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1.
Int J Tuberc Lung Dis ; 27(11): 803-809, 2023 11 01.
Article in English | MEDLINE | ID: mdl-37880892

ABSTRACT

Air pollution is an environmental risk for the general population and for patients with various diseases, particularly respiratory diseases. Little data are available on personal exposure, but the recent emergence of low-cost air quality sensors (LCSs) should enable a better understanding of the health impacts of air pollution at the individual level. However, the reliability and accuracy of most sensors in the market have not been established, and a thorough understanding of their strengths and limitations is needed. We therefore conducted a review to address the following questions: 1) What is an LCS and what is the extent of its possible application? 2) Is the data obtained a reliable indicator of exposure? 3) What are the advantages and disadvantages of LCSs? 4) Could LCSs be useful in investigating the impact of air pollution on respiratory health? Further studies are needed to promote the use of LCS in research settings and among respiratory patients. This will allow us to monitor exposure levels, provide alerts and study the respiratory effects of individual-level air pollution.


Subject(s)
Air Pollutants , Air Pollution , Respiratory Tract Diseases , Humans , Air Pollutants/adverse effects , Air Pollutants/analysis , Reproducibility of Results , Air Pollution/adverse effects , Air Pollution/analysis , Respiratory Tract Diseases/diagnosis , Environmental Monitoring , Particulate Matter/adverse effects , Particulate Matter/analysis
2.
Int J Tuberc Lung Dis ; 27(10): 729-741, 2023 10 01.
Article in English | MEDLINE | ID: mdl-37749839

ABSTRACT

BACKGROUND: The aim of these clinical standards is to provide guidance on 'best practice' care for the diagnosis, treatment and prevention of post-COVID-19 lung disease.METHODS: A panel of international experts representing scientific societies, associations and groups active in post-COVID-19 lung disease was identified; 45 completed a Delphi process. A 5-point Likert scale indicated level of agreement with the draft standards. The final version was approved by consensus (with 100% agreement).RESULTS: Four clinical standards were agreed for patients with a previous history of COVID-19: Standard 1, Patients with sequelae not explained by an alternative diagnosis should be evaluated for possible post-COVID-19 lung disease; Standard 2, Patients with lung function impairment, reduced exercise tolerance, reduced quality of life (QoL) or other relevant signs or ongoing symptoms ≥4 weeks after the onset of first symptoms should be evaluated for treatment and pulmonary rehabilitation (PR); Standard 3, The PR programme should be based on feasibility, effectiveness and cost-effectiveness criteria, organised according to local health services and tailored to an individual patient's needs; and Standard 4, Each patient undergoing and completing PR should be evaluated to determine its effectiveness and have access to a counselling/health education session.CONCLUSION: This is the first consensus-based set of clinical standards for the diagnosis, treatment and prevention of post-COVID-19 lung disease. Our aim is to improve patient care and QoL by guiding clinicians, programme managers and public health officers in planning and implementing a PR programme to manage post-COVID-19 lung disease.


Subject(s)
COVID-19 , Quality of Life , Humans , Disease Progression , Educational Status , Exercise , COVID-19 Testing
3.
Rev Mal Respir ; 39(9): 740-757, 2022 Nov.
Article in French | MEDLINE | ID: mdl-36115752

ABSTRACT

Asthma is a multifactorial disease with complex pathophysiology. Knowledge of its immunopathology and inflammatory mechanisms is progressing and has led to the development over recent years of increasingly targeted therapeutic strategies. The objective of this review is to pinpoint the different predictive markers of asthma severity and therapeutic response. Obesity, nasal polyposis, gastroesophageal reflux disease and intolerance to aspirin have all been considered as clinical markers associated with asthma severity, as have functional markers such as bronchial obstruction, low FEV1, small daily variations in FEV1, and high FeNO. While sinonasal polyposis and allergic comorbidities are associated with better response to omalizumab, nasal polyposis or long-term systemic steroid use are associated with better response to antibodies targeting the IL5 pathway. Elevated total IgE concentrations and eosinophil counts are classic biological markers regularly found in severe asthma. Blood eosinophils are predictive biomarkers of response to anti-IgE, anti-IL5, anti-IL5R and anti-IL4R biotherapies. Dupilumab is particularly effective in a subgroup of patients with marked type 2 inflammation (long-term systemic corticosteroid therapy, eosinophilia≥150/µl or FENO>20 ppb). Chest imaging may help to identify severe patients by seeking out bronchial wall thickening and bronchial dilation. Study of the patient's environment is crucial insofar as exposure to tobacco, dust mites and molds, as well as outdoor and indoor air pollutants (cleaning products), can trigger asthma exacerbation. Wider and more systematic use of markers of severity or response to treatment could foster increasingly targeted and tailored approaches to severe asthma.


Subject(s)
Anti-Asthmatic Agents , Asthma , Hypersensitivity , Humans , Asthma/diagnosis , Asthma/drug therapy , Asthma/epidemiology , Omalizumab/therapeutic use , Eosinophils , Biomarkers , Anti-Asthmatic Agents/therapeutic use
5.
Rev Mal Respir ; 37(6): 505-510, 2020 Jun.
Article in French | MEDLINE | ID: mdl-32410773

ABSTRACT

The French-language Respiratory Medicine Society (SPLF) proposes a guide for the follow-up of patients who have presented with SARS-CoV-2 pneumonia. The proposals are based on known data from previous epidemics, on acute lesions observed in SARS-CoV-2 patients and on expert opinion. This guide proposes a follow-up based on three categories of patients: (1) patients managed outside hospital for possible or proven SARS-CoV-2 infection, referred by their physician for persistent dyspnoea; (2) patients hospitalized for SARS-CoV-2 pneumonia in a medical unit; (3) patients hospitalized for SARS-CoV-2 pneumonia in an intensive care unit. The subsequent follow-up will have to be adapted to the initial assessment. This guide emphasises the possibility of others causes of dyspnoea (cardiac, thromboembolic, hyperventilation syndrome…). These proposals may evolve over time as more knowledge becomes available.


Subject(s)
Aftercare/methods , Coronavirus Infections/therapy , Pneumonia, Viral/therapy , Aftercare/standards , Ambulatory Care/methods , Ambulatory Care/standards , COVID-19 , Cardiovascular Diseases/prevention & control , Coronavirus Infections/complications , Coronavirus Infections/rehabilitation , Critical Care/methods , Critical Care/standards , Diagnostic Techniques, Respiratory System/standards , Disease Management , Emergency Medical Services/methods , Emergency Medical Services/standards , Health Priorities , Hospitalization , Humans , Inpatients , Outpatients , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/rehabilitation , Respiratory Therapy/methods , Respiratory Therapy/standards , Symptom Assessment/methods , Symptom Assessment/standards , Thromboembolism/prevention & control , Thrombophilia/drug therapy , Thrombophilia/etiology
6.
Rev Mal Respir ; 37(4): 341-345, 2020 Apr.
Article in French | MEDLINE | ID: mdl-32284205

ABSTRACT

In systemic sclerosis, the presence of an anti-RNA polymerase III antibody (ARNpol3) is associated with an increased risk of cancer. The characteristic picture of this serotype includes severe diffuse cutaneous involvement, a high risk of renal scleroderma crisis and a 10 year survival of only around 30%. Pulmonary involvement is less common. We report the case of a woman initially treated for drug-induced acute interstitial lung disease revealing chronic interstitial pneumonia with autoimmune features. The disease evolved in three stages with the occurrence of a rapidly progressive diffuse skin sclerosis with anti-ARNPol3 antibodies in the context of ovarian cancer remission.


Subject(s)
Cystadenocarcinoma, Serous/complications , Flecainide/adverse effects , Lung Diseases, Interstitial/chemically induced , Ovarian Neoplasms/complications , Scleroderma, Systemic/complications , Scleroderma, Systemic/diagnosis , Aged , Autoantibodies/blood , Cystadenocarcinoma, Serous/pathology , Cystadenocarcinoma, Serous/therapy , Female , Humans , Lung Diseases, Interstitial/complications , Lung Diseases, Interstitial/immunology , Ovarian Neoplasms/pathology , Ovarian Neoplasms/therapy , RNA Polymerase III/immunology , Remission Induction , Scleroderma, Systemic/blood
7.
Rev Mal Respir ; 37(5): 389-398, 2020 May.
Article in French | MEDLINE | ID: mdl-32278507

ABSTRACT

Few studies have examined the effects of air pollution in diffuse interstitial lung disease and they have focused on small numbers of patients. Most data are available in idiopathic pulmonary fibrosis and studies suggest that the level of exposure to pollutants may influence the development of acute exacerbations (ozone and NO2), their incidence (NO2), decline in respiratory function (PM10) and death (PM10 and PM2.5). Several studies show an increase in the incidence of rheumatoid arthritis in people living near busy roads. In systemic scleroderma, hypersensitivity pneumonitis and sarcoidosis although negative effects of pollution have been reported the data are insufficient to be conclusive. Nevertheless, the observed effects of air pollution are consistent with those described for other chronic respiratory diseases. Exposure to pollution induces oxidative stress, chronic inflammation and shortening of telomeres, which are all mechanisms described in fibrogenesis. New epidemiological studies are needed with individual measurements of exposure to outdoor and indoor pollution, as well as fundamental studies to clarify the effect of pollution on fibrogenesis.


Subject(s)
Air Pollution/adverse effects , Lung Diseases, Interstitial/etiology , Air Pollutants/adverse effects , Air Pollutants/toxicity , Air Pollution/statistics & numerical data , Alveolitis, Extrinsic Allergic/epidemiology , Alveolitis, Extrinsic Allergic/etiology , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Environmental Exposure/adverse effects , Humans , Idiopathic Pulmonary Fibrosis/epidemiology , Idiopathic Pulmonary Fibrosis/etiology , Incidence , Lung Diseases, Interstitial/epidemiology , Lung Diseases, Interstitial/physiopathology , Ozone/adverse effects , Particulate Matter/adverse effects , Respiratory Physiological Phenomena/drug effects , Risk Factors
8.
Thorax ; 73(1): 78-81, 2018 01.
Article in English | MEDLINE | ID: mdl-28258249

ABSTRACT

Lung function tests have a major role in respiratory medicine. Training in lung function tests is variable within the European Union. In this study, we have shown that an internship in a lung function tests laboratory significantly improved the technical and diagnostic skills of French respiratory trainees.


Subject(s)
Clinical Competence , Internship and Residency , Pulmonary Medicine/education , Respiratory Function Tests , Respiratory Physiological Phenomena , Adult , Cross-Sectional Studies , Female , France , Humans , Male
9.
Clin Exp Allergy ; 46(3): 472-8, 2016 Mar.
Article in English | MEDLINE | ID: mdl-26750091

ABSTRACT

BACKGROUND: The diagnosis of HSR to iodinated contrast media (ICM) is challenging based on clinical history and skin tests. OBJECTIVE: This study evaluates the negative predictive value (NPV) of skin tests and intravenous provocation test (IPT) with low-dose ICM in patients with suspected immediate hypersensitivity reaction (HSR) to ICM. METHODS: Thirty-seven patients with suspected immediate hypersensitivity reaction to ICM were included retrospectively. Skin tests and a single-blind placebo-controlled intravenous provocation test (IPT) with low-dose iodinated contrast media (ICM) were performed. RESULTS: Skin tests with ICM were positive in five cases (one skin prick test and five intradermal test). Thirty-six patients were challenged successfully by IPT, and only one patient had a positive challenge result, with a grade I reaction by the Ring and Messmer classification. Ten of 23 patients followed up by telephone were re-exposed to a negative tested ICM during radiologic examination; two experienced a grade I immediate reaction. CONCLUSIONS & CLINICAL RELEVANCE: For immediate hypersensitivity reaction to ICM, the NPV for skin tests and IPT with low dose was 80% (95% CI 44-97%).


Subject(s)
Contrast Media/adverse effects , Drug Hypersensitivity/diagnosis , Hypersensitivity, Immediate/diagnosis , Hypersensitivity, Immediate/etiology , Iodine Compounds/adverse effects , Adult , Aged , Contrast Media/administration & dosage , Female , Humans , Iodine Compounds/administration & dosage , Male , Middle Aged , Reproducibility of Results , Respiratory Function Tests , Retrospective Studies , Severity of Illness Index , Skin Tests
10.
Ann Dermatol Venereol ; 142(6-7): 438-42, 2015.
Article in French | MEDLINE | ID: mdl-25999261

ABSTRACT

BACKGROUND: Cutaneous eruption around a peritoneal dialysis (PD) catheter exit site is a rare complication. Herein we report a case of bullous eruption; we discuss the diagnostic approach and the related therapeutic implications. PATIENTS AND METHODS: A 63-year-old man presented a bullous periumbilical eruption two months after initiation of PD. Cultures of laboratory samples ruled out an infectious origin and systemic corticosteroids initiated at 0.5mg/kg for suspected eosinophilic peritonitis produced significant improvement of the cutaneous eruption. Recurrence of the bullous eruption was observed upon dose-reduction of the corticosteroid. Skin histology showed a clinical picture of eczema and direct immunofluorescence was negative. Patch testing was carried out using the European Standard Battery comprising antiseptic, cosmetic and plastic series; a semi-open test was performed with the dressing used for PD, and ROAT was carried out on the povidone iodine (Betadine™) 10% used for topical care during PD. The patch testing and ROAT were positive (++), confirming contact dermatitis due to Betadine™. The eruption totally disappeared on substitution of Betadine™ by chlorhexidine for topical antisepsis of the PD catheter, thus enabling PD to be continued rather than instituting hemodialysis. DISCUSSION: Allergic contact dermatitis around a PD catheter is a rare and little-known complication. In the present case, ROAT testing showed sensitization to Betadine™ and enabled an alternative antisepsis solution to be found, allowing PD to be continued.


Subject(s)
Anti-Infective Agents, Local/adverse effects , Blister/chemically induced , Catheters , Dermatitis, Allergic Contact/etiology , Eczema/chemically induced , Peritoneal Dialysis/instrumentation , Povidone-Iodine/adverse effects , Adrenal Cortex Hormones/therapeutic use , Biopsy , Catheter-Related Infections/diagnosis , Dermatitis, Allergic Contact/drug therapy , Diagnosis, Differential , Disinfection , Fluorescent Antibody Technique, Indirect , Humans , Male , Middle Aged , Patch Tests , Peritonitis/diagnosis , Skin Diseases, Infectious/diagnosis
11.
Rev Mal Respir ; 32(3): 256-61, 2015 Mar.
Article in French | MEDLINE | ID: mdl-25847203

ABSTRACT

RATIONALE: Few studies have analyzed the aggressiveness of the care (continuation of active treatments) at the end of life in patients with lung cancer. The objective of this study was to assess practices in this setting in a university department of respiratory medicine. PATIENTS AND METHODS: This retrospective study has consecutively included all patients who were managed for lung cancer and died over a period of 18 months. The analysis focused on the characteristics of the patients, the modalities of cancer treatment and the delays between the last active treatment and death. RESULTS: The overall median survival of the 94 patients included was 9.6 months; 92% of patients having received at least one active treatment. During the 4 and 2 weeks periods preceding death, respectively 55% and 22% of the patients received active treatments. The median time between the last day of active treatment and death was 27 days. CONCLUSION: These results, in concordance with the published data, showed that end of life active treatment in patients with lung cancer is a complex problem. We need prospective multicentric studies, with testing tools allowing better sharing of the decisions on active treatment between the medical team, the patient and his family.


Subject(s)
Antineoplastic Agents/therapeutic use , Lung Neoplasms/drug therapy , Terminal Care , Aged , Antineoplastic Agents/administration & dosage , Carcinoma, Non-Small-Cell Lung/drug therapy , Carcinoma, Non-Small-Cell Lung/epidemiology , Carcinoma, Small Cell/drug therapy , Carcinoma, Small Cell/epidemiology , Clinical Trials as Topic , Drug Utilization , Female , France/epidemiology , Hospitalization , Humans , Lung Neoplasms/epidemiology , Male , Medical Futility , Middle Aged , Molecular Targeted Therapy , Palliative Care , Retrospective Studies , Salvage Therapy , Socioeconomic Factors , Time Factors , Unnecessary Procedures
12.
J Chem Phys ; 132(4): 046101, 2010 Jan 28.
Article in English | MEDLINE | ID: mdl-20113070

ABSTRACT

In this note we present results for the heat capacity at constant pressure for the TIP4PQ/2005 model, as obtained from path-integral simulations. The model does a rather good job of describing both the heat capacity of ice I(h) and of liquid water. Classical simulations using the TIP4P/2005, TIP3P, TIP4P, TIP4P-Ew, simple point charge/extended, and TIP5P models are unable to reproduce the heat capacity of water. Given that classical simulations do not satisfy the third law of thermodynamics, one would expect such a failure at low temperatures. However, it seems that for water, nuclear quantum effects influence the heat capacities all the way up to room temperature. The failure of classical simulations to reproduce C(p) points to the necessity of incorporating nuclear quantum effects to describe this property accurately.

13.
J Chem Phys ; 131(12): 124518, 2009 Sep 28.
Article in English | MEDLINE | ID: mdl-19791905

ABSTRACT

Path integral simulations have been performed to determine the temperature of the maximum in density of water of the rigid, nonpolarizable TIP4PQ/2005 model treating long range Coulombic forces with the reaction field method. A maximum in density is found at 280 K, just 3 K above the experimental value. In tritiated water the maximum occurs at a temperature about 12 K higher than in water, in reasonable agreement with the experimental result. Contrary to the usual assumption that the maximum in classical water is about 14 K above that in water, we found that for TIP4PQ/2005 this maximum is about 30 K above. For rigid water models the internal energy and the temperature of maximum density do not follow a linear behavior when plotted as a function of the inverse of the hydrogen mass. In addition, it is shown that, when used with Ewald sums, the TIP4PQ/2005 reproduces quite nicely not only the maximum in density of water, but also the liquid densities, the structure of liquid water and the vaporization enthalpy. It was shown in a previous work that it also reproduces reasonably well the density and relative stabilities of ices. Therefore the TIP4PQ/2005 model, while still simple, allows one to analyze the interplay between quantum effects related to atomic masses and intermolecular forces in water.

14.
Am J Obstet Gynecol ; 159(4): 852-4, 1988 Oct.
Article in English | MEDLINE | ID: mdl-3177535

ABSTRACT

A giant cervical polyp occurring in a 56-year-old multiparous woman is described. Although the polyp was benign, total hysterectomy and bilateral salpingo-oophorectomy were carried out because of incidental cystic and adenomatous hyperplasia of the endometrium.


Subject(s)
Polyps/pathology , Uterine Cervical Neoplasms/pathology , Female , Humans , Middle Aged , Polyps/surgery , Uterine Cervical Neoplasms/surgery
15.
Obstet Gynecol ; 47(1): 37-40, 1976 Jan.
Article in English | MEDLINE | ID: mdl-1246390

ABSTRACT

On reviewing 17,647 pregnancies over a 6-year period, 291 of 17,229 singleton pregnancies were noted to be associated with renal glucosuria. On analyzing these 291 pregnancies in 277 women, renal glucosuria was more frequently observed in those women with blood group types A and B and less in those with blood group type O. The incidence of renal glucosuria in nulliparous women, 2.8%, was significantly higher than that in parous women, 1.1%. A significantly high incidence of prematurity, 25.0%, was noted in women who persistently spilled a large amount of glucose.


Subject(s)
Glycosuria, Renal/epidemiology , Pregnancy in Diabetics/epidemiology , ABO Blood-Group System , Adult , Age Factors , Female , Humans , New York , Parity , Pregnancy
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