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OBJECTIVE: To assess the relationship between the site, ischaemia, neuropathy, bacterial infection, area, depth (SINBAD) score and major adverse foot events in patients with diabetes and foot ulcers. METHODS: For this retrospective ancillary study, patients (n = 537) followed for a diabetic foot ulcer (DFU) in six French hospitals were included between 1 February 2019 and 17 March 2019, and between 1 February 2020 and 17 March 2020. The SINBAD score was assessed at inclusion. The frequency of a composite outcome consisting of eight major adverse foot events (MAFE) was assessed after 5-6 months of follow-up: hospitalisation for DFU, septic surgery, revascularisation, minor amputation, major amputation, death, secondary infection and ulcer recurrence. A logistical regression explored the link between the SINBAD score and MAFE and each of its component. RESULTS: A low SINBAD score (from 0 to 3) was observed in 61% of patients and a high (from 4 to 6) in 39%. MAFE occurred in, respectively, 24% and 28% of these patients. Multivariate analyses showed a significant relationship between the SINBAD score and MAFE, with the continuous SINBAD score: odds ratio (OR) 1.72 [95% CI (1.51-1.97)] or dichotomic SINBAD score (values: 0-3 and 4-6): OR 3.71 [95% CI (2.54-5.42)]. The SINBAD score (continuous or dichotomic) at inclusion was also significantly associated with six out of the eight components of the MAFE. CONCLUSIONS: The SINBAD score is a useful tool for predicting major adverse foot events.
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Diabetes Mellitus , Pie Diabético , Úlcera del Pie , Humanos , Pie Diabético/diagnóstico , Pie Diabético/epidemiología , Pie Diabético/etiología , Estudios Retrospectivos , Pie , Extremidad InferiorRESUMEN
INTRODUCTION: Dengue is an arboviral disease transmitted by the dengue virus, whose vectors are Aedes aegypti and Aedes albopictus. The acute phase with its cohort of well-known symptoms is usually spontaneously favorable. Since 2020 in Reunion Island, a new symptom has appeared: the ocular damage of dengue fever, which has already been described in South Asia and South-East Asia. We therefore decided to describe the clinical, biological, ophthalmological, therapeutic, and outcomes of patients with ocular manifestations during dengue fever in Reunion Island in 2020. PATIENTS AND METHODS: This was a retrospective observational study. Patients were included from January 2020 to August 2020 and then reassessed by teleconsultation 1 year later. The patients were identified from the French public health surveillance network by all ophthalmologists on the island. Medical data were collected directly from medical records. RESULTS: Twenty-eight patients were included. The mean age was 41.9 years. Ocular involvement occurred approximately 9.2 days after the onset of dengue symptoms. The main symptoms were scotoma (71.4%) and sudden decrease of visual acuity (39.2%). Eighteen patients (64.2%) had macular involvement. Fourteen patients were treated with oral or intravenous corticosteroids. Twenty-two (78.5%) patients were evaluated by telephone one year later. Scotoma and decreased visual acuity persisted in 15 patients. Thirteen patients (59%) were bothered by night driving, 32% of patients had reading difficulties and 27% of patients became sensitive to prolonged exposure to screens. CONCLUSION: Ocular complications of dengue require early and collegial management to limit the risk of long-term sequelae. Further studies on the characteristics and complications of dengue fever are needed to better understand this disease.
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Aedes , Virus del Dengue , Dengue , Animales , Humanos , Adulto , Reunión/epidemiología , Dengue/complicaciones , Dengue/epidemiología , Escotoma , Mosquitos Vectores , Estudios Observacionales como AsuntoRESUMEN
BACKGROUND: Data from the PEXIVAS trial challenged the role of plasma exchange (PLEX) in ANCA-associated vasculitides (AAV). We aimed to describe kidney biopsy from patients with AAV treated with PLEX, evaluate whether histopathologic findings could predict kidney function, and identify which patients would most benefit from PLEX. METHODS: We performed a multicenter, retrospective study on 188 patients with AAV and AKI treated with PLEX and 237 not treated with PLEX. The primary outcome was mortality or KRT at 12 months (M12). RESULTS: No significant benefit of PLEX for the primary outcome was found. To identify patients benefitting from PLEX, we developed a model predicting the average treatment effect of PLEX for an individual depending on covariables. Using the prediction model, 223 patients had a better predicted outcome with PLEX than without PLEX, and 177 of them had >5% increased predicted probability with PLEX compared with without PLEX of being alive and free from KRT at M12, which defined the PLEX-recommended group. Risk difference for death or KRT at M12 was significantly lower with PLEX in the PLEX-recommended group (-15.9%; 95% CI, -29.4 to -2.5) compared with the PLEX not recommended group (-4.8%; 95% CI, 14.9 to 5.3). Microscopic polyangiitis, MPO-ANCA, higher serum creatinine, crescentic and sclerotic classes, and higher Brix score were more frequent in the PLEX-recommended group. An easy to use score identified patients who would benefit from PLEX. The average treatment effect of PLEX for those with recommended treatment corresponded to an absolute risk reduction for death or KRT at M12 of 24.6%. CONCLUSIONS: PLEX was not associated with a better primary outcome in the whole study population, but we identified a subset of patients who could benefit from PLEX. However, these findings must be validated before utilized in clinical decision making.
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Lesión Renal Aguda , Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos , Lesión Renal Aguda/complicaciones , Lesión Renal Aguda/terapia , Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos/complicaciones , Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos/terapia , Anticuerpos Anticitoplasma de Neutrófilos , Femenino , Humanos , Riñón/patología , Masculino , Intercambio Plasmático/efectos adversos , Estudios RetrospectivosRESUMEN
OBJECTIVES: GCA is a large vessel vasculitis for which triggering factors remain unknown. Clonal haematopoiesis (CH) was associated with atherosclerosis through the induction of inflammation in myeloid cells, and data suggest that CH expansion and inflammation may support each other to induce a pro-inflammatory loop. Our objective was to describe the impact of JAK2p.V617F-mutated myeloproliferative neoplasms (MPNs) on GCA and to screen MPN-free patients for CH mutations. METHODS: We performed a retrospective case-control study comparing the characteristics of 21 GCA patients with MPN and 42 age- and gender-matched GCA patients without MPN. Also, 18 GCA patients were screened for CH through next-generation sequencing (NGS). RESULTS: The most frequent associated MPN was essential thrombocythaemia (ET; n = 11). Compared with controls, GCA patients with MPN had less-frequent cephalic symptoms (71.4 vs 97.6%; P = 0.004) and higher platelet counts at baseline [485 × 109/l (interquartile range 346-586) vs 346 (296-418); P = 0.02]. There was no difference between groups for other clinical features. Overall survival was significantly shorter in patients with MPN compared with controls [hazard ratio 8.2 (95% CI 1.2, 56.6); P = 0.03]. Finally, screening for CH using NGS in 15 GCA patients without MPN revealed CH in 33%. CONCLUSION: GCA patients with MPN display higher platelet counts and shorter overall survival than controls. This association is not fortuitous, given the possible pathophysiological relationship between the two diseases. CH was found in one-third of GCA patients, which may be higher than the expected prevalence for a similar age, and should be confirmed in a larger cohort.
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Hematopoyesis Clonal , Arteritis de Células Gigantes/etiología , Enfermedades Mielodisplásicas-Mieloproliferativas/complicaciones , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Hematopoyesis Clonal/genética , Femenino , Arteritis de Células Gigantes/genética , Arteritis de Células Gigantes/mortalidad , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Janus Quinasa 2/genética , Masculino , Enfermedades Mielodisplásicas-Mieloproliferativas/genética , Enfermedades Mielodisplásicas-Mieloproliferativas/mortalidad , Recuento de Plaquetas , Estudios Retrospectivos , Análisis de SupervivenciaRESUMEN
Murine typhus case was initially identified in Reunion, France, in 2012 in a tourist. Our investigation confirmed 8 autochthonous cases that occurred during January 2011-January 2013 in Reunion. Murine typhus should be considered in local patients and in travelers returning from Reunion who have fevers of unknown origin.
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Tifus Endémico Transmitido por Pulgas/epidemiología , Adulto , Anciano , Femenino , Francia , Geografía Médica , Historia del Siglo XXI , Humanos , Masculino , Persona de Mediana Edad , Tipificación Molecular , Reunión , Rickettsia typhi/clasificación , Rickettsia typhi/genética , Estaciones del Año , Serotipificación , Tifus Endémico Transmitido por Pulgas/diagnóstico , Tifus Endémico Transmitido por Pulgas/historia , Adulto JovenRESUMEN
Erythema nodosum (EN) is a dermatological manifestation, the common etiologies of which are already widely described. Here, we report the case of a patient who presented an EN, where the etiology was found to be a rare diagnosis: syphilis, a sexually transmitted infection with various clinical presentations. A 42-year-old female patient without any medical condition presented with a clinical picture associating a maculopapular rash at first, and later on a well-defined hypodermic lesion, clinically suggestive of an EN, on the right forearm. The etiologic workup ruled out sarcoidosis, which was the first suspected diagnosis. Positive VDRL-TPHA and recovery within 15 days after benzathine benzylpenicillin administration allowed the diagnosis of syphilis to be made on the EN. EN is a rare manifestation of syphilis that should be kept in mind in these times of strong recrudescence of the disease among men who have sex with men in mainland France but also among heterosexuals in Reunion Island.
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BACKGROUND: Patients under biological therapy for auto-immune disease are considered immunosuppressed and several recent recommendations highlight the need for vaccination against influenza and pneumococcal infections. The aims of this study were to evaluate influenza and pneumococcal vaccine coverage among patients receiving biological therapy and identify factors associated with vaccine uptake within this population. METHODS: A retrospective cross-sectional study was performed in adult patients attending hospitals for an auto-immune/inflammatory disease and treated with biological therapy. Vaccine uptake was evidenced from patient's medical records or from their pharmacist's records. Questionnaires about attitudes and knowledge regarding vaccinations were administered to patients and their physicians. Multivariable logistic regression was used to determine factors significantly associated with influenza and pneumococcal vaccine receipt. RESULTS: A total of 208 patients were included: 52% female and mean age 50.6 (± 14.7) years. Among them 173 completed the questionnaire while 72 physicians replied. Underlying inflammatory diseases were rheumatisms (46%), bowel diseases (31%) and skin diseases (23%). Vaccine uptake was 28% for influenza, 48% for pneumococcus and 22% received both vaccines. Main factors associated to positive uptake were receiving a prescription from a physician, as well as having a good knowledge of vaccines. Factors limiting vaccination were a negative attitude toward vaccines in general, and belonging to the group of inflammatory bowel diseases. CONCLUSIONS: Vaccine coverage for influenza and pneumococcal infections are low in the patients under biologics for auto-immune/inflammatory disease. Health policies should reinforce information and promotion of these vaccines among these patients but also the prescribers.
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Actitud del Personal de Salud , Actitud Frente a la Salud , Enfermedades Autoinmunes/terapia , Terapia Biológica , Vacunas contra la Influenza , Gripe Humana/prevención & control , Médicos , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas , Cobertura de Vacunación , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Research on autobiographical memory (AM) and the ability to retrieve specific autobiographical events in euthymic depressed patients yielded divergent results. The main goal of the present study was to further explore episodic specificity of AM among fully remitted depressed patients. Twenty euthymic depressed patients and 20 matched healthy controls were given a semi-structured interview, which assesses episodic specificity of positive and negative autobiographical memories regarding event and details' specificity, autonoetic consciousness (remember/know procedure) and visual perspective (field/observer procedure). Results showed an impairment of episodic specificity of AM in euthymic depressed patients. This impairment was explained by a field perspective deficit for positive memories only. These results suggest that euthymic patients continue to exhibit discrepancy between their current self and their self for positive past behaviors, which maintains an unfavorable view of their current self. Specific cognitive interventions may improve the self-relevance of their positive memories.
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Trastorno Depresivo/psicología , Trastornos de la Memoria/etiología , Recuerdo Mental , Adulto , Estudios de Casos y Controles , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Inducción de Remisión , AutoimagenRESUMEN
BACKGROUND: Although peripheral nervous system involvement is common in eosinophilic granulomatosis with polyangiitis (EGPA), central nervous system (CNS) manifestations are poorly described. This study aimed to describe CNS involvement in EGPA. PATIENTS AND METHODS: This retrospective, observational, multicenter study included patients with EGPA and CNS involvement affecting cranial nerves, brain and/or spinal cord. We also undertook a systematic literature review. RESULTS: We analyzed 26 personal cases and 62 previously reported cases. At EGPA diagnosis, asthma was noted in 97%, eosinophilia in 98%, peripheral neuropathy in 55% and cardiac involvement in 41%. 38/71 (54%) were ANCA-positive, with a perinuclear-labeling pattern and/or anti-MPO specificity. CNS was involved in 86% at EGPA diagnosis, preceded EGPA in 2%, and occurred during follow-up in 12% after a median of 24months. Main neurological manifestations were ischemic cerebrovascular lesions in 46 (52%), intracerebral hemorrhage and/or subarachnoid hemorrhage in 21 (24%), loss of visual acuity in 28 (33%) (15 with optic neuritis, 9 with central retinal artery occlusion, 4 with cortical blindness), and cranial nerves palsies in 18 (21%), with 25 patients having ≥1 of these clinical CNS manifestations. Among the 81 patients with assessable neurological responses, 43% had complete responses without sequelae, 43% had partial responses with long-term sequelae and 14% refractory disease. After a mean follow-up of 36months, 11 patients died including 5 from intracerebral hemorrhages. CONCLUSION: EGPA-related CNS manifestations form 4 distinct neurological pictures: ischemic lesions, intracerebral hemorrhages, cranial nerve palsies and loss of visual acuity. Such manifestation should prompt practitioners to consider EGPA in such conditions. Long-term neurological sequelae were common, and intracerebral hemorrhages had the worst prognostic impact.
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Encéfalo/patología , Eosinofilia/patología , Granulomatosis con Poliangitis/patología , Adulto , Anciano , Asma/diagnóstico por imagen , Asma/patología , Encéfalo/diagnóstico por imagen , Eosinofilia/diagnóstico por imagen , Eosinofilia/tratamiento farmacológico , Femenino , Granulomatosis con Poliangitis/diagnóstico por imagen , Granulomatosis con Poliangitis/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Oclusión de la Arteria Retiniana/diagnóstico por imagen , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Reunion Island is a French overseas territory located in the south-western of Indian Ocean, 700 km east of Madagascar. Leprosy first arrived on Reunion Island in the early 1700s with the African slaves and immigration from Madagascar. The disease was endemic until 1980 but improvement of health care and life conditions of inhabitants in the island have allowed a strong decrease in new cases of leprosy. However, the reintroduction of the disease by migrants from endemic neighbouring countries like Comoros and Madagascar is a real and continuing risk. This observational study was then conducted to measure the number of new cases detected annually on Reunion Island between 2005 and 2013, and to describe the clinical features of these patients. METHODOLOGY/PRINCIPAL FINDINGS: Data were collected over two distinct periods. Incident cases between 2005 and 2010 come from a retrospective study conducted in 2010 by the regional Office of French Institute for Public Health Surveillance (CIRE of Indian Ocean), when no surveillance system exist. Cases between 2011 and 2013 come from a prospective collection of all new cases, following the implementation of systematic notification of all new cases. All patient data were anonymized. Among the 25 new cases, 12 are Reunion Island residents who never lived outside Reunion Island, and hence are considered to be confirmed autochthonous patients. Registered prevalence in 2014 was 0.05 /10 000 habitants, less than the WHO's eradication goal (1/10 000). CONCLUSIONS/SIGNIFICANCE: Leprosy is no longer a major public health problem on Reunion Island, as its low prevalence rate indicates. However, the risk of recrudescence of the disease and of renewed autochthonous transmission remains real. In this context, active case detection must be pursued through the active declaration and rapid treatment of all new cases.
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Lepra/epidemiología , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos , Reunión/epidemiología , Adulto JovenRESUMEN
OBJECTIVES: While the prevalence of Group B streptococcus (GBS) colonization is important, little is known about invasive GBS (iGBS) disease in tropical areas. Our objective was to assess the burden of iGBS disease among non-pregnant adults. METHODS: A prospective hospital-based study of all non-pregnant adult patients with iGBS disease was conducted between January and December 2011 in Saint Pierre, Réunion Island, to assess its cumulative incidence rate (CIR). Capsular serotyping and multilocus sequence typing were performed to characterize GBS isolates. Case-control study was done to identify risk factors. RESULTS: The overall CIR of iGBS disease was 10.1 per 100,000. The CIR in elderly patients (≥ 65 yrs) was estimated at 40.6 per 100.000, and that of adults (15-64 years) at 6.7 per 100.000. Aboriginal origin in the Indian Ocean and overweight were both associated with iGBS disease. The most prominent clinical forms were osteo-articular and skin/soft tissue infections, as a consequence of diabetic foot. The serotypes were classic, type-Ia being the most prevalent. The hyper virulent ST-17 (CC17) was associated with type-III. CONCLUSIONS: The incidence of iGBS disease found in Réunion island is twofold that usually reported. This burden is linked to overweight in aboriginal people from the Indian Ocean.
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Infecciones Estreptocócicas/epidemiología , Streptococcus agalactiae , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Pie Diabético/complicaciones , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Sobrepeso/complicaciones , Estudios Prospectivos , Reunión/epidemiología , Factores de Riesgo , Enfermedades Cutáneas Bacterianas/complicaciones , Enfermedades Cutáneas Bacterianas/epidemiología , Infecciones de los Tejidos Blandos/epidemiología , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/microbiología , Streptococcus agalactiae/clasificación , Adulto JovenRESUMEN
The present study examined the influence of trait anxiety on the early stages of emotional face processing. In order to test if such early effect of anxiety could appear in response to positive as well as to negative stimuli, we recorded event-related potentials in response to both happy and fearful faces - contrasted with neutral faces - during a task where attention was explicitly directed to the emotion, in two groups differing by their anxiety level. We observed an amplification of the occipital P1 peak (90-120 ms) in response to happy compared to neutral faces in high trait anxious participants but not in the low trait anxious ones. Additionally, the N170 and EPN components were enhanced for the negative (fearful) faces, with no impact of trait anxiety. Our results provide evidence for an early bias towards positive stimuli in trait anxiety.
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Ansiedad/fisiopatología , Sesgo , Potenciales Evocados/fisiología , Expresión Facial , Felicidad , Reconocimiento Visual de Modelos/fisiología , Adolescente , Adulto , Análisis de Varianza , Ansiedad/psicología , Electroencefalografía , Femenino , Humanos , Masculino , Estimulación Luminosa , Psicometría , Tiempo de Reacción/fisiología , Adulto JovenAsunto(s)
Proteína ADAMTS13/deficiencia , Larva Migrans Visceral/diagnóstico , Larva Migrans Visceral/patología , Hepatopatías/parasitología , Trombosis/etiología , Proteína ADAMTS13/genética , Proteína ADAMTS13/metabolismo , Albendazol/uso terapéutico , Antihelmínticos/uso terapéutico , Regulación de la Expresión Génica , Humanos , Larva Migrans Visceral/tratamiento farmacológico , Hepatopatías/diagnóstico , Hepatopatías/patología , Masculino , Microcirculación , Persona de Mediana Edad , Trombosis/patologíaRESUMEN
The computation by which our brain elaborates fast responses to emotional expressions is currently an active field of brain studies. Previous studies have focused on stimuli taken from everyday life. Here, we investigated event-related potentials in response to happy vs neutral stimuli of human and non-humanoid robots. At the behavioural level, emotion shortened reaction times similarly for robotic and human stimuli. Early P1 wave was enhanced in response to happy compared to neutral expressions for robotic as well as for human stimuli, suggesting that emotion from robots is encoded as early as human emotion expression. Congruent with their lower faceness properties compared to human stimuli, robots elicited a later and lower N170 component than human stimuli. These findings challenge the claim that robots need to present an anthropomorphic aspect to interact with humans. Taken together, such results suggest that the early brain processing of emotional expressions is not bounded to human-like arrangements embodying emotion.
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Encéfalo/fisiología , Emociones/fisiología , Reconocimiento Visual de Modelos/fisiología , Robótica/métodos , Adulto , Mapeo Encefálico , Electroencefalografía/métodos , Potenciales Evocados Visuales/fisiología , Cara , Femenino , Humanos , Masculino , Estimulación Luminosa/métodos , Tiempo de Reacción/fisiología , Adulto JovenRESUMEN
Human faces are the main emotion displayers. Knowing that emotional compared to neutral stimuli elicit enlarged ERPs components at the perceptual level, one may wonder whether this has led to an emotional facilitation bias toward human faces. To contribute to this question, we measured the P1 and N170 components of the ERPs elicited by human facial compared to artificial stimuli, namely non-humanoid robots. Fifteen healthy young adults were shown sad and neutral, upright and inverted expressions of human versus robotic displays. An increase in P1 amplitude in response to sad displays compared to neutral ones evidenced an early perceptual amplification for sadness information. P1 and N170 latencies were delayed in response to robotic stimuli compared to human ones, while N170 amplitude was not affected by media. Inverted human stimuli elicited a longer latency of P1 and a larger N170 amplitude while inverted robotic stimuli did not. As a whole, our results show that emotion facilitation is not biased to human faces but rather extend to non-human displays, thus suggesting our capacity to read emotion beyond faces.