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1.
Encephale ; 50(2): 200-210, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38176977

RESUMEN

OBJECTIVES: Humor is essential to social relationships. Its use and understanding appear to be impaired in people with Autism Spectrum Disorder (ASD). The main objective was to review the existing literature on the detection, understanding and use of humor in persons with ASD. The secondary objective involved exploring assessment scales and specific intervention tools. METHODS: A systematic review of the literature was carried out on all available French and English scientific papers about humor - including irony - in persons with ASD up to November 2021. We extracted 552 references and included 43 articles from six databases. RESULTS: Studies suggest that those with ASD can detect audiovisual and written humor. Understanding humor was impaired in writing and when using pure auditory stimuli and non-verbal cartoons. For irony, the results indicated a lower detection of quality and less understanding in speaking but not in writing. Regarding its use, in terms of expression, people with ASD use benevolent humor less often and do not consider humor as a key source of satisfaction with life, as opposed to the control group. CONCLUSIONS: It appears that it would be worthwhile to develop standardized humor detection and assessment tools specific to persons with ASD. Practical strategies that focus on humor ability could be worth developing, either individually or in groups.


Asunto(s)
Trastorno del Espectro Autista , Ingenio y Humor como Asunto , Humanos , Trastorno del Espectro Autista/psicología , Trastorno del Espectro Autista/diagnóstico , Ingenio y Humor como Asunto/psicología
2.
J Obstet Gynaecol Can ; 45(7): 536-537, 2023 07.
Artículo en Francés | MEDLINE | ID: mdl-37400186

RESUMEN

DÉCLARATIONS SOMMAIRES: RECOMMANDATIONS.

3.
Emerg Radiol ; 30(5): 659-666, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-37535144

RESUMEN

Two major earthquakes measuring 7.8 and 7.7 on the Richter scale struck Turkey and Northern Syria on February 6, claiming more than 50,000 lives. In such an unprecedented disaster, radiologists were confronted with very critical tasks of stepping out of the routine reporting process, performing radiological triage, managing acute adverse events, and optimizing imaging protocols. In our experience, radiologists can take three different positions in such disasters: (1) in the scene of the disaster, (2) serving in teleradiology, and (3) working in tertiary hospital for transported patients. With this article, we aimed to describe the challenges radiologists face on the three main fronts and how we manage these challenges.


Asunto(s)
Desastres , Terremotos , Humanos , Triaje , Radiólogos , Centros de Atención Terciaria
4.
Emerg Radiol ; 30(4): 513-523, 2023 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-37270438

RESUMEN

On February 6, two major earthquakes with magnitudes of 7.8 and 7.7 on the Richter scale hit Turkey and Northern Syria causing more than 50,000 deaths. In the immediate aftermath of the earthquakes, our major tertiary medical referral center received dozens of cases of crush syndrome, presenting with a variety of imaging findings. Crush syndrome is characterized by hypovolemia, hyperkalemia, and myoglobinuria that can lead to rapid death of victims, despite their survival of staying under wreckage for days. The typical triad of crush syndrome consists of the acute tubular necrosis, paralytic ileus, and third-space edema. In this article, we focus primarily on characteristic imaging findings of earthquake-related crush syndrome and divided them into two distinct subsections: myonecrosis, rapid hypovolemia, excessive third-space edema, acute tubular necrosis, and paralytic ileus, which are directly related to crush syndrome, and typical accompanying findings of earthquake-related crush syndrome. Lower extremity compression in earthquake survivors results in the typical third-space edema. In addition to the lower extremities, other skeletal muscle regions are also affected, especially rotator muscles, trapezius, and pectoral muscles. Although it may be relatively easy to better detect myonecrosis with contrast-enhanced CT scans, changing the windowing of the images may be helpful.


Asunto(s)
Síndrome de Aplastamiento , Terremotos , Humanos , Síndrome de Aplastamiento/diagnóstico por imagen , Síndrome de Aplastamiento/complicaciones , Hipovolemia/complicaciones , Tomografía Computarizada por Rayos X , Necrosis/complicaciones
5.
Soins Psychiatr ; 44(348): 29-33, 2023.
Artículo en Francés | MEDLINE | ID: mdl-37743089

RESUMEN

Although folie à deux is a confidential entity that has disappeared from psychiatric textbooks and is disguised in current international classifications of mental disorders, which tend to obscure the fundamental notion of the dyad, recent case reports highlight the topicality of the disorder. The richness of the clinical encounter with twin sisters, presenting a common delusion of parasitic infestation, may prompt us to question the disorder differently, guided in particular by ancient writings and the analytic compass.


Asunto(s)
Trastorno Paranoide Compartido , Humanos , Trastorno Paranoide Compartido/psicología
6.
Rev Infirm ; 72(296): 28-29, 2023 Dec.
Artículo en Francés | MEDLINE | ID: mdl-38071013

RESUMEN

From the earliest stages of adolescence, the question of alcohol consumption should be addressed by health professionals (GPs, midwives, gynecologists, pediatricians, nurses) working in the field of perinatal care or public health. All alcohol consumption is prohibited during pregnancy. In fact, a 2022 study showed that even low exposure to alcohol in utero has measurable effects on the structure of children's brains.


Asunto(s)
Etanol , Tabú , Embarazo , Femenino , Niño , Adolescente , Humanos , Consumo de Bebidas Alcohólicas/prevención & control , Personal de Salud
7.
Rev Infirm ; 72(290): 18-21, 2023 Apr.
Artículo en Francés | MEDLINE | ID: mdl-37088489

RESUMEN

In the hospital, the geriatric missions of nurses and paramedical and medical teams are essential in order to benefit elderly patients and to fight against the immobilization syndrome through responsiveness and quality care. This care takes place in parallel with the specific medical care of the medical pathologies treated. In 2017, the High Authority for Health advocated good professional practices to avoid iatrogenic dependence of hospitalized elderly people. Through this article, we carry out a focus on the immobilization syndrome and its deleterious consequences: we must not do in the place of the elderly subject!


Asunto(s)
Anciano Frágil , Hospitales , Enfermedad Iatrogénica , Anciano , Humanos , Hospitalización/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Anciano de 80 o más Años , Inmovilización/estadística & datos numéricos , Síndrome , Anciano Frágil/estadística & datos numéricos
8.
Encephale ; 48(2): 171-178, 2022 Apr.
Artículo en Francés | MEDLINE | ID: mdl-34092378

RESUMEN

OBJECTIVES: In the literature, several studies have investigated the particular relationship between major depression and obstructive sleep apnoea syndrome (OSAS). However, most of these studies have focused primarily on middle-aged to elderly individuals (≥40 years) which means that this problem has been little studied in young adults (<30 years). Nevertheless, in young adults the prevalence of major depression (particularly its atypical subtype) is not negligible, which seems to justify carrying out additional investigations in order to allow a better understanding of the potential role played by major depression in the pathophysiology of OSAS in this particular subpopulation. The aim of this study was therefore to empirically investigate the prevalence of OSAS in young adults and to study the risk of OSAS associated with major depression in this particular subpopulation. METHODS: Polysomnographic and demographic data from 264 young adults were collected from the Erasme Hospital Sleep Laboratory (Brussels, Belgium) database to enable our analyses. During their two-night stay (including a first night of habituation and a night of polysomnography) at the Sleep Laboratory, these individuals underwent a complete somatic assessment (including blood test, electrocardiogram, daytime electroencephalogram and urinalysis), a systematic psychiatric assessment by a unit psychiatrist and an assessment of their complaints related to sleep. These different steps made it possible to systematically diagnose all somatic pathologies, psychiatric disorders according to the diagnostic criteria of the DSM-IV-TR and sleep pathologies according to the diagnostic criteria of the AASM. This allowed the selection of young adults included in our study based on our inclusion and exclusion criteria. Polysomnographic recordings from our Sleep Laboratory were visually scored according to AASM criteria. An obstructive sleep apnoea-hypopnoea index ≥5/hour was used for the diagnosis of OSAS. At the statistical level, in order to allow our analyses, we subdivided our sample of young adults into two groups: a control group without OSAS (n=215) and a patient group with OSAS (n=49). After checking the normal distribution of our data, normally distributed data were analysed with t-tests whereas asymmetrically or dichotomously distributed data were analysed with Wilcoxon tests or Chi2 tests. Univariate regression models were used to study the risk of OSAS associated with major depression (categorized: absent, typical, atypical) in young adults and potential confounding factors. In multivariate regression models, the risk of OSAS associated with major depression (categorized: absent, typical, atypical) in young adults was adjusted only for confounding factors significantly associated with OSAS during univariate analysis. These confounding factors were introduced in a hierarchical manner in the various multivariate regression models constructed. RESULTS: The prevalence of OSAS in our population of young adults was 18.6 %. During univariate analyses, atypical depression [OR 2.51 (95% CI 1.18-5.32), p-value=0.014], male gender [OR 4.53 (95% CI 2.20-9.34), P-value <0.001], presence of snoring [OR 2.51 (95% CI 1.33-4.75), P-value=0.005], presence of at least one cardio-metabolic alteration [OR 2.26 (95% CI 1.19-4.28), P-value=0.012], body mass index>30 kg/m2 [OR 4.55 (95% CI 2.07-10.03), P-value <0.001] and ferritin ≥150 µg/L [OR 3.28 (95% CI 1.69-6.36), P-value<0.001] were associated with increased risk of OSAS in our population of young adults. After adjusting for these major confounding factors associated with OSAS (gender, body mass index, cardio-metabolic alterations, ferritin level, and snoring) in the four models studied, multivariate regression analyses confirmed that unlike typical depression, atypical depression [OR 3.09 (95% CI 1.26-7.54), P-value=0.019] was a risk factor for OSAS in young adults. CONCLUSIONS: In our study, we demonstrated that the prevalence of OSAS was 18.6 % in young adults referred to the Erasme Hospital Sleep Laboratory. In addition, we have shown that unlike typical depression, atypical depression was associated with an increased risk of OSAS in young adults, which seems to justify more systematic research of this pathology in young adults suffering from atypical depression in order to allow the establishment of adapted therapeutic strategies and avoid the negative consequences associated with the co-occurrence of these two pathologies.


Asunto(s)
Apnea Obstructiva del Sueño , Ronquido , Adulto , Depresión , Ferritinas , Humanos , Masculino , Factores de Riesgo , Apnea Obstructiva del Sueño/complicaciones , Apnea Obstructiva del Sueño/diagnóstico , Apnea Obstructiva del Sueño/epidemiología , Ronquido/complicaciones , Ronquido/epidemiología , Adulto Joven
9.
Encephale ; 48(3): 325-334, 2022 Jun.
Artículo en Francés | MEDLINE | ID: mdl-34916075

RESUMEN

INTRODUCTION: Sleep disorders are prevalent in patients with a neurocognitive disorder, and diagnosis and treatment in these patients remain challenging in clinical practice. METHODS: This narrative review offers a systematic approach to diagnose and treat sleep disorders in neurocognitive disorders. RESULTS: Alzheimer's disease is often associated with circadian rhythm disorders, chronic insomnia, and sleep apnea-hypopnea syndrome. Alpha-synucleinopathies (e.g., Parkinson's disease and Lewy body dementia) are often associated with a rapid eye movement sleep behavior disorder, restless legs syndrome, chronic insomnia, and sleep apnea-hypopnea syndrome. A focused history allows to diagnose most sleep disorders. Clinicians should ensure to gather the following information in all patients with a neurocognitive disorder: (1) the presence of difficulties falling asleep or staying asleep, (2) the impact of sleep disturbances on daily functioning (fatigue, sleepiness and other daytime consequences), and (3) abnormal movements in sleep. Sleep diaries and questionnaires can assist clinicians in screening for specific sleep disorders. Polysomnography is recommended if a rapid eye movement sleep behavior disorder or a sleep apnea-hypopnea syndrome are suspected. Sleep complaints should prompt clinicians to ensure that comorbidities interfering with sleep are properly managed. The main treatment for moderate to severe obstructive sleep apnea-hypopnea syndrome remains continuous positive airway pressure, as its efficacy has been demonstrated in patients with neurocognitive disorders. Medications should also be reviewed, and time of administration should be optimized (diuretics and stimulating medications in the morning, sedating medications in the evening). Importantly, cholinesterase inhibitors (especially donepezil) may trigger insomnia. Switching to morning dosing or to an alternative drug may help. Cognitive-behavioral therapy for insomnia is indicated to treat chronic insomnia in neurocognitive disorders. False beliefs regarding sleep should be addressed with the patient and their caregiver. The sleep environment should be optimized (decrease light exposure at night, minimize noise, avoid taking vital signs, etc.). Sleep restriction can be considered as patients with a neurocognitive disorder often spend too much time in bed. The need for naps should be assessed case by case as naps may contribute to insomnia in some patients but allow others to complete their diurnal activities. Trazodone (50mg) may also be used under certain circumstances in chronic insomnia. Recent evidence does not support a role for exogenous melatonin in patients with a neucognitive disorder and insomnia. Patients in long-term care facilities are often deprived of an adequate diurnal exposure to light. Increasing daytime exposure to light may improve sleep and mood. Patients with circadian rhythm disorders can also benefit from light therapy (morning bright light therapy in case of phase delay and evening bright light therapy in case of phase advance). Rapid eye movement sleep behavior disorder can lead to violent behaviors, and the sleeping environment should be secured (e.g., mattress on the floor, remove surrounding objects). Medication exacerbating this disorder should be stopped if possible. High dose melatonin (6 to 18mg) or low dose clonazepam (0.125-0.25mg) at bedtime may be used to reduce symptoms. Melatonin is preferred in first-line as it is generally well tolerated with few side effects. Patients with restless legs syndrome should be investigated for iron deficiency. Medication decreasing dopaminergic activity should be reduced or stopped if possible. Behavioral strategies such as exercise and leg massages may be beneficial. Low-dose dopamine agonists (such as pramipexole 0.125mg two hours before bedtime) can be used to treat the condition, but a prolonged treatment may paradoxically worsen the symptoms. Alpha-2-delta calcium channel ligands can also be used while monitoring for the risk of falls. CONCLUSION: Multiple and sustained nonpharmacological approaches are recommended for the treatment of sleep disturbances in patients with neurocognitive disorder. Pharmacological indications remain limited, and further randomized clinical trials integrating a multimodal approach are warranted to evaluate the treatment of sleep disorders in specific neurocognitive disorders.


Asunto(s)
Enfermedad de Alzheimer , Trastornos Cronobiológicos , Melatonina , Trastorno de la Conducta del Sueño REM , Síndrome de las Piernas Inquietas , Síndromes de la Apnea del Sueño , Trastornos del Inicio y del Mantenimiento del Sueño , Trastornos del Sueño-Vigilia , Enfermedad de Alzheimer/complicaciones , Enfermedad de Alzheimer/terapia , Trastornos Cronobiológicos/inducido químicamente , Trastornos Cronobiológicos/complicaciones , Trastornos Cronobiológicos/tratamiento farmacológico , Humanos , Melatonina/uso terapéutico , Trastorno de la Conducta del Sueño REM/inducido químicamente , Trastorno de la Conducta del Sueño REM/complicaciones , Trastorno de la Conducta del Sueño REM/tratamiento farmacológico , Síndrome de las Piernas Inquietas/complicaciones , Síndrome de las Piernas Inquietas/diagnóstico , Síndrome de las Piernas Inquietas/tratamiento farmacológico , Sueño , Síndromes de la Apnea del Sueño/inducido químicamente , Síndromes de la Apnea del Sueño/complicaciones , Síndromes de la Apnea del Sueño/tratamiento farmacológico , Trastornos del Inicio y del Mantenimiento del Sueño/tratamiento farmacológico , Trastornos del Sueño-Vigilia/tratamiento farmacológico , Trastornos del Sueño-Vigilia/terapia
10.
Paediatr Child Health ; 26(3): 173-181, 2021 Jun.
Artículo en Inglés, Inglés | MEDLINE | ID: mdl-33936338

RESUMEN

Le syndrome d'entérocolite induite par les protéines alimentaires et la proctocolite allergique induite par les protéines alimentaires sont les principaux types d'allergies alimentaires non induites par les immunoglobines E. Le syndrome d'entérocolite induit par les protéines alimentaires se manifeste par des vomissements réfractaires tardifs, tandis que la proctocolite allergique induite par les protéines alimentaires se révèle par une hématochézie chez des nourrissons autrement en santé. La prise en charge immédiate du syndrome d'entérocolite induite par les protéines alimentaires inclut la réhydratation, l'ondansétron ou ces deux traitements, mais est inutile pour soigner la proctocolite allergique induite par les protéines alimentaires. À long terme, il faut éviter l'aliment déclencheur pour prendre en charge ces deux affections, dont le pronostic est un fort taux de résolution au bout de quelques années.

11.
Prog Urol ; 31(11): 627-633, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34312078

RESUMEN

PURPOSE: The safety of mirabegron 50mg monotherapy was comprehensively assessed versus placebo for overactive bladder. METHODS: A systematic literature search was conducted up to June, 2020 using PUBMED, EMBASE and Cochrane Library. Randomized controlled trials evaluating safety of mirabegron in overactive bladder were collected, and safety was assessed according to 15 adverse events. Adverse events were widely selected to be assessed if they could be calculated. Heterogeneity among studies was assessed by using the χ2 test based on the Q and I2 tests. Pooled effect sizes were calculated using fixed model if I2<50%, otherwise a random-effects model was chosen. The outcomes were nasopharyngitis, dry mouth, hypertension, constipation, headache, dyspepsia, urinary tract infection, dizziness, blurred vision, nausea, cardiovascular events, influenza, electrocardiogram QT prolonged, upper respiratory tract infection and high blood pressure. RESULTS: In all, 10 peer-reviewed trials comprising 6135 patients were identified. Compared with placebo, mirabegron 50mg had an unfavorable safety profile resulting in nasopharyngitis (OR, 1.54[95% credible interval, 1.05-2.25]; P=0.03. No statistical difference was found between mirabegron 50mg and placebo groups in other 14 outcomes. CONCLUSION: Mirabegron 50mg is further confirmed to be nearly as safe as placebo, expect for nasopharyngitis. Nasopharyngitis is associated with mirabegron 50mg monotherapy for patients with overactive bladder.


Asunto(s)
Vejiga Urinaria Hiperactiva , Agentes Urológicos , Acetanilidas/efectos adversos , Humanos , Tiazoles/efectos adversos , Resultado del Tratamiento , Vejiga Urinaria Hiperactiva/tratamiento farmacológico
12.
Ann Dermatol Venereol ; 147(2): 131-134, 2020 Feb.
Artículo en Francés | MEDLINE | ID: mdl-31973905

RESUMEN

BACKGROUND: Severe combined immunodeficiency (SCID) is a the most severe form of primary immunodeficiency and is highly heterogeneous. We report an atypical form of SCID revealed by exfoliative erythroderma. PATIENTS AND METHODS: A 3-month-old boy, born to consanguineous parents, was admitted to the dermatology department with exfoliative erythroderma associated with eczematous patches and alopecia of the scalp, eyelashes, and eyebrows, but with no lymphadenopathy or hepatosplenomegaly. He displayed chronic diarrhea and recurrent infection since birth. A complete blood count showed marked leukocytosis with eosinophilia and lymphocytosis. These clinical and biological findings improved partly with topical steroids. The patient no longer had erythroderma and showed regrowth of hair, eyelashes and eyebrows. The subsequent CBC showed less marked eosinophilia with mild lymphopenia and no leukocytosis. Immunoglobulin levels were undetectable. Primary immunodeficiency was discussed. Immunological investigations concluded on a diagnosis of T-B-NK+ SCID. Mutation analysis revealed a homozygous c.1338C>G (pCys446Trp) mutation in the RAG2 gene. Hematopoietic stem cell transplantation is planned in the near future. CONCLUSION: This case illustrates atypical T-B-NK+ SCID revealed by severe exfoliative erythroderma in a 3-month-old boy with RAG2 gene mutation. Neonatal erythroderma must be considered a warning sign of primary immunodeficiency requiring immediate immunological phenotyping as well as genetic testing for a definitive diagnosis.


Asunto(s)
Dermatitis Exfoliativa/etiología , Inmunodeficiencia Combinada Grave/complicaciones , Alopecia/etiología , Alopecia/patología , Enfermedad Crónica , Consanguinidad , Proteínas de Unión al ADN/genética , Dermatitis Exfoliativa/patología , Diarrea/etiología , Eccema/etiología , Eccema/patología , Trasplante de Células Madre Hematopoyéticas , Humanos , Lactante , Masculino , Proteínas Nucleares/genética , Fotograbar , Inmunodeficiencia Combinada Grave/genética , Inmunodeficiencia Combinada Grave/terapia
13.
Soins Gerontol ; 25(145): 34-39, 2020.
Artículo en Francés | MEDLINE | ID: mdl-32988486

RESUMEN

The malaise in the gerontology sector can be accounted for and new explanations for caregiver burnout can be proposed. Through a review of the literature, an overview of the issue can be drawn up and a theoretical and clinical reflection can be initiated. After having contextualized the extent of the phenomenon, we will present the plural conceptions of burn out and its origin. A new look will be taken at this syndrome by raising a set of factors potentially involved in the exhaustion of caregivers.


Asunto(s)
Agotamiento Profesional , Cuidadores/psicología , Geriatría , Anciano , Humanos
14.
Rheumatol Int ; 39(10): 1697-1702, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31471716

RESUMEN

Primary Sjögren syndrome (pSS) is usually a mild disease, but serious complications such as non-Hodgkin lymphoma-and hypothetically other malignancies-may develop. The aim of this study was to evaluate both overall and specific incidence of cancer in a cohort of patients with pSS compared to the expected incidence in general population of Argentina. Retrospective analytic study of pSS patients fulfilling American-European Consensus Group (AECG) criteria, followed from the time of their diagnosis until the end of the study, death, loss of follow- up, or being given a diagnosis of cancer. Cancer incidence for the general population was obtained from GLOBOCAN 2018, and demographic information was obtained from the national institute for statistics and census. Age- and sex-specific Standardized Incidence Ratio (SIR) were then calculated. One hundred fifty-seven patients, with a mean age of 57.8 years (SD 18.3), were included. Mean patient follow-up duration was 7.37 years (SD 4.2), contributing to a total of 1158 patient/years. Fifteen patients developed a malignancy during follow-up. Cancer incidence for pSS patients was compared with the general population's incidence through SIRs. Female patient's SIRs for overall cancer was 4.17 (95% CI 2.30-6.87), non-Hodgkin lymphoma 41.40 (95% CI 10.12-102.1), multiple myeloma 41.49 (95% CI 1.14-167.28), tongue cancer 44.4 (95% CI 1.23-177.31), uterus cancer 8.39 (95% CI 0.19-40.73), lung cancer 4.51 (95% CI 0.1-22.16), and breast cancer 3.76 (95% CI 1.04-9.45). An increased overall cancer risk, and particularly for non-Hodgkin lymphoma, multiple myeloma, breast cancer and tongue cancer was observed in female pSS patients compared to control group.


Asunto(s)
Neoplasias/epidemiología , Síndrome de Sjögren/epidemiología , Adulto , Anciano , Argentina/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/diagnóstico , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Síndrome de Sjögren/diagnóstico , Factores de Tiempo , Adulto Joven
15.
Ann Pathol ; 39(1): 36-39, 2019 Feb.
Artículo en Francés | MEDLINE | ID: mdl-30322718

RESUMEN

Diffuse esophageal leiomyomatosis is a rare esophageal tumor characterized by circumferential thickening of smooth muscle layers. Diffuse esophageal leiomyomatosis can be associated with Alport's syndrome and therefore diagnosed by skin biopsy. Alport syndrome is a hereditary disease usually defined by the association of glomerular nephropathy and perceptual deafness. Here we describe the management of a young women with a diffuse esophageal leiomyomatosis and a past history of uterine leiomyoma. The surgical treatment depends on the esophageal extent of the disease. Association between diffuse esophageal leiomyomatosis and early uterine leiomyomas could be also observed and leading to Alport's syndrome diagnosis despite the absence of renal abnormalities.


Asunto(s)
Neoplasias Esofágicas/complicaciones , Leiomiomatosis/complicaciones , Nefritis Hereditaria/complicaciones , Adulto , Femenino , Humanos
17.
Ann Dermatol Venereol ; 146(11): 715-719, 2019 Nov.
Artículo en Francés | MEDLINE | ID: mdl-31606261

RESUMEN

INTRODUCTION: Ekbom syndrome is a rare disease characterized by a delusional conviction on the part of the patient of infestation with cutaneous parasites. It is rarely described in an African setting. Herein we report three cases observed in Ouagadougou. PATIENTS AND METHODS: Case 1: a 40-year-old housewife, living alone since her spouse left her, consulted for a feeling of insects under the skin and exulceration progressing over the previous year. A diagnosis was made of Ekbom syndrome in a depressed patient. Case 2: a 45-year-old bachelor, unemployed and with no children, consulted in dermatology for a sensation of continuous movement of insects under his skin, experienced over the previous six years. This sensation, which was worse in hair-covered areas, led to regular hair removal and untimely cleansing in a bid to dislodge them. Case 3: an 80-year-old patient, widowed for 3 years, consulted for a sensation of insects under her skin over the previous 2 years. This sensation was accompanied by intermittent pruritus and she removed the "insects" from her skin, which she brought to us in a sachet, but which in reality corresponded to debris of dead skin. We concluded on Ekbom syndrome in a depressive patient. CONCLUSION: These three cases of delusional parasitism observed in Ouagadougou, Burkina Faso, confirm the main clinical characteristics of Ekbom syndrome and underline the role of emotional and financial isolation, as well as pre-existing psychological difficulties, as potential triggers for this syndrome.


Asunto(s)
Delirio de Parasitosis/diagnóstico , Delirio de Parasitosis/psicología , Adulto , Anciano de 80 o más Años , Burkina Faso , Depresión/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad
18.
Ann Dermatol Venereol ; 146(3): 181-191, 2019 Mar.
Artículo en Francés | MEDLINE | ID: mdl-30691875

RESUMEN

INTRODUCTION: Basaloid follicular hamartoma (BFH) is a rare tumor first described in 1985. It bears clinical and histologic similarities with basal cell carcinoma (BCC), in particular the so-called infundibulocystic form. We performed a single-center clinicopathological study of a series of typical cases of this entity that is occasionally difficult to diagnose. MATERIALS AND METHODS: All cases of BFH seen at the Dermatopathology Laboratory of Strasbourg University Hospital were included and analyzed by means of HE staining and Ber-EP4 and PHLDA1 immunolabelling. Diagnosis was made in the event of basaloid proliferation with anastomosing cords developed from a hair follicle. Clinical data were collected from clinical files. RESULTS: We identified 15 cases in 13 patients of mean age 44.8 years (range: 4 to 90) and the sex-ratio was 5/8. Lesions consisted of flesh-colored papules measuring 0.3 to 1.2cm in diameter, without any preferential site. Three patients had multiple lesions consisting of several coalescent papules on a breast for one, sparse papules on the back for another, and hundreds of linear unilateral BFHs, associated with osseous abnormalities, characteristic of Happle-Tinschert syndrome, for the third. All tumors were limited to the superficial and mid dermis, with a vertical orientation and connection to the epidermis in 14 of the 15 patients. In some cases, the outermost cells were basophilic while the central cells were eosinophilic. Peripheral palisading and clefting were frequently observed. Keratin cysts or sebaceous ducts were consistently present, indicating follicular differentiation. Ber-EP4+ cells were restricted to the periphery of the cords and PHLDA1 was weakly expressed. DISCUSSION: BFH is a rare entity that must be differentiated from BCC. It presents as solitary or multiple lesions, either grouped in plaques or with a generalized or linear unilateral distribution. Generalized BFH may be associated with autoimmune diseases and linear unilateral BFH with osseous, dental and cerebral abnormalities in Happle-Tinschert syndrome. It is important to distinguish BFH from BCC to avoid inappropriate aggressive treatment.


Asunto(s)
Hamartoma/patología , Enfermedades de la Piel/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Basocelular/patología , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
19.
Biochem Cell Biol ; 96(2): 77-87, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-29069552

RESUMEN

Vertebrate model systems are central to characterize the outcomes of ethanol exposure and the etiology of fetal alcohol spectrum disorder (FASD), taking advantage of their genetic and morphological closeness and similarity to humans. We discuss the contribution of amphibian embryos to FASD research, focusing on Xenopus embryos. The Xenopus experimental system is characterized by external development and accessibility throughout embryogenesis, large clutch sizes, gene and protein activity manipulation, transgenesis and genome editing, convenient chemical treatment, explants and conjugates, and many other experimental approaches. Taking advantage of these methods, many insights regarding FASD have been obtained. These studies characterized the malformations induced by ethanol including quantitative analysis of craniofacial malformations, induction of fetal growth restriction, delay in gut maturation, and defects in the differentiation of the neural crest. Mechanistic, biochemical, and molecular studies in Xenopus embryos identified early gastrula as the high alcohol sensitivity window, targeting the embryonic organizer and inducing a delay in gastrulation movements. Frog embryos have also served to demonstrate the involvement of reduced retinoic acid production and an increase in reactive oxygen species in FASD. Amphibian embryos have helped pave the way for our mechanistic, molecular, and biochemical understanding of the etiology and pathophysiology of FASD.


Asunto(s)
Embrión no Mamífero/embriología , Desarrollo Embrionario , Trastornos del Espectro Alcohólico Fetal/metabolismo , Teratogénesis , Animales , Modelos Animales de Enfermedad , Embrión no Mamífero/patología , Trastornos del Espectro Alcohólico Fetal/patología , Xenopus laevis
20.
Biochem Cell Biol ; 96(2): 213-221, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-29091739

RESUMEN

Ethanol is the most important teratogen agent in humans. Prenatal alcohol exposure can lead to a wide range of adverse effects, which are broadly termed as fetal alcohol spectrum disorder (FASD). The most severe consequence of maternal alcohol abuse is the development of fetal alcohol syndrome, defined by growth retardation, facial malformations, and central nervous system impairment expressed as microcephaly and neurodevelopment abnormalities. These alterations generate a broad range of cognitive abnormalities such as learning disabilities and hyperactivity and behavioural problems. Socioeconomic status, ethnicity, differences in genetic susceptibility related to ethanol metabolism, alcohol consumption patterns, obstetric problems, and environmental influences like maternal nutrition, stress, and other co-administered drugs are all factors that may influence FASD manifestations. Recently, much attention has been paid to the role of nutrition as a protective factor against alcohol teratogenicity. There are a great number of papers related to nutritional treatment of nutritional deficits due to several factors associated with maternal consumption of alcohol and with eating and social disorders in FASD children. Although research showed the clinical benefits of nutritional interventions, most of work was in animal models, in a preclinical phase, or in the prenatal period. However, a minimum number of studies refer to postnatal nutrition treatment of neurodevelopmental deficits. Nutritional supplementation in children with FASD has a dual objective: to overcome nutritional deficiencies and to reverse or improve the cognitive deleterious effects of prenatal alcohol exposure. Further research is necessary to confirm positive results, to determine optimal amounts of nutrients needed in supplementation, and to investigate the collective effects of simultaneous multiple-nutrient supplementation.


Asunto(s)
Trastornos del Espectro Alcohólico Fetal/dietoterapia , Trastornos Neurocognitivos/dietoterapia , Consumo de Bebidas Alcohólicas/efectos adversos , Consumo de Bebidas Alcohólicas/metabolismo , Animales , Etanol/efectos adversos , Etanol/metabolismo , Trastornos del Espectro Alcohólico Fetal/genética , Trastornos del Espectro Alcohólico Fetal/metabolismo , Trastornos del Espectro Alcohólico Fetal/patología , Predisposición Genética a la Enfermedad , Humanos , Trastornos Neurocognitivos/genética , Trastornos Neurocognitivos/metabolismo , Trastornos Neurocognitivos/patología
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