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Rostoker G.,Service Route | Hummel A.,Service de Nephrologie et de Dialyse Adultes | Chantrel F.,Center Hospitalier Of Mulhouse | Ryckelynck J.-P.,Caen University Hospital Center
Nephrologie et Therapeutique

The Kidney Disease Improving Global Outcomes (KDIGO)-2012 on the treatment of anemia emit suggestions (which differ from recommendations) based on a scientific evidence of low level. The first rule is no harm; physicians must take into account the profile of the patient and its associated morbidities and remember on the potential risks to begin a treatment by erythropoiesis stimulating agents (ESA) (thrombosis of arteriovenous fistula, hypertension, stroke). All correctable causes of anemia other than erythropoietin deficiency should be actively sought. It is necessary to individualize the treatment by ESA and assess the clinical improvement expected. The ESA will be used in the following way: initiate at 10 g/dL of hemoglobin level with the aim of 11.5 g/dL, without exceeding 13 g/dL. In case of ESA resistance, it seems suitable to assess the risks and benefits of ESA versus blood transfusion. The ERBP-2013 have endorsed the KDIGO-2012 except the proposals dealing with the treatment by IV iron. The use of intravenous iron must be more cautious in the future taking into account the results of a recent French study published in the American Journal of Medicine showing the high frequency of iron overload at quantitative hepatic MRI among haemodialysis patients receiving iron IV following the current guidelines. It is appropriate to use oral iron in first intention as recommended by the ANSM (French Drug Agency) in a recent information note and respect the dosage regimen of the label. The realization of a quantitative hepatic MRI to evaluate iron overload and monitor the treatment by iron IV must also be considered on a case by case basis. © 2014 Association Socié té de né phrologie. Publié par Elsevier Masson SAS. Tous droits ré servé s. Source

The coxo-femoral articulation therapy according to the concept of "Sohier's analytic kinesitherapy" aims at treating the articulation lesions known as "osteopathic". After an inspection which takes into account the morphological elements of the patient, the palpatory assessment and the quality analyses of articular motion end of the range, allows us to propose soft and precise corrective gestures taking care not to start defence reactions from the recipient. Level of evidence: Not applicable. © 2012 Elsevier Masson SAS. All rights reserved. Source

Kuhn P.,University of Strasbourg | Dheu C.,University of Strasbourg | Dheu C.,Center Hospitalier Of Colmar | Bolender C.,Center Hospitalier Of Haguenau | And 7 more authors.
Paediatric and Perinatal Epidemiology

In 2001 France issued a new set of guidelines for the use of antenatal antibiotics (AA). These guidelines recommended intrapartum antimicrobial prophylaxis (IAP) to prevent group B streptococcal (GBS) disease and AA to prolong pregnancy in the event of preterm premature rupture of membranes (AA for PPROM). This study aims to determine the effects of AA, recommended by national guidelines, on the incidence and distribution of pathogens in early-onset neonatal sepsis (EONS). We performed a population-based, prospective, observational study of level II and III perinatal centres throughout the region of Alsace, a northeastern area of France, between March 2004 and February 2005. The study population included all neonates with confirmed or probable EONS, who were treated with antibiotics for at least 5 days. We analysed exposure to AA, as well as clinical and microbiological data obtained from medical records. A total of 20 131 neonates were born during the study period, and 217 were included in the study. Of these, 24 subjects had confirmed sepsis, 140 had probable sepsis and 53 had possible EONS. The overall incidence of confirmed EONS was 1.19 per 1000 births. The infecting bacteria was GBS in 15 of 24 (62.5%) confirmed EONS cases (incidence: 0.75 per 1000 births) and in 81 of 140 (58%) probable sepsis cases. Escherichia coli was identified in 6 of 24 (25%) cases of confirmed EONS (incidence: 0.3 per 1000 births) and in 30 of 140 (21%) cases of clinical sepsis. Among E. coli infections (n = 36), amoxicillin resistance (n = 18) was statistically linked with AA use (P = 0.045). This link was significant in cases of PPROM (P = 0.015), but not when IAP was administered to prevent GBS disease (P = 0.264). IAP was not performed in 18 of 60 (30%) cases and 32 of 93 (34%) cases, despite positive screening or the presence of risk factors for EONS, respectively. Group B streptococcus remains the predominant pathogen in the era of AA. Aminopenicillin-resistant E. coli infections seem to be linked to prolonged AA in cases of PPROM and appear to preferentially affect preterm infants. Therefore, postnatal treatment strategies should consider this possible effect. Our data indicate that the current policy of GBS maternal prophylaxis is not associated with an excessive risk of pathogen resistance. Considering the high incidence of GBS EONS in our region, possible progress could result from better observance of guidelines. These results strengthen the need for continuation of surveillance. © 2010 Blackwell Publishing Ltd. Source

Didier C.,University of Strasbourg | Streicher M.-P.,Center Hospitalier Of Haguenau | Chognot D.,Center Hospitalier Of Colmar | Campagni R.,Center Hospitalier Of Mulhouse | And 7 more authors.
European Journal of Pediatrics

Widespread use of intrapartum antimicrobial prophylaxis has significantly reduced the incidence of earlyonset neonatal infection (EONI); however, little is known about the effects of increased maternal exposure to antibiotics on late-onset neonatal infection (LONI). This study aims to evaluate LONI epidemiology in our region after the application of French recommendations and to determine whether LONI-causing organisms and their antibiotic susceptibility are influenced by peripartum antibiotic exposure. We performed a prospective epidemiologic study of 139 confirmed and possible cases of bacterial LONI in patients treated with antibiotics for at least 5 days of the 22,458 infants born in our region in the year 2007. The overall incidence of LONI caused by all pathogens, Group B streptococcus (GBS) and Escherichia coli (E. coli) were 6.19, 0.36 and 2.72, respectively, per 1,000 live births. Our findings revealed three major types of LONI: E. coli-induced urinary tract infection (UTI) among term infants, coagulase negative Staphylococcus septicemia affecting preterm infants, and GBS infections with severe clinical presentation. Univariable analysis revealed that maternal antibiotic exposure was significantly associated with the risk of amoxicillin-resistant E. coli infection (p00.01). Postnatal antibiotic exposure was associated with an increased risk of E. coli LONI (p00.048). This link persisted upon multivariable analysis; however, no additional risk factors were identified for LONI caused by antibiotic-resistant E. coli. Conclusion Our findings confirm that despite the benefits of antenatal antibiotics, this treatment can increase the risk of antibiotic-resistant cases of LONI. National and international surveillance of LONI epidemiology is essential to assess benefits and potential negative consequences of perinatal antibiotic exposure. © Springer-Verlag 2011. Source

Houot R.,University of Rennes 1 | Le Gouill S.,University of Nantes | Le Gouill S.,French Institute of Health and Medical Research | Uribe M.O.,Center Hospitalier Of Mulhouse | And 17 more authors.
Annals of Oncology

Background: There is no consensual first-line chemotherapy for elderly patients with mantle cell lymphoma (MCL). The GOELAMS (Groupe Ouest-Est des Leucémies Aiguë s et Maladies du Sang) group previously developed the (R)VAD+C regimen (rituximab, vincristine, doxorubicin, dexamethasone and chlorambucil), which appeared as efficient as R-CHOP (rituximab, cyclophosphamide, doxorubicine, vincristine, prednisone) while less toxic. Based on this protocol, we now added bortezomib (RiPAD+C: rituximab, bortezomib, doxorubicin, dexamethasone and chlorambucil) given its efficacy in relapsed/refractory MCL patients. The goal of the current phase II trial was to evaluate the feasibility and efficacy of the RiPAD+C regimen as frontline therapy for elderly patients with MCL. Patients and methods: Patients between 65 and 80 years of age with newly diagnosed MCL received up to six cycles of RiPAD+C. Results: Thirty-nine patients were enrolled. Median age was 72 years (65-80). After four cycles of RiPAD+C, the overall response rate was 79%, including 51% complete responses (CRs). After six cycles, CR rate increased up to 59%. After a 27-month follow-up, median progression-free survival (PFS) is 26 months and median overall survival has not been reached. Four patients (10%) discontinued the treatment because of a severe toxicity and seven patients (18%) experienced grade 3 neurotoxicity. Conclusion: The bortezomib-containing RiPAD+C regimen results in high CR rates and prolonged PFS with predictable and manageable toxic effects in elderly patients with MCL. © The Author 2011. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. Source

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