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Rosa I.,Center Hospitalier Intercommunal Of Creteil
Clinics and research in hepatology and gastroenterology | Year: 2011

The current treatment of chronic hepatitis C is the triple combination of pegylated interferon, ribavirin and a new direct-acting antiviral [either telaprevir (TVR) or boceprevir (BOC)]. This new association produces better viral response rates, but may induce or enhance adverse events, which can lead to discontinuation of treatment. TVR regimens are associated with an increased risk of dermatological side-effects such as rash, albeit generally mild. In these cases, optimal skincare treatments, including emollient creams and topical corticosteroids, allow the continuation of antiviral treatment. In a minority of cases, the rash may be severe and life-threatening, leading to immediate discontinuation of all treatments. The goal for the physician is to differentiate severe cutaneous adverse reactions (SCARs), including DRESS (drug reactions with eosinophilia and systemic symptoms). Anaemia is also more frequent with triple combinations using TVR or BOC. The management of anaemia requires the use of erythropoietin alpha (EPO) and the need to decrease ribavirin doses. Thus, monitoring haemoglobin has to be more frequent in difficult-to-treat patients such as cirrhosis cases; nevertheless, despite the use of EPO and ribavirin-dose adaptation, blood transfusion is sometimes still required. Thus, triple combination therapy with a DAA is effective, but it increases the rate of adverse events, and adds to the well-known adverse effects of pegylated interferon and ribavirin. This suggests the need for a different clinical and biological management of patients treated with the triple combination. Copyright © 2011 Elsevier Masson SAS. All rights reserved. Source

Launay E.,Nantes University Hospital Center | Bingen E.,University Paris Diderot | Cohen R.,Center Hospitalier Intercommunal Of Creteil
Archives de Pediatrie | Year: 2012

Urinary tract infections is one of the most common bacterial infections in pediatrics The increasing involvement of multiresistant bacteria including E. coli producing extended spectrum ß-lactamase (ESBL) makes its management difficult. The purpose of this article is to evaluate the state of the art and to propose ways of thinking about the management of E. coli urinary tract infection in children. The current percentage (less than 10%) of E. coli strains resistant to third generation cephalosporins and the relative efficiency of the latter, should not led to an immediate change of our protocols. Nevertheless, we should verify as soon as possible susceptibility of E. coli responsible for urinary tract infections and consider other therapeutic options for initial therapy and adaptation after obtaining antibiogram. The use of an aminoglycosid as initial treatment seems very interesting. Aminoglycosides have a very good distribution in the renal parenchyma and are still working on the majority of ESBL-producing bacteria. A rapid oral relay after 48 to 72 hours may be proposed according to the results of the susceptibility with either cotrimoxazole, cefixime, ciprofloxacin or an association cefixime-amoxicilline/clavulanate. The treatment of cystitis due to ESBL E. coli is much less problematic given the good urinary beta-lactam antibiotics diffusion. If clinical improvement occurs, even if antibiogram shows that the strain is resistant to the antibiotic prescribed, it is usually unnecessary to change treatment. © 2012 Elsevier Masson SAS. Source

Kodjikian L.,Hospices Civils de Lyon | Kodjikian L.,University of Lyon | Kodjikian L.,CNRS Laboratory for Materials: Engineering and Science | Souied E.H.,Center Hospitalier Intercommunal Of Creteil | And 12 more authors.
Ophthalmology | Year: 2013

Objective To evaluate the relative efficacy and safety profile of bevacizumab versus ranibizumab intravitreal injections for the treatment of neovascular age-related macular degeneration (AMD). Design Multicenter, prospective, noninferiority, double-masked, randomized clinical trial performed in 38 French ophthalmology centers. The noninferiority limit was 5 letters. Participants Patients aged ≥50 years were eligible if they presented with subfoveal neovascular AMD, with best-corrected visual acuity (BVCA) in the study eye of between 20/32 and 20/320 measured on the Early Treatment of Diabetic Retinopathy Study chart and a lesion area of less than 12 optic disc areas (DA). Methods Patients were randomly assigned to intravitreal administration of bevacizumab (1.25 mg) or ranibizumab (0.50 mg). Hospital pharmacies were responsible for preparing, blinding, and dispensing treatments. Patients were followed for 1 year, with a loading dose of 3 monthly intravitreal injections, followed by an as-needed regimen (1 injection in case of active disease) for the remaining 9 months with monthly follow-up. Main Outcome Measures Mean change in visual acuity at 1 year. Results Between June 2009 and November 2011, 501 patients were randomized. In the per protocol analysis, bevacizumab was noninferior to ranibizumab (bevacizumab minus ranibizumab +1.89 letters; 95% confidence interval [CI], -1.16 to +4.93, P < 0.0001). The intention-to-treat analysis was concordant. The mean number of injections was 6.8 in the bevacizumab group and 6.5 in the ranibizumab group (P = 0.39). Both drugs reduced the central subfield macular thickness, with a mean decrease of 95 μm for bevacizumab and 107 μm for ranibizumab (P = 0.27). There were no significant differences in the presence of subretinal or intraretinal fluid at final evaluation, dye leakage on angiogram, or change in choroidal neovascular area. The proportion of patients with serious adverse events was 12.6% in the bevacizumab group and 12.1% in the ranibizumab group (P = 0.88). The proportion of patients with serious systemic or ocular adverse events was similar in both groups. Conclusions Bevacizumab was noninferior to ranibizumab for visual acuity at 1 year with similar safety profiles. Ranibizumab tended to have a better anatomic outcome. The results are similar to those of previous head-to-head studies. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references. © 2013 by the American Academy of Ophthalmology. Source

Cohen J.F.,University of Paris Descartes | Cohen J.F.,University of Amsterdam | Chalumeau M.,University of Paris Descartes | Cohen R.,Association clinique et therapeutique infantile du Val de Marne ACTIV | And 4 more authors.
Journal of Clinical Epidemiology | Year: 2015

Objectives Empirical evaluations have demonstrated that diagnostic accuracy frequently shows significant heterogeneity between subgroups of patients within a study. We propose to use Cochran's Q test to assess heterogeneity in diagnostic likelihood ratios (LRs). Study Design and Setting We reanalyzed published data of six articles that showed within-study heterogeneity in diagnostic accuracy. We used the Q test to assess heterogeneity in LRs and compared the results of the Q test with those obtained using another method for stratified analysis of LRs, based on subgroup confidence intervals. We also studied the behavior of the Q test using hypothetical data. Results The Q test detected significant heterogeneity in LRs in all six example data sets. The Q test detected significant heterogeneity in LRs more frequently than the confidence interval approach (38% vs. 20%). When applied to hypothetical data, the Q test would be able to detect relatively small variations in LRs, of about a twofold increase, in a study including 300 participants. Conclusion Reanalysis of published data using the Q test can be easily performed to assess heterogeneity in diagnostic LRs between subgroups of patients, potentially providing important information to clinicians who base their decisions on published LRs. © 2015 Elsevier Inc. All rights reserved. Source

Patients with small cell lung cancer present initially with brain metastases in 10 to 24% of the cases when detected respectively by CT scan or Gadolinium-enhanced MRI of the brain. The aim of this review is to evaluate the effectiveness of systemic chemotherapy for the treatment of brain metastases from small cell lung cancer in first and second line: in fact, there are only case reports, small phase II studies and one phase III study. In spite of the scarcity of these data, the efficacy of the systemic treatment is shown and the guidelines recommend the use of chemotherapy, particularly in asymptomatic patients. © John Libbey Eurotext. Source

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