[Colchicine and non-severe ocular inflammation excluding Behcet's disease: 16 cases and literature review]. / Colchicine et inflammation oculaire non sévère hors maladie de Behcet : 16 cas et revue de la littérature.

INTRODUCTION: Colchicine is a narrow therapeutic margin drug that does not have the adverse effects of corticosteroids and immunosuppressants. Its use in non-severe ocular inflammatory disease excluding Behcet's disease has not been studied. METHODS: We included patients seen in the internal medicine department of Dijon University Hospital consecutively between September 2020 and September 2021 if they had received colchicine during their pathology. Patients with suspected Behçet's disease were excluded. Treatment efficacy was studied in patients with at least one year of disease progression who had received more than one year of colchicine. Successful treatment was defined as a 50 % reduction in the number of annual relapses on colchicine. RESULTS: Sixteen patients were included (9 women and 7 men). They had recurrent anterior uveitis (n=10), recurrent scleritis (n=5) and intermediate uveitis. Opthalmological involvement was neither severe nor complicated. All patients combined, the annual relapse ratio (ARR) decreased from 1.8 (0.8-3.5) to 0.3 (0-1.6), (P=0.06). Colchicine was considered effective in three of 10 analyzable patients. In only one patient, treatment was stopped for adverse effects after six weeks. CONCLUSION: In view of the interesting benefit-risk ratio of colchicine, it seems appropriate to focus on this molecule in non-granulomatous anterior uveitis and non-severe recurrent scleritis.

[Outdoor aeroallergens and climate change]. / Les aéroallergènes de l'environnement extérieur et le changement climatique.

INTRODUCTION: Pollen and fungal spore concentrations in outdoor air are partly dependent on atmospheric conditions. Since the climate is changing, there is a growing body of research on the effects of climate change on aeroallergens. The present article provides a rapid review of this literature, highlighting the points of agreement, but also drawing attention to the main mistakes to be avoided. STATE OF ART: For pollen, the prevailing view is that rising temperatures lead to an earlier start to the pollen season, a longer season, increased allergenic potential and higher concentrations. However, there are exceptions: what is true for one taxon, in one place and at one time, can almost never be generalised. For fungal spores, it is even more difficult to state universal rules. PERSPECTIVES: Four priorities can be set for future research: (1) to look for trends only on sufficiently long series and not to neglect possible trend reversals; (2) to give priority to the local scale and the separate consideration of the various pollen and mycological taxa; (3) not to limit oneself to temperature as an element of explanation, but also to consider the other elements of the climate; (4) not to try to explain any evolution in the abundance or seasonality of aeroallergens by climate change alone. CONCLUSIONS: Many more analytical studies giving precedence to observation over reasoning are still required, without any preconceptions, before it is possible to synthesise the impacts of climate change on pollen and, even more so, on fungal spores.

[Use of biotherapy in the management of Behçet's disease in a department of internal medicine]. / Recours à la biothérapie dans la prise en charge de la maladie de Behçet dans un service de médecine interne.

BACKGROUND: Behçet's disease (BD) is a recurrent multisystemic disease responsible for occlusive vasculitis with arterial, venous and capillary involvement. The aim of this study was to determine the frequency and the features associated with the use of biotherapy in the management of patients followed in our department for BD. METHODS: This is a retrospective study of patients medical records followed for BD in a department of internal medicine from January 2005 to August 2018. RESULTS: A total of 41 patients were included with a mean age at diagnosis of 42.5±12.1 years (range 16 to 63) and a sex ratio men/women of 1.05. Oral and/or genital aphtosis was present in 70.7% of the patients. Other lesions were: ocular (78.0%), articular (46.3%), cutaneous (41.5%), central neurological (34.1%), vascular (26.8%), digestive (7.3%), pericardial (2.4%) and epididymal (2.4%). A biotherapy, interferon α and monoclonal antibodies, was used in 15 patients (36.6%), after failure of conventional treatments. The monoclonal antibodies were anti-TNFα (infliximab, adalimumab, certolizumab and golimumab) except in one patient for whom ustekinumab was used. Biotherapy was used in 46.9% of the patients with ocular involvement and never used in those patients without ocular involvement (P=0.01). CONCLUSION: Biotherapy is effective and represents a solution to the failures of conventional treatments in severe forms of Behçet's disease with ocular involvement.

Associated arterial and venous cerebral manifestations in Behçet's disease.

Behçet's disease is a rare multisystemic vasculitis with an etiology that is still unknown. Neurological manifestations may be seen in approximately 5-15% of patients, and both parenchymal and extraparenchymal neurological involvement has been described. When cerebral venous thrombosis (CVT) is the main extraparenchymal manifestation of Behçet's disease, the condition is then dubbed "angio-Behçet's syndrome". However, arterial involvement is extremely rare, with only one reported case of vasculo-neuro-Behçet's disease, characterized by both venous and intracranial arterial involvement - until now. This report is of two patients diagnosed with Behçet's disease characterized by the concomitant presence of both cerebral arterial manifestations and CVT.

[Hyper-IgE in internal medicine]. / Hyper-IgE en médecine interne.

Hyper-IgE may be found under many pathological conditions. The role of IgE is essentially associated with the occurrence of allergic manifestations, which may be accompanied by an increase of their serum levels. Elevation of total IgE has also been reported in association with certain rare genetic immune deficiencies called hyper-IgE syndromes. Other circumstances such as infectious diseases, tumors or autoimmune diseases may also be accompanied by an excessive synthesis of IgE. Considering the diversity of these situations, discussion of the prognostic value of total IgE is useful to the internist.

[Quality of life measures in SLE: An update]. / Mesures de qualité de vie au cours du lupus systémique : état des lieux, actualité et utilisation pratique.

Systemic lupus erythematosus (SLE) is a chronic disease that considerably hampers patient's daily living. Qualitative studies with patients' interviews have been conducted to describe the experiences and perspectives of adults living with SLE. Among existing generic and disease-specific quality of life (QOL) questionnaires, none succeeded to exhaustively measure patient's preoccupations. However, these tools are useful to quantify the burden of the disease. Social precariousness, socioeconomic status and education level are intimately correlated to QOL measures, either generic or disease-specific. Musculoskeletal disease activity is also associated with a lower QOL. Using disease-specific tools may be useful because of a better aptitude to record an improvement in health status. Moreover, using generic and disease-specific questionnaires together may help to identify factors associated with a lower quality of life but not related to SLE from the patient's perspective (such as smoking or obesity). Developing new ways of recording QOL data in the future may help to evaluate the real benefit of using QOL scales in daily practice.

[Eye and cat scratch disease: A case series]. / Œil et maladie des griffes du chat : à propos de 7 cas.

INTRODUCTION: Cat scratch disease is a pleiomorphic condition, sometimes with isolated ophthalmic involvement. We report the clinical observations of seven cases with ophthalmologic manifestations of cat scratch disease. OBSERVATIONS: There were seven patients, with a median age of 52 years, of whom five were women and three had unilateral involvement. Six exhibited Leber's stellate neuroretinitis, an incomplete syndrome in two cases, and one associated with chorioretinal foci. One patient had isolated retinal infiltrates. The diagnosis of cat scratch disease was confirmed by Bartonella henselae serology, positive in all cases. All patients received treatment with doxycycline. Ocular complications (with optic atrophy and macular retinal pigment epithelial changes) were noted in five cases. DISCUSSION: Ocular bartonellosis is an atypical clinical form. It requires a directed ancillary work-up with serology or PCR, which has the peculiarity of being highly specific if not very sensitive. Treatment is above all preventive. Antibiotics may be initiated. CONCLUSION: Cat scratch disease must be excluded in the work-up of posterior uveitis.

Impact of microbiological samples in the hospital management of community-acquired, nursing home-acquired and hospital-acquired pneumonia in older patients.

We investigated the positivity rate, the detection rates for non-covered pathogens and the therapeutic impact of microbiological samples (MS) in community-acquired pneumonia (CAP), nursing home-acquired pneumonia (NHAP) and hospital-acquired pneumonia (HAP) in elderly hospitalised patients. Patients aged 75 years and over with pneumonia and hospitalised between 1/1/2013 and 30/6/2013 in the departments of medicine (5) and intensive care (1) of our university hospital were included. Microbiological findings, intra-hospital mortality and one-year mortality were recorded. Among the 217 patients included, there were 138 CAP, 56 NHAP and 23 HAP. MS were performed in 89.9, 91.1 and 95.6 % of CAP, NHAP and HAP, respectively. Microbiological diagnosis was made for 29, 11.8 and 27.3 % of patients for CAP, NHAP and HAP, respectively (p = 0.05). Non-covered pathogens were detected for 8 % of CAP, 2 % of NHAP and 13.6 % of HAP (p = 0.1). The antimicrobial spectrum was significantly more frequently reduced when the MS were positive (46.7 % vs. 10.8 % when MS were negative, p = 10(-7)). The MS positivity rate was significantly lower in NHAP than in CAP and HAP. MS revealed non-covered pathogens in only 2 % of NHAP. These results show the poor efficiency and weak clinical impact of MS in the management of pneumonia in hospitalised older patients and suggest that their use should be rationalised.

Short-term effects of airborne ragweed pollen on clinical symptoms of hay fever in a panel of 30 patients.

OBJECTIVES: Ragweed, Ambrosia artemisiifolia, is a highly allergenic annual herbaceous plant that is spreading quickly across the globe. Few studies have investigated the relationship between ragweed pollen counts and hay fever symptoms. We investigate the dose-response relationship between ragweed exposure in patients sensitized to ragweed and daily hay fever symptoms. METHOD: A panel study was conducted among 31 adult patients sensitized to A artemisiifolia in France and Switzerland. Rhinitis, conjunctivitis, and bronchial symptoms were recorded daily, as well as daily pollen counts of ragweed, air pollutants, and meteorological data over 2 successive years. Data were analyzed with generalized estimating equation models to quantify effects of ragweed pollen whilst controlling for confounders. RESULTS: The relationship between ragweed pollen and the percentage of patients with nasal, ocular, and bronchial symptoms was linear. For every increase of 10 grains/m3, the odds ratio (OR) (95% confidence interval) for nasal symptoms was, in 2009, 1.18 [1.04-1.35] on weekdays and 1.43 [1.16-1.75] at weekends, and in 2010, 1.04 [1.00-1.07] on weekdays and 1.25 [1.06-1.46] at weekends.The OR for ocular symptoms was 1.32 [1.16-1.56] in 2009 and 1.05 [1.02-1.07] in 2010. Finally, the OR for bronchial symptoms was 1.14 [1.03-1.25] in 2009 and 1.03 [0.97-1.08] in 2010. CONCLUSION: There is a statistically significant linear relationship between ragweed pollen counts and hay fever symptoms. Our study shows that nasal symptoms differ on weekdays and at weekends.

Short-term effects of airborne ragweed pollen on clinical symptoms of hay fever in a panel of 30 patients

Objectives: Ragweed, Ambrosia artemisiifolia , is a highly allergenic annual herbaceous plant that is spreading quickly across the globe. Few studies have investigated the relationship between ragweed pollen counts and hay fever symptoms. We investigate the dose-response relationship between ragweed exposure in patients sensitized to ragweed and daily hay fever symptoms. Method: A panel study was conducted among 31 adult patients sensitized to A artemisiifolia in France and Switzerland. Rhinitis, conjunctivitis, and bronchial symptoms were recorded daily, as well as daily pollen counts of ragweed, air pollutants, and meteorological data over 2 successive years. Data were analyzed with generalized estimating equation models to quantify effects of ragweed pollen whilst controlling for confounders. Results: The relationship between ragweed pollen and the percentage of patients with nasal, ocular, and bronchial symptoms was linear. For every increase of 10 grains/m 3 , the odds ratio (OR) (95% confidence interval) for nasal symptoms was, in 2009, 1.18 [1.04-1.35] on weekdays and 1.43 [1.16-1.75] at weekends, and in 2010, 1.04 [1.00-1.07] on weekdays and 1.25 [1.06-1.46] at weekends. The OR for ocular symptoms was 1.32 [1.16-1.56] in 2009 and 1.05 [1.02-1.07] in 2010. Finally, the OR for bronchial symptoms was 1.14 [1.03- 1.25] in 2009 and 1.03 [0.97-1.08] in 2010. Conclusion: There is a statistically significant linear relationship between ragweed pollen counts and hay fever symptoms. Our study shows that nasal symptoms differ on weekdays and at weekends (AU)

Objetivos: La Ambrosia artemisiifolia es una planta herbácea, altamente alergénica, que tiende a extenderse mundialmente muy rápidamente. Muy pocos estudios han investigado la relación de los contajes de polen de ambrosia con la intensidad de los síntomas. En este trabajo hemos documentado la relación dosis/respuesta entre la exposición a ambrosia, en pacientes sensibilizados a este polen, y la intensidad de su sintomatología Métodos: En el estudio se incluyeron 31 pacientes residentes en Francia o Suiza y sensibilizados a Ambrosia artemisiifolia . Durante dos años consecutivos, se registraron diariamente los síntomas oculares, nasales y bronquiales de los pacientes, los niveles de polen de ambrosía, los niveles de contaminantes ambientales junto con los datos. El análisis de los datos se realizó mediante la construcción de modelos de ecuaciones de estimación generalizada, de forma que se pudiera cuantificar los efectos del polen de ambrosia y controlando las variables de confusión. Resultados: La relación entre los recuentos de polen de ambrosía y el porcentaje de pacientes con síntomas nasales, oculares y bronquiales fue linear. Para cada incremento de 10 granos/m 3 , el OR para los síntomas nasales, en el año 2009, fue 1.18 [1.04-1.35] durante los días entre semana, y 1.43 [1.16-1.75] durante el fin de semana, y en 2010, 1.04 [1.00-1.07] durante los días entre semana y 1.25 [1.06-1.46] durante el fin de semana; el OR para los síntomas oculares fue de 1.32 [1.16-1.56] en el 2009 y 1.05 [1.02-1.07] en el 2010; el OR para los síntomas bronquiales fue 1.14 [1.03-1.25] en 2009 y 1.03 [0.97-1.08] en 2010. Conclusión: Hemos demostrado una relación lineal significativa entre los recuentos de polen de ambrosía y los síntomas de la polinosis en los pacientes sensibilizados. Nuestro estudio también demostró que el nivel de molestias difiere entre los días entre semana comparados con los del fin de semana (AU)

[Health impact of exposure to pollens: A review of epidemiological studies]. / Impact sanitaire des pollens : revue des études épidémiologiques.

The aim of this review is to describe the health impact of exposure to pollen based on recently published epidemiological studies. The methodology chapter, describes a review of the literature and outlines important elements of these studies: measurement of exposure to pollens, study types used, study populations and the health indicators related to pollen exposure. In this review, two types of studies have been used to assess the epidemiological evidence of short-term links between pollen exposure and hay fever or asthma. Ecological time-series studies use daily indicators of asthma exacerbations (emergency room admissions or hospitalizations), consultations for rhinitis or conjunctivitis, or anti-allergic drug consumption within general population. Panel studies relate measurements of pollen grain concentrations to nasal, ocular and bronchial symptom severity in a group of subjects sensitized to a specific pollen, monitored during the pollen season. In both cases, the studies show a relationship on a day-to-day basis between health indicators and daily rates of atmospheric pollen collected by a pollen trap. These studies take into account confounding factors, such as air pollution, weather factors and sometimes exposure to outdoor molds. Unlike earlier studies, more and more studies focus on the shape of the dose-response relationship and the lag between pollen exposure and symptoms. Only rarely, individual susceptibility factors, the clinical phenomenon of priming and polysensitization are reported. Thus, ecological time-series studies and panel studies assess respectively the impact of pollen exposure in the general population and in groups of sensitized patients. Using appropriate statistical tools, these studies provide insight into the shape of the dose-response relationship, with a potential threshold below which symptoms are absent, then a linear relationship for nasal, ocular and bronchial symptoms and a plateau where the symptoms do not increase despite the continued increase in pollen.

[Methods of studying airborne pollen and pollen calendars]. / Méthodes d'étude des pollens atmosphériques et calendriers polliniques.

INTRODUCTION: Pollen is a major cause of allergy and monitoring pollen in the air is relevant for diagnosis, treatment and prevention, as well as for biomedical and biological research. Many aero-biological studies have been conducted all over the world to ascertain aerial concentrations and seasonality of pollen grains. BACKGROUND: Monitoring of airborne biological particles is carried out by various gravimetric, impaction, and suction sampling devices. The Hirst trap, later modified to Burkard(®) or Lanzoni(®) traps, is the most widely used sampler. Counting and identifying pollen grains is then performed under optical microscopy. Based on differences in airborne pollen recorded over several years of observation, pollen calendars have been drawn up as aids to allergy diagnosis and management but they could be replaced advantageously by allergy-risk calendars. Pollen counts also provide valuable information about the geographical origin of pollen grains. VIEWPOINTS: Since the identifying and counting of pollen grains in ambient air samples is still a demanding and time-consuming task, there is an increasing interest in the automation of pollen monitoring. Furthermore, the divergence sometimes observed between clinical observations and pollen counts provides an incentive to collect aero-allergens directly. Lastly, pollen monitoring could be improved through the use of personal bioaerosol samplers. CONCLUSIONS: Great progress has been made in aerobiology for over a century, but much remains to be accomplished, particularly in relation with the standardization of methods.

[Climate change and pollination]. / Changement climatique et pollinisation.

INTRODUCTION: There is growing evidence to support an increase in air temperature over recent decades, with significant effects on aeroallergens such as pollen. It is generally accepted that the trend will continue, and become even more pronounced in the future. BACKGROUND: Global climate change is already affecting, and will continue to affect, with earlier floral initiation, the timing of the production of allergenic pollen. In addition, a warmer climate might lead to a longer pollen season and more days with high pollen counts. It could also increase the allergen content of pollens, and result in extension of plant species towards the poles and higher altitudes. Finally, rising levels of atmospheric CO2 are likely to reinforce these trends. VIEWPOINT: These predictions are subject to uncertainties that may lead to outcomes that differ materially from what is expected. Understanding the magnitude and direction of the changes affecting pollinisation is critical in order to quantify the future allergic disease burden and model the impacts of different climate change scenarios. CONCLUSIONS: Climate change influences the production, distribution, dispersion and allergenicity of anemophilous pollen and the growth and distribution of weeds, grasses and trees that produce it. These changes in aeroallergens and subsequent human exposure could affect the prevalence and severity of allergic disorders. There is, therefore, an important public health issue that requires development and implementation of appropriate response strategies without delay.

Has allergenic pollen an impact on non-allergic diseases?

Recent observations suggest that pollen do not only interacts with the human immune system to elicit an allergic response in susceptible individuals. It would have a much broader impact on human health. This applies more especially, yet not exclusively, to three groups of diseases: non-allergic respiratory conditions, cardio- and cerebrovascular accidents, and psychiatric disorders including suicide and suicide attempt. At present, the reasons for these unexpected connections are only hypothetical, and require further exploration in larger samples, but there is perhaps a multitude of them. One must therefore favour a holistic approach of pollen and its impact on human health.

[Birt-Hogg-Dubé syndrome and multiple recurrent tumors]. / Syndrome de Birt-Hogg-Dubé et tumeurs multiples récidivantes.

Birt-Hogg-Dubé (SBHD) syndrome is a rare autosomal dominant genodermatosis, predisposing to the occurrence of tumors associated with skin manifestations. We report a male patient who presented with a history of recurrent pneumothorax and was treated by nephrectomy for a left kidney carcinoma at 20 years old. Skin examination disclosed numerous fibrofolliculomas of the scalp. During follow-up, surgical resection of parotid oncocytomas and of a parathyroid adenoma were performed. SBHD was confirmed by molecular biology. In the presence of fibrofolliculomas and kidney tumors and recurrent spontaneous pneumothorax, a diagnosis of SHBD syndrome should be discussed, and tests need to be performed on the whole family.

Heart involvement in Churg-Strauss syndrome: retrospective study in French Burgundy population in past 10 years.

INTRODUCTION: Heart manifestations of Churg-Strauss syndrome (CSS) are varied. In the early stages of the disease, it is difficult to distinguish between lesions that are specific to CSS and those of other etiologies. The aim of our work was to compare the characteristics of patients with heart manifestations linked or not to Churg-Strauss syndrome. MATERIAL AND METHODS: We recorded all clinical symptoms of patients with CSS hospitalized between 1998 and 2008 in Burgundy, France, and determined the possible relationships between heart symptoms and CSS. RESULTS: From a cohort of 31 patients, we found 20 with heart lesions. When heart lesions were present, we noted fewer initial symptoms of digestive disorders (p<0.05), lower levels of lung infiltrates and fewer anti-MPO pANCA (p<0.05). Heart lesions were linked to CSS in 75% of cases. Their patients were thus younger than those in the other cardiac patients (p<0.05), were more likely to have clinical manifestations of heart involvement at diagnosis, were less likely to have lung infiltrates on the X-ray at diagnosis and during flare-ups and less likely to have lung abnormalities on X-rays during flare-ups (p<0.05) and higher level of leucocytes and eosinophils at diagnosis. CONCLUSION: Heart lesions directly attributable to CSS are frequent, severe and probably underestimated. A specific physiopathology that is not mediated by ANCA seems to be involved in the genesis of CSS-related heart lesions.

[Acute pseudo-membranous laryngitis in epidermolysis bullosa acquisita]. / Laryngite pseudo-membraneuse sévère dans le cadre d'une épidermolyse bulleuse acquise.

Epidermolysis bullosa acquisita is a rare entity belonging to the auto-immune cutaneous blistering disorders of the dermo-epidermal junction. Clinical manifestations are generally cutaneous including the development of sub-epidermal blisters. Mucosal manifestations should be systematically looking for, but laryngeal involvement remains uncommon. We report an 81-year-old woman who presented with dysphagia, dyspnea and dysphonia as the presenting features of laryngeal involvement of an epidermolysis bullosa acquisita. This is the tenth reported case in the literature. We describe our diagnostic approach and the therapeutic management, comparing them with the literature.