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Hôpital-Camfrout, France

Cerebral venous thrombosis associated with protein S deficiency during early pregnancy remains exceptional. We report the case of Mrs. D., a 20 year-old Senegalese woman with no significant medical history, admitted with left hemiparesis, headache, vomiting. All of this took place in a context marked by early pregnancy (12 weeks of amenorrhoea). The diagnosis of cerebral venous thrombosis was made on the basis of CT brain scan results. Etiological research showed protein S deficiency at a rate of about 40% (60-124), three times over quite considerable time intervals. She was treated with enoxaparin sodium. The clinical and radiological outcome was good following two-year follow-up with a successful outcome of pregnancy and delivery. Cerebral venous thrombosis is very rare during the first month of pregnancy. It requires an exhaustive etiological research and the rapid induction of anticoagulation therapy with low molecular weight heparin. © Maouly Fall et al.

Godeau B.,Service de Medecine Interne
Seminars in Hematology | Year: 2016

During the last two decades, new therapeutic strategies have been developed, particularly anti-CD20 agents and thrombopoietin-receptor (TPO-r) mimetics, for immune thrombocytopenia (ITP). However, although the new efficient drugs have deeply modified the therapeutic strategy and the disease prognosis, there are still unmet needs and challenges. Concerning rituximab, reassuring data concerning its safety have recently been reported. The main limitation of the treatment is its modest long-term efficacy, with frequent disease relapse. Maintenance treatment or association with other immunomodulatory drugs such as dexamethasone may achieve better long-term response. With failure of one of the available TPO-r agonists (ie, romiplostim and eltrombopag), another can be used. Switching may be beneficial, with more than 50% chance of response, and could limit the risk of platelet fluctuation occasionally observed with these treatments. According to the mechanism of action of TPO-r agonists, a rapid relapse of thrombocytopenia should be observed after they are stopped. Several recent observational studies suggested sustained responses in patients achieving complete response with TPO-r agonists and who stopped the treatments. Prospective studies to confirm these unexpected data are needed. Thrombosis in ITP is a concern, particularly with TPO-r agonists, even though the pivotal studies of eltrombopag and romiplostim did not report a higher incidence of thrombosis events with TPO-r agonists than placebo. Despite these reassuring data, the risk of thrombosis with TPO-r agonists remains unanswered, particularly with secondary ITP or in older adults. © 2016 Elsevier Inc..

Anaphylaxis is the most severe type of food allergy. Factors of risk are advanced age, cardiopathy, asthma, mastocytosis. Age may be linked to an increased consumption of drugs: aspirin, nonsteroidal anti-inflammatory drugs, beta-blockers, inhibitors of angiotensin converting enzyme (ACE). A case-control study comparing anaphylaxis and mild food allergies has shown a sharp increase of consumption of these drugs in patients with anaphylaxis, with odds ratio respectively of 10.8 [Cl 95%: 3.10-41.3], 8.2 [Cl 95%: 1.37-62.51], 6.8 [Cl 95%: 1.78-27.78] and 13 [Cl 95%: 1.34-310.38]. Besides, exercise potentiates the relative risk of drug consumption. Predominant mechanisms could be an increase of gut permeability enhancing the passage of food allergens in the mucosa and in blood, and the inhibition of ACE, so that the angiotensin homeostatic mechanism deteriorates. Main sites of interference may be endothelium and gut epithelium. Preventive measures excluding the intake of aspirin and nonsteroidal anti-inflammatory drugs before the meals can be recommended for food allergic and food sensitized adults. Treatment of hypertension can address to other families of drugs than ACE inhibitors (ACEI) and beta blockers. The benefit-risk ratio of beta blockers and ACEI has to be carefully considered in the case of cardiopathy.

This purpose of this study was to determine prevalences and risk factors associated with infection by human immunodeficiency virus, hepatitis B Virus, syphilis and bacillary pulmonary tuberculosis in prisons in Burkina Faso. From February 20 to March 20, 2009, 300 prisoners over 18 years of age held in Ouagadougou were selected to take part in this descriptive and analytical cross-sectional study. Sociodemographic data, confinement information (number, motive and prison time), medical history, substance addiction (alcohol, tobacco, drug), and the other risk behaviors (sexual relations, type of partners, sharing of toiletries or razor) were compiled for each prisoner. Serological tests were performed to detect anti-HIV antibodies, Hbs antigen, and anti-treponema antibody. In prisoners presenting signs of tuberculosis, BAAR detection was performed by direct examination of sputum. Men represented 95% of the study population. Median age was of 30.1 +/- 8.9 years (range, 18 and 63). The prevalences of HIV infection, Hbs antigen and positive syphilitic serology were 5%, 27.3% and 5.7% respectively. Four prisoners (1.3%) had bacillary pulmonary tuberculosis. Two prisoners reported homosexual intercourse and 44 reported drug abuse. Sharing of toiletries and razor blades was reported by 18.7% and 20% of the prisoners respectively. Immediate measures are needed reduce the spread of these infections in prisons in Africa.

Patients treated with chemotherapy are at a high risk of venous thromboembolism (VTE), including pulmonary embolisms (PE) and deep vein thrombosis (DVT). The evaluation of the risk of VTE is based on the Khorana risk score or the existence of a thrombogenic neoplasia or treatment. Clinical studies based on this prognostic score are expected. Clinical trials show a benefit of primary prophylaxy of venous thromboembolism with low-molecularweight heparins (LMWHs) for myeloma and advanced or metastatic pancreatic cancers, and it is therefore possible to offer it to patient with a low haemorrhagic risk. The place of primary prevention of VTE in patients with locaaly advanced or metastatic pulmonary cancer is still under debate. In other cases systematic primary prophylaxis is not recommended. © 2016, Springer-Verlag France.

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