Medecine Interne

Paris, France

Medecine Interne

Paris, France
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PubMed | Cardiologie, Maladies infectieuses, CHU Sylvanus Olympio and Medecine interne
Type: Journal Article | Journal: Medecine et sante tropicales | Year: 2016

to describe the course and the etiologic, prognostic, and therapeutic aspects of effusive pericarditis (EP) in Togo. MATERIAL ANDMETHODS: Prospective and longitudinal study conducted at the cardiology department of Sylvanus Olympio Teaching Hospital of Lome from February 1, 2011, to January 31, 2014, of patients hospitalized for EP, confirmed by Doppler echocardiography.The study included 38 patients. The hospital incidence rate of EP was 2.0%. The mean age was 42.5 14.9 years (range: 16 to 73 years) with a sex ratio of 0.7. Exertional dyspnea, poor general condition, chest pain, and fever were the main symptoms. Pericardial effusion was abundant in 24 patients (63%). The Koch bacillus was identified on direct examination in five patients (13%) and only from sputum. HIV serology was positive in 18 patients (47%). Pericardial fluid was collected from 24 patients (63%). Pathology examinations of pericardial tissue found nonspecific inflammation in 5 patients and pericardial tuberculosis in 7. The causes of EP were: tuberculous (55%), idiopathic (16%), bacterial (8%), HIV-related (5%), uremic (5%), neoplastic (5%), lupus (3%), and rheumatic (3%).EFP is a frequent, serious, even deadly disease in Africa because of the HIV-AIDS pandemic. Treatment depends on the cause, most often tuberculosis.

PubMed | Endocrinologie et maladies hereditaires du metabolisme, groupe hospitalier Diaconesses Croix Saint Simon, French Institute of Health and Medical Research, Lyon University Hospital Center and 11 more.
Type: | Journal: La Revue de medecine interne | Year: 2016

Acid sphingomyelinase deficiency (ASMD) is an autosomal recessive disease with a clinical spectrum ranging from a neurovisceral infantile form (Niemann-Pick disease type A) to a chronic visceral form also encountered in adults (Niemann-Pick disease type B, NP-B).Retrospective multicentric analysis of French adult patients with ASMD over the period 1985-March 2015. Clinical, biological, and imaging data were analyzed.Twenty-eight patients (19males, 9females) were analyzed. Diagnosis was made before the age of 10years in 16cases. Main symptoms at diagnosis were spleen/liver enlargement and interstitial lung disease. Biological abnormalities included: thrombocytopenia (platelet count <150000/mmASMD in adulthood (NP-B) associates spleen/liver enlargement and interstitial lung disease. Early diagnosis and appropriate management are essential for reducing the risk of complications, improving quality of life, and avoiding inappropriate procedures such as splenectomy. To date, only symptomatic therapy is available. A phase 2/3 therapeutic trial with IV infusion of recombinant enzyme is on-going.

Gestermann N.,University Paris - Sud | Mekinian A.,University Paris - Sud | Comets E.,University Paris Diderot | Loiseau P.,French Institute of Health and Medical Research | And 5 more authors.
Genes and Immunity | Year: 2010

Signal transducer and activator of transcription 4 (STAT4) is a transcription factor mainly activated by interleukin 12, which promotes the secretion of type 2 interferon (IFN) by T-helper 1 cells. We assessed the association of STAT4 gene polymorphism and primary Sjögren's syndrome (pSS) and its functional relevance. We analyzed STAT4 rs7582694 polymorphism in an exploratory cohort of 186 pSS patients and 152 controls, and in a replication cohort of 192 pSS patients and 483 controls, all Caucasian. mRNA levels of STAT4α, STAT4Β, STAT1, and the type 1 IFN-induced genes PKR, MX1 and IFITM1 were assessed in peripheral blood mononuclear cells (PBMCs) from 30 pSS patients. STAT4 rs7582694 C allele was associated with pSS in both cohorts (odds ratio (OR) 1.57, 95% confidence interval (CI) 1.27-1.93, P2.3 × 10 -5). The association was increased for homozygous subjects, which suggests a recessive effect of the STAT4 at-risk allele. STAT4α, STAT4Β and STAT1 mRNA levels in PBMCs were not significantly associated with rs7582694 genotypes, however the mRNA levels of STAT4α and type 1 IFN-induced genes were strongly correlated: PKR (P4 × 10-3, r0.51), MX1 (P2 × 10-4, r0.63) and IFITM1 (P8 × 10 3, r0.47), suggesting that STAT4 might be involved in not only type 2 IFN production but also in type 1 IFN-mediated effects. © 2010 Macmillan Publishers Limited All rights reserved.

PubMed | Service dhematologie clinique du CHU Yalgado Ouedraogo, University of Ouagadougou and Medecine interne
Type: Journal Article | Journal: Medecine et sante tropicales | Year: 2016

Pernicious anemia (also known as Biermer disease or anemia, Addison or Addisonian anemia, and Addison-Biermer anemia) is an autoimmune atrophic gastritis responsible for vitamin B12 malabsorption due to a deficiency of intrinsic factor. We report eight cases of pernicious anemia in Burkina Faso, collected over a 44-month period. The three criteria for diagnosis of pernicious anemia were: vitamin B12 deficiency, gastric disease (gastric histology) with presence of anti-intrinsic factor, and/or anti-gastric parietal cell antibodies in serum. All patients had anemia, with a mean hemoglobin level of 8.75 g/100mL. The average mean corpuscular volume (MCV) was 122.1 fL the average mean corpuscular hemoglobin (MCH) 39.3 pg, the mean reticulocyte count 12.069 10(9)/L reticulocytes, and the mean rate of megaloblast marrow cells 17.2%. The serum vitamin B12 level ranged from 35 to 71 pmol/L. Antibodies against intrinsic factor were found in all eight patients. All ABO blood groups were present with a predominance (4 cases) of group O. Endoscopy found a normal fundic mucosa in three patients. Histology showed gastric atrophy and intestinal metaplasia for six patients (85.7%). Under B12 vitamin therapy, the course was favorable in all patients; seven patients also had 10 days of iron therapy. We recommend a gastric biopsy even in the absence of macroscopic gastric lesions on the upper gastrointestinal endoscopy.

PubMed | Orgametrie Biostatistiques, Medecine Interne, Medecine Vasculaire, Rhumatologie and 7 more.
Type: Journal Article | Journal: Annals of the rheumatic diseases | Year: 2016

To assess the effect of sildenafil, a phosphodiesterase type 5 inhibitor, on digital ulcer (DU) healing in systemic sclerosis (SSc).Randomised, placebo-controlled study in patients with SSc to assess the effect of sildenafil 20mg or placebo, three times daily for 12weeks, on ischaemic DU healing. The primary end point was the time to healing for each DU. Time to healing was compared between groups using Cox models for clustered data (two-sided tests, p=0.05).Intention-to-treat analysis involved 83 patients with a total of 192 DUs (89 in the sildenafil group and 103 in the placebo group). The HR for DU healing was 1.33 (0.88 to 2.00) (p=0.18) and 1.27 (0.85 to 1.89) (p=0.25) when adjusted for the number of DUs at entry, in favour of sildenafil. In the per protocol population, the HRs were 1.49 (0.98 to 2.28) (p=0.06) and 1.43 (0.93 to 2.19) p=0.10. The mean number of DUs per patient was lower in the sildenafil group compared with the placebo group at week (W) 8 (1.231.61 vs 1.792.40 p=0.04) and W12 (0.861.62 vs 1.512.68, p=0.01) resulting from a greater healing rate (p=0.01 at W8 and p=0.03 at W12).The primary end point was not reached in intention-to-treat, partly because of an unexpectedly high healing rate in the placebo group. We found a significant decrease in the number of DUs in favour of sildenafil compared with placebo at W8 and W12, confirming a sildenafil benefit.NCT01295736.

Bouazza N.,University of Paris Descartes | Pestre V.,Medecine Interne | Jullien V.,Service de Pharmacologie Clinique | Curis E.,University of Paris Descartes | And 5 more authors.
British Journal of Clinical Pharmacology | Year: 2012

AIMS This study was performed to describe clindamycin, administered either orally or intravenously, concentration-time courses to patients with osteomyelitis, to study the effects of different covariates on clindamycin pharmacokinetics and to simulate an optimized administration scheme. METHODS Clindamycin concentrations were measured in 50 patients. A total of 122 plasma concentrations were available (58 from oral administration and 64 from i.v. infusion). A population pharmacokinetic model was developed with MONOLIX 4 software. RESULTS A one compartment model adequately described the data. Clindamycin clearance increased significantly with body weight (BW). The typical population estimates (interindividual variability) for clearance, volume of distribution and absorption rate constant were 16.2lh-1 (0.39), 70.2l and 0.92h-1, respectively. The bioavailability of the oral form was estimated to be 87.6%. According to BW, theoretical doses needed to reach a Cmin of 2mgl-1 were then calculated. CONCLUSIONS The current recommendation of 600mg three times daily seems to be effective up to 75kg but the dose should be raised to 900mg three times daily thereafter. These assumptions should be prospectively confirmed. © 2012 The Authors. British Journal of Clinical Pharmacology © 2012 The British Pharmacological Society.

Desmettre T.,University of Franche Comte | Dehours E.,Toulouse University Hospital Center | Samama C.-M.,University of Paris Descartes | Jhundoo S.,Urgences | And 6 more authors.
Critical Care | Year: 2012

Introduction: Prothrombin Complex Concentrate (PCC) is a key treatment in the management of bleeding related to Vitamin K antagonists (VKA). This study aimed to evaluate prospectively PCC use in patients with VKA-related bleeding in view of the French guidelines published in 2008.Methods: All consecutive patients with VKA-related bleeding treated with a 4-factor PCC (Octaplex®) were selected in 33 French hospitals. Collected data included demographics, site and severity of bleeding, modalities of PCC administration, International Normalized Ratio (INR) values before and after PCC administration, outcomes and survival rate 15 days after infusion.Results: Of 825 patients who received PCC between August 2008 and December 2010, 646 had severe bleeding. The main haemorrhage sites were intracranial (43.7%) and abdominal (24.3%). Mean INR before PCC was 4.4 ± 1.9; INR was unavailable in 12.5% of patients. The proportions of patients who received a PCC dose according to guidelines were 15.8% in patients with initial INR 2-2.5, 41.5% in patients with INR 2.5-3, 40.8% in patients with INR 3-3.5, 26.9% in patients with INR > 3.5, and 63.5% of patients with unknown INR. Vitamin K was administered in 84.7% of patients. The infused dose of PCC did not vary with initial INR; the mean dose was 25.3 ± 9.8 IU/Kg. Rates of controlled bleeding and target INR achievement were similar, regardless of whether or not patients were receiving PCC doses as per the guidelines. No differences in INR after PCC treatment were observed, regardless of whether or not vitamin K was administered. INR was first monitored after a mean time frame of 4.5 ± 5.6 hours post PCC. The overall survival rate at 15 days after PCC infusion was 75.4% (65.1% in patients with intracranial haemorrhage). A better prognosis was observed in patients reaching the target INR.Conclusions: Severe bleeding related to VKA needs to be better managed, particularly regarding the PCC infused dose, INR monitoring and administration of vitamin K. A dose of 25 IU/kg PCC appears to be efficacious in achieving a target INR of 1.5. Further studies are required to assess whether adjusting PCC dose and/or better management of INR would improve outcomes. © 2012 Desmettre et al.; licensee BioMed Central Ltd.

Unfractionated heparin (UFH) and low-molecular-weight heparins (LMWH) are broadly used for the thromboprophylaxis during pregnancy. Long-term heparin therapy has raised concern about the risk of bone loss and osteoporotic fractures while pregnancy by itself favors osteoporosis. Experimental studies show a comparable effect of UFH and LMWH on bone formation while UFH has a more marked effect on bone resorption. Available clinical studies do not provide evidence of a difference between UFH and LMWH or among different LMWH on the bone risk. However, clinical studies show that bone loss observed with LMWH is not different from the physiological loss related to pregnancy, and osteoporotic fractures are associated with comorbiditiesor osteoporosis risk factors. LMWH represent the preferred alternative for thromboprophylaxis during pregnancy. © Société Française de Pharmacologie et de Thérapeutique.

Antibiotics have been a true miracle. Would it end in a nightmare? Possibly. Since 1941, the antibiotic treatment of bacterial infections has been a revolution. The golden age lasted half a century, a period during which infectious diseases were considered definitely defeated. And \although from the beginning some kind of bacterial resistance was observed, a strong long-lasting belief was that continuous innovation and invention of new molecules would keep providing a step ahead in the war waged between the human and microbes. For twenty years the resistances became each year a greater concern. Having first hit the hospital, they now affect the community. New effective antibiotics are scarce, and innovation once thought endless, stopped. Today, to escape the nightmare of a return to the pre-antibiotic era, we must find a way to curb the spread of resistant bacteria, change radically our irresponsible squander of antibiotics, and give ways to new treatments effective against future resistant pathogens. These topics are developed in the present paper dealing with the real risk that these 20th century wonder of the medical science, become an object of memory.

Morisset M.,Medecine interne
Revue Francaise d'Allergologie | Year: 2011

The recent increase in the number of clinical trials demonstrates progress in the treatment of food allergies and confirms the value of oral immunotherapy. This article aims to review recent advances in understanding the subject. © 2011 Elsevier Masson SAS.

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