonephritis CONCLUSION: "Anti-Ku with elevated CK" syndrome and "anti-Ku with anti-dsDNA" syndrome represent two distinct entities that are important to recognise in order to best tailor patient care.
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Affiliation(s)
- Lionel Spielmann
- Service de Rhumatologie, hôpitaux civils de Colmar, Colmar, France
| | - Benoit Nespola
- Laboratoire d'immunologie, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - François Séverac
- Service de Santé Publique, GMRC, hôpitaux universitaires de Strasbourg, Strasbourg, France.,ICube, UMR 7357, université de Strasbourg, Strasbourg, France
| | - Emmanuel Andres
- Service de médecine interne, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Romain Kessler
- Service de pneumologie, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Aurélien Guffroy
- Service d'immunologie clinique, hôpitaux universitaires de Strasbourg, Strasbourg, France.,Centre de référence national des maladies auto-immunes rares, Strasbourg, France.,Fédération de médecine translationnelle de Strasbourg, FRU 6702, université de Strasbourg, Strasbourg, France
| | - Vincent Poindron
- Service d'immunologie clinique, hôpitaux universitaires de Strasbourg, Strasbourg, France.,Centre de référence national des maladies auto-immunes rares, Strasbourg, France
| | - Thierry Martin
- Service d'immunologie clinique, hôpitaux universitaires de Strasbourg, Strasbourg, France.,Centre de référence national des maladies auto-immunes rares, Strasbourg, France.,Fédération de médecine translationnelle de Strasbourg, FRU 6702, université de Strasbourg, Strasbourg, France
| | - Bernard Geny
- Fédération de médecine translationnelle de Strasbourg, FRU 6702, université de Strasbourg, Strasbourg, France.,Service de physiologie et d'explorations fonctionnelles, hôpitaux universitaires de Strasbourg et EA 3072, Strasbourg, France
| | - Jean Sibilia
- Centre de référence national des maladies auto-immunes rares, Strasbourg, France.,Fédération de médecine translationnelle de Strasbourg, FRU 6702, université de Strasbourg, Strasbourg, France.,Service de rhumatologie, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Alain Meyer
- Centre de référence national des maladies auto-immunes rares, Strasbourg, France.,Fédération de médecine translationnelle de Strasbourg, FRU 6702, université de Strasbourg, Strasbourg, France.,Service de physiologie et d'explorations fonctionnelles, hôpitaux universitaires de Strasbourg et EA 3072, Strasbourg, France.,Service de rhumatologie, hôpitaux universitaires de Strasbourg, Strasbourg, France
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