Subject(s)
Anemia, Hemolytic, Autoimmune/etiology , BCG Vaccine/adverse effects , Purpura, Thrombocytopenic, Idiopathic/etiology , Tuberculosis/etiology , Administration, Intravesical , Aged , Antitubercular Agents/therapeutic use , BCG Vaccine/therapeutic use , Blood Vessel Prosthesis/microbiology , Carcinoma, Transitional Cell/surgery , Carcinoma, Transitional Cell/therapy , Combined Modality Therapy , Drug Therapy, Combination , Humans , Male , Mycobacterium bovis/isolation & purification , Tuberculoma/etiology , Tuberculoma/microbiology , Tuberculosis/drug therapy , Tuberculosis/immunology , Urinary Bladder Neoplasms/surgery , Urinary Bladder Neoplasms/therapyABSTRACT
PURPOSE: To develop French recommendations about the management of vaccinations, the screening of cervical cancer and the prevention of pneumocystis pneumonia in systemic lupus erythematosus (SLE). METHODS: Thirty-seven experts qualified in internal medicine, rheumatology, dermatology, nephrology and pediatrics have selected recommendations from a list of proposition based on available data from the literature. For each recommendation, the level of evidence and the level of agreement among the experts were specified. RESULTS: Inactivated vaccines do not cause significant harm in SLE patients. Experts recommend that lupus patient should receive vaccinations accordingly to the recommendations and the schedules for the general public. Pneumococcal vaccination is recommended for all SLE patients. Influenza vaccination is recommended for immunosuppressed SLE patients. Live attenuated vaccines should be avoided in immunosuppressed patients. Yet, recent works suggest that they can be considered in mildly immunosuppressed patients. Experts have recommended a cervical cytology every year for immunosuppressed patients. No consensus was obtained for the prevention of pneumocystis pneumonia. CONCLUSION: These recommendations can be expected to improve clinical practice uniformity and, in the longer term, to optimize the management of SLE patients.
Subject(s)
Expert Testimony , Infection Control/standards , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/therapy , Practice Guidelines as Topic , Adolescent , Adult , France , Humans , Immunocompromised Host , Infection Control/methods , Infections/diagnosis , Lupus Erythematosus, Systemic/diagnosis , Lupus Erythematosus, Systemic/immunology , Review Literature as Topic , Vaccination/standards , Young AdultABSTRACT
PURPOSE: The diagnostic value of selective anorexia is debated. Some authors have suggested an association between meat aversion and cancer, but most do not use it as a diagnostic tool. We aimed to characterize anorexia of different diseases to search for an association between selective aversions and diagnostic groups. METHODS: All the patients admitted to three departments of a teaching hospital were included consecutively for 22months if they had more than 10 % weight loss in less than one year. Patients were excluded if history taking was not reliable, or if they suffered from anorexia nervosa. We compiled diagnoses at discharge and validated them six months later. We used logistic regression to identify independent factors associated with selective anorexia. RESULTS: Inclusion criteria were met in 106patients (female 44 %, median age 65years). Most frequent diagnoses were: cancer (36 %), infection (35 %), digestive diseases (19 %), non organic diseases (21 %). Recent selective anorexia was found in 46 % of the cases. It was significantly associated with female gender (P=0.002), marginally with young age (P=0.069) and long duration of weight loss (P=0.079). Opioid use at admission was negatively associated with selective anorexia (P=0.001). No specific diagnostic category was found to be associated. CONCLUSION: Selective anorexia does not appear to be a useful symptom to investigate pathological weight loss. It behaves more like a non-specific reactivation by current disease of earlier latent personal food aversions.
Subject(s)
Anorexia/etiology , Symptom Assessment , Taste , Weight Loss , Aged , Aged, 80 and over , Anorexia/classification , Female , Humans , Male , Middle Aged , Prospective Studies , Surveys and QuestionnairesABSTRACT
Drug-induced adverse effects are one of the main avoidable causes of hospitalization in older people. Numerous lists of potentially inappropriate medications for older people have been published, as national and international guidelines for appropriate prescribing in numerous diseases and for different age categories. The present review describes the general rules for an appropriate prescribing in older people and summarizes, for the main conditions encountered in older people, medications that are too often under-prescribed, the precautions of use of the main drugs that induce adverse effects, and drugs for which the benefit to risk ratio is unfavourable in older people. All these data are assembled in educational tables designed to be printed in a practical pocket format and used in daily practice by prescribers, whether physicians, surgeons or pharmacists.
Subject(s)
Aged , Drug Prescriptions , Practice Patterns, Physicians' , Age Factors , Aged, 80 and over , Drug Prescriptions/standards , Drug Prescriptions/statistics & numerical data , Drug-Related Side Effects and Adverse Reactions/epidemiology , Humans , Inappropriate Prescribing/prevention & control , Inappropriate Prescribing/statistics & numerical data , Medication Errors/prevention & control , Medication Errors/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical dataABSTRACT
PURPOSE: To develop French recommendations about screening and management of cardiovascular risk factors in systemic lupus erythematosus (SLE). METHODS: Thirty-nine experts qualified in internal medicine, rheumatology and nephrology have selected recommendations from a list developed based on evidence from the literature. For each recommendation, the level of evidence and the level of agreement among the experts were specified. RESULTS: Experts recommended an annual screening of cardiovascular risk factors in SLE. Statins should be prescribed for primary prevention in SLE patients based on the level of LDL-cholesterol and the number of cardiovascular risk factors, considering SLE as an additional risk factor. For secondary prevention, experts have agreed on an LDL-cholesterol target of <0.7 g/L. Hypertension should be managed according to the 2013 European guidelines, using renin-angiotensin system blockers as first line agents in case of renal involvement. Aspirin can be prescribed in patients with high cardiovascular risk or with antiphospholipid antibodies. CONCLUSION: These recommendations about the screening and management of cardiovascular risk factors in SLE can be expected to improve clinical practice uniformity and, in the longer term, to optimize the management of SLE patients.
Subject(s)
Cardiovascular Diseases/etiology , Lupus Erythematosus, Systemic/complications , Mass Screening/methods , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/drug therapy , Evidence-Based Medicine , Expert Testimony , Guidelines as Topic , Humans , Risk Factors , Secondary PreventionABSTRACT
INTRODUCTION: Morbid obesity is an emerging condition in the general population. Bariatric surgery, which has demonstrated its effectiveness for weight loss, mortality and morbidity related to obesity, is required in some patients. However, it may be associated with various adverse effects, including vitamin deficiencies. CASE REPORT: We report a 33-year old man who presented central and peripheral neurological deficits and cardiac manifestations related to multiple vitamin deficiencies, following "sleeve" gastrectomy. The vitamin deficiencies were related to insufficient ingesta secondary to psychogenic anorexia. The patient improved with vitamins, antidepressant drugs and atypical neuroleptics. CONCLUSION: Post-operative complications of "sleeve" gastrectomy include vitamin deficiencies that can develop in the context of psychogenic anorexia and ingesta reduction, in the absence of any digestive malabsorption.
Subject(s)
Anorexia Nervosa/etiology , Avitaminosis/etiology , Gastrectomy/adverse effects , Obesity, Morbid/surgery , Adult , Gastrectomy/methods , Humans , Male , Obesity, Morbid/blood , Obesity, Morbid/psychology , Postoperative Complications/diagnosis , Severity of Illness Index , Weight Loss/physiologySubject(s)
Churg-Strauss Syndrome/complications , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/etiology , Adrenal Cortex Hormones/therapeutic use , Anticoagulants/therapeutic use , Churg-Strauss Syndrome/drug therapy , Humans , Male , Middle Aged , Pulmonary Embolism/drug therapy , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
We report the first case of cutaneous leishmaniasis in a patient treated with infliximab. The species was Leishmania infantum, agent of both cutaneous leishmaniasis and visceral leishmaniasis. Cutaneous leishmaniasis occurred after the 9th infusion of infliximab in a patient who was suffering from ankylosing spondylitis.
Subject(s)
Antibodies, Monoclonal/adverse effects , Antirheumatic Agents/adverse effects , Leishmania infantum , Leishmaniasis, Cutaneous/etiology , Spondylitis, Ankylosing/drug therapy , Antibodies, Monoclonal/therapeutic use , Antiprotozoal Agents/therapeutic use , Antirheumatic Agents/therapeutic use , Humans , Infliximab , Leishmaniasis, Cutaneous/parasitology , Leishmaniasis, Cutaneous/pathology , Male , Meglumine/therapeutic use , Meglumine Antimoniate , Middle Aged , Organometallic Compounds/therapeutic use , Spondylitis, Ankylosing/immunology , Tumor Necrosis Factor-alpha/antagonists & inhibitorsABSTRACT
INTRODUCTION: Acute pericarditis is a frequent hospitalization cause. A prospective, bicentric study aimed at different goals: population description, aetiologies screening, and evaluation of the interest of a coordinated and combined management between cardiologists and internists. PATIENTS AND METHODS: Between May 2005 and September 2007, all patients admitted for acute pericarditis were prospectively enrolled. Physical examination, ECG, echocardiography, biological screening were performed. Patients were asked to consult both cardiologist and internist, one month later. RESULTS: Hundred and three patients were enrolled (mean age 43 years). Clinical outcome was classical in 60% of cases. ECG was typical in 59%. Troponin elevation was noted in 30% of patients. CRP was normal at diagnosis in 27% of patients, and increased significantly at first day (P=0.002). Possible cause was identified in 44 patients. In 26 patients (24.3%), precise diagnosis was performed: six cancers, one hemopathy, three connectivities, one EBV and one parvovirus B19 seroconversions, two untreated HIV patients, four inflammatory diseases, three endocrinology troubles, one oesophagitis, one dental sepsis, one amyloidosis, one acute pancreatitis, one declined dialysis indication. Eighteen de novo diagnoses (16.5%) were performed, out of them at least 12 benefited from specific management. CONCLUSION: Population of patients admitted for acute pericarditis are very heterogeneous. Our co-management between internists and cardiologists aims to diagnose earlier and easier curable diseases. Long-term follow-up remains of great interest, in order to diagnose later other disorders, which remained hidden, and to follow evolution of the population.
Subject(s)
Pericarditis/diagnosis , Pericarditis/etiology , Acute Disease , Adult , C-Reactive Protein/analysis , Echocardiography , Electrocardiography , Female , Humans , Male , Prospective Studies , Troponin/bloodABSTRACT
BACKGROUND: Behçet's disease (BD) shares clinical features with well-recognised autoinflammatory disorders. In addition, mutations in genes for familial Mediterranean fever and tumour necrosis factor receptor-associated periodic syndrome have been reported to have increased in patients with BD. PATIENTS AND METHODS: DNA samples from 97 patients with BD and 51 matched healthy controls were analysed for the mevalonate kinase (MVK), cold-induced autoinflammatory syndrome 1 (CIAS1) and proline/serine/threonine phosphatase-interacting protein 1 (PSTPIP1) genes, responsible for mevalonate kinase deficiency (MKD), cryopyrin associated periodic syndromes (CAPS) and pyogenic sterile arthritis, pyoderma gangrenosum and acne (PAPA) syndrome, respectively. Over 90% of known mutations were screened using restriction fragment length polymorphism analysis and/or sequencing. RESULTS: Two patients had paired mutations in the MVK gene (genotypes V377I/V377I and V377I/S135L) and displayed typical features of BD and MKD. Another was heterozygotic for the V377I genotype. The V198M mutation in the CIAS1 gene was identified in one patient with typical BD but no symptoms of CAPS. No mutations were identified in the control group. PSTPIP1 analysis revealed a new exon 10 insertion variant (c.741+33_741+34insGT) in 2 of 97 patients and in 1 of 51 controls (p>0.05), indicating that it is a polymorphism rather than a true mutation. DISCUSSION: This study could not demonstrate any significant increases in MVK, CIAS1 or PSTPIP1 mutations in patients with BD as compared with controls.
Subject(s)
Autoimmune Diseases/genetics , Behcet Syndrome/genetics , Mutation , Adaptor Proteins, Signal Transducing/genetics , Adolescent , Adult , Carrier Proteins/genetics , Case-Control Studies , Cytoskeletal Proteins/genetics , DNA Mutational Analysis/methods , Female , Genetic Predisposition to Disease , Humans , Male , NLR Family, Pyrin Domain-Containing 3 Protein , Phosphotransferases (Alcohol Group Acceptor)/geneticsABSTRACT
UNLABELLED: Adult-Onset Still's disease (AOSD) is a rare condition of unknown origin with various presentations and unpredictable outcome. The aim of this study was to analyse clinical and biological presentation, and outcome of patients admitted to an internal medicine service. METHOD: A retrospective cohort design with prospective follow-up was used. All the patients admitted to our internal medicine service for AOSD between January 1998 and March 2004 were included. RESULTS: According to Yamaguchi's classification criteria, 17 patients were analysed with a mean age at onset of 37.3 years and a 2.4 sex-ratio (female/male). Mean follow-up length was 52.1 months. Eight patients developed a monocyclic systemic form, 8 a polycyclic systemic form and 1 a chronic articular form. Arthralgia (87%) and arthritis (53%) were less frequent than in other series. Sixteen patients were treated: 14 by corticosteroids, 6 by non-steroid anti-inflammatory drugs, 5 by methotrexate, 2 intravenous polyglobulin and one by anti-TNF drug. Patients with a corticodependant or corticoresistant form had more polyarthritis at the onset of the disease (3/6 vs 0/11, P=0.029). DISCUSSION: In internal medicine activity, AOSD without oligo- or polyarthritis may be more frequent than expected according to the literature. Corticotherapy alone is often efficient in these AOSD form without synovitis, and methotrexate use is uncommon.
Subject(s)
Still's Disease, Adult-Onset , Adolescent , Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/therapeutic use , Adult , Aged , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Antirheumatic Agents/administration & dosage , Antirheumatic Agents/therapeutic use , Aspirin/administration & dosage , Aspirin/therapeutic use , Cohort Studies , Data Interpretation, Statistical , Female , Follow-Up Studies , Humans , Male , Methotrexate/administration & dosage , Methotrexate/therapeutic use , Middle Aged , Prognosis , Prospective Studies , Retrospective Studies , Still's Disease, Adult-Onset/diagnosis , Still's Disease, Adult-Onset/drug therapy , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: The diagnostic value of molecular analysis of the familial Mediterranean fever (FMF) gene (Mediterranean fever (MEFV)) has been well established only in patients selected on the basis of ethnic background or clinical criteria. Genetic diagnosis for other hereditary periodic fever syndromes has been poorly evaluated. OBJECTIVE: To determine the diagnostic contribution of genetic tests for hereditary periodic syndromes in a large, unselected series of patients. METHODS: A retrospective study was conducted on 1941 patients referred to us for FMF genetic tests between 1997 and 2005. MEFV genotypes were compared with clinical data to appraise criteria for FMF diagnosis. Genetic tests for tumour necrosis factor receptor-associated periodic syndrome (TRAPS), hyperimmunoglobulinaemia D syndrome (HIDS) and cryopyrin-associated periodic syndromes (CAPS) were also reviewed. RESULTS: 71% of the 1574 patients with enough data had a clinical diagnosis of FMF according to the widely used Israeli criteria. Two MEFV mutations were found in only 409 patients of this subgroup (sensitivity = 37%) and in 15 (3.3%) of the patients with an improbable clinical diagnosis of FMF (specificity = 97%). Molecular diagnosis for alternate hereditary periodic syndromes was carried out in 456 of the patients having a non-conclusive FMF genetic test. A positive diagnosis was obtained in 31 of these patients (TRAPS (n = 19), HIDS (n = 4) and CAPS (n = 8)). CONCLUSIONS: First-line MEFV mutation screening in patients with clinically typical FMF may be appropriate only in particular areas. To optimise genetic diagnosis, we propose a decision tree, which, with the advice of an expert practitioner, could help redirect test indications towards non-FMF hereditary periodic syndromes.
Subject(s)
Cytoskeletal Proteins/genetics , Decision Trees , Familial Mediterranean Fever/diagnosis , Mutation , Adolescent , Adult , Child , Child, Preschool , DNA Mutational Analysis/methods , Diagnosis, Differential , Familial Mediterranean Fever/ethnology , Familial Mediterranean Fever/genetics , Female , Genotype , Humans , Male , Middle Aged , Pyrin , Retrospective Studies , Sensitivity and SpecificitySubject(s)
Histiocytosis, Langerhans-Cell , Biopsy , Diabetes Mellitus, Type 1/complications , Hemochromatosis/complications , Histiocytosis, Langerhans-Cell/diagnosis , Histiocytosis, Langerhans-Cell/diagnostic imaging , Histiocytosis, Langerhans-Cell/pathology , Humans , Lung/pathology , Male , Middle Aged , Radiography, Thoracic , Tomography, X-Ray ComputedABSTRACT
PURPOSE: Central nervous system manifestations are rare clinical features of Wegener's granulomatosis, and occur in 4-8% of the patients, but few studies were dedicated to them. METHODS: This retrospective study (1988-2001) include 14 consecutive patients suffering from Wegener's granulomatosis. Involvement of central nervous system was defined as follows: suggestive neurological signs, compatible cerebral imaging, efficacy of the specific treatment of the granulomatosis. RESULTS: Four patients had a central nervous system manifestation (29%), including three women (average age 51 years). The signs were inaugural in a case. The manifestations were the following: sensibility disturbance (three cases), motor weakness (two cases), aphasia (one case), and mood disorders (two cases). Cranial nerves were constantly involved. Cerebral magnetic resonance imaging findings were: pachymeningitis and venous thrombosis (one case), vasculitis (two cases). Under steroid therapy associated with cyclophosphamide, in spite of a recurrence at 27 months in one patient, all patients had a complete remission. There was no death, with a median follow-up of 66 months. Except the ocular signs, that were more common (three cases), these patients had the usual characteristics of the Wegener's granulomatosis: rhinosinusitis (four cases), pulmonary (three cases), renal (three cases), and peripheral nervous system involvement (three cases). CONCLUSIONS: Our study, based on precise criteria, indicates that the frequency of the central neurologic manifestations of Wegener's granulomatosis is probably under estimated. Cranial nerves involvement is highly evocative. The long-term prognosis seems good, in spite of the associated multivisceral disorder.
Subject(s)
Granulomatosis with Polyangiitis/complications , Nervous System Diseases/diagnosis , Nervous System Diseases/epidemiology , Adult , Aged , Female , Humans , Incidence , Male , Middle Aged , Nervous System Diseases/etiology , Retrospective StudiesSubject(s)
Cryoglobulinemia/complications , Hypopigmentation/etiology , Aged , Female , Humans , PostureABSTRACT
INTRODUCTION: Spinal cord lesions are an uncommon mode of discovering acquired immunodeficiency syndrome because they usually appear at a later stage. EXEGESIS: We report a 58-year-old patient who had a spastic paraparesia and sphincter dysfunction. The spinal cord magnetic resonance imaging showed spontaneous hypersignals on T2-weighted images at the cervical and thoracic levels, enhanced with gadolinium, and without swelling. No cause was found. The HIV serology was positive and allowed us to consider an HIV-associated myelopathy. The antiretroviral therapy led to functional recovery. CONCLUSION: An HIV serology is suggested whenever an unexplained intramedullary lesion is discovered. Indeed, the diagnosis of HIV-associated myelopathy implies a specific therapeutic approach.