Early infectious risk in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis according to remission-induction therapy.

OBJECTIVE: Few comparative data exist on early infections secondary to remission-induction therapy (RIT) with rituximab (RTX) versus cyclophosphamide (CYC) in newly diagnosed anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) patients. We compared and analysed the rates and predictors of severe infection in such patients within the first 6 months following RIT. METHOD: From the Caen University Hospital databases, we included all consecutive adults newly diagnosed with ANCA-positive granulomatosis with polyangiitis or microscopic polyangiitis between January 2006 and December 2019. We compared rates of survival without severe infection and survival without infections of any severity within 6 months of RIT and used a multivariate Cox analysis to identify predictors of infection. RESULTS: We included 145 patients, 27 in the RTX and 118 in the CYC group. Patients in the RTX group more frequently had pneumococcal vaccination (p < 0.01) and creatinine < 150 µmol/L; other characteristics were comparable between the two groups. Overall, 37 severe infections and 65 infections of any severity were recorded. Rates of survival without severe infection were similar in both groups (p = 0.69), but survival without infections of any severity was lower in the RTX group (p = 0.005). In multivariate analysis, risk factors at diagnosis for severe infections included chronic urinary tract disease, dialysis, and absence of trimethoprim-sulfamethoxazole prophylaxis (p < 0.01 each). CONCLUSIONS: Within 6 months of RIT, rates of survival without severe infection were similar in newly diagnosed ANCA-positive AAV patients treated with RTX or CYC, but survival rates without infections of any severity appeared to be lower with RTX treatment.

Efficacy, tolerance and acceptability of pulsed dye laser on facial and neckline telangiectasias in systemic scleroderma: a prospective open-label monocentric study in 21 patients.

Facial and neckline telangiectasias have an underestimated yet important impact on quality of life of patients with systemic scleroderma (SSc). This monocentric, prospective, open-label, intra-patient comparative study was conducted in 21 consecutive patients with SSc. Patients underwent 4 sessions of PDL 8 weeks apart. A final quadruple assessment was performed by several raters 2 months after the last session, based on the following criteria: change in telangiectasia number; subjective improvement score (LINKERT scale); impact on the quality of life (QoL; SKINDEX score); visual analog pain scale; adverse effects (AEs), including treatment discontinuation for PDL-induced purpura and patient satisfaction. The mean telangiectasia number decreased by 5 (32%) at the end of the protocol. Eighteen patients (85.7%) reported an improvement or a strong improvement, versus 73.81% for the expert committee. Immediate session pain (mean = 3.4/10) was slightly less than overall pain (mean = 4.6/10). Ten patients (47%) experienced at least one AE (oozing/crusts, edema, epidermal blistering), including PDL-induced purpura in 3 patients (14%). AEs were mostly transient (<1 week) and mild (CTCAE grade 1). All QoL parameters improved after treatment, and 85% of patients were satisfied.

[IgA vasculitis secondary to Klebsiella pneumoniae infection]. / Vascularite à IgA satellite d'une pneumopathie abcédée à Klebsiella pneumoniae.

INTRODUCTION: IgA vasculitis is a leucocytoclastic vasculitis of small vessels with immune deposits of IgA. It tends to occur in a post-infectious context, though the pathogenic agent is rarely found. OBSERVATION: We report, for the first time, the case of an 81-year old patient who presented with an acute IgA vasculitis with cutaneous and joint involvement during a Klebsiella pneumoniae respiratory infection. Remission of vasculitis was observed after antibiotic therapy alone. CONCLUSION: This observation reminds us of the need to search carefully for any pathogenic agent that may be driving IgA vasculitis as this may be important both for understanding aetiology and for treatment.

Clinical benefit of infectious diseases consultation: a monocentric prospective cohort study.

PURPOSE: To determine the association of clinical outcomes with the adherence to Infectious Diseases Consultation (IDC) recommendations. METHODS: From March to August 2009, all patients hospitalized in our hospital, for whom an IDC was requested, were prospectively enrolled. The adherence to recommendations was ascertained after 72 h from the IDC. The primary objective of the study was to evaluate the clinical cure rate 1 month after the IDC, according to the adherence to IDC recommendations. RESULTS: An IDC was requested for 258 inpatients. The infectious disease (ID) was most often non-severe (66%), community-acquired (62%), and already under treatment (47%). IDC proposals were most often formulated via a formal consultation (57%). Physicians' adherence to IDC recommendations was 87% for diagnostic tests and 90% for antibiotherapy. In the multivariate analysis, severe infections and direct consultation were independently associated with increased odds of adherence to recommendations for performing diagnostic tests (odds ratios 5.4 and 4.0, respectively). The overall clinical cure rate was 84% and this did not differ according to the adherence to IDC recommendations for diagnostic tests (84.3 vs. 71.4%, p = 0.15) and antimicrobial treatment (84.8 vs. 77.8%, p = 0.34). CONCLUSIONS: Some limitations of the study may explain the lack of evidence of a clinical benefit, such as the very high level of adherence to IDC recommendations and the low proportion of severe infections. However, clinical improvement was always better when recommendations were followed. Therefore, further larger randomized multicentric studies including more patients suffering from more severe IDs may be needed in order to demonstrate a clinical impact.

[Trimetazidine-induced encephalopathy with choreiform disorders: a case report]. / Encéphalopathie avec mouvements choréiformes induits par la trimétazidine: à propos d'un cas.

Trimetazidine is known to induce parkinsonism but choreiform disorders have not yet been described with this drug. A 88-year-old patient treated with trimetazidine developed choreiform movements, gait disorders, tremor and visual hallucinations. These symptoms disappeared after drug withdrawal. Although this drug contains a piperazinic ring like other anti-dopaminergic drugs which are already known to potentially induce chorea like neuroleptics and some anti-convulsive drugs. When a patient treated with trimetazidine develops or worsens motor disorders (parkinsonism or choreiform disorders), this drug must be stopped.

[Effects of ambulatory respiratory rehabilitation on exercise tolerance and quality of life in chronic obstructive lung disease patients]. / Effets de la réhabilitation respiratoire en ambulatoire sur la tolérance à l'effort et la qualité de vie des patients atteints de bronchopneumopathie chronique obstructive.

Respiratory rehabilitation is a multidisciplinary medical approach which allows a total care of patients suffering from COPD. Optimisation of bronchodilator treatment, health education, cessation of smoking, dietetic, relaxation and re-entrainment to effort. We report out experience concerning 88 BPCO (mean age 62.1, FEV1 of 1.4 litres; or 48% of predicted normal); these 88 patients were cared for on an ambulatory basis at our centre for two hours per session, three times per week for seven weeks. The objective results were analysed on exercise tests before and after treatment. For ventilation, there was a significant improvement in the power developed (from 45.5+/-17.1 to 53.4+/-23 watts; p<0.001) without any change in the oxygen consumption (VO2), ventilation (VE) or heart rate (FC) and of oxygen pulse (VO2/FC). For the same level of power (80% of maximum power for the initial exercise test) there was a significant lowering of ventilation (V=33.5+/-9.4 to 30.7+/-7.4 litres per minute, p<0.001), cardiac frequency (FC: from 116.9+/-16 to 111.1+/-13.1 beats per minute, p<0.001) as well as the oxygen pulse (VO2/FC: from 7.9+/-2.7 to 8.3+/-3.7). At the maximum on the exercise test all the parameters studied were significantly better: watts, VO2, VE, cardiac frequency and VO2/FC. A study of the visual analogue scale (EVA), analysing sleep, anxiety, dyspnoea and the physical aspects showed a significant improvement in the four subjective parameters. Respiratory rehabilitation of BPCO practiced as an out patient has shown an improvement in exercise tolerance in every day activities and improvement in dyspnoea and in the quality of life.

[The possible endometrial risk of ovarian stimulation. Apropos of 3 cases]. / Du risque endométrial de la stimulation ovarienne. A propos de trois cas.

Three cases of adenomatous hyperplasia of the endometrium--one of them degenerated--have been reported in young women provided with ovulation stimulation. The association between these hormonal therapies and the adenocarcinoma or its antecedents signs, is particularly disturbing. However, it's difficult to establish a relationship between cause and effect. Indeed the women who suffer from an ovarian sterility are a group exposed to a cancer of the endometrium independently of any other iatrogenic agent. The method of detection is yet to be found, as is the mode of conduct which can reconcile the risk of a carcinoma and the desire of pregnancy.

Serum and seminal gonadotropins in normal and infertile men: correlations with sperm count, prolactinemia, and seminal prolactin.

Serum and seminal gonadotropins were evaluated in 30 normozoospermic and 30 oligozoospermic patients. Mean values of basal serum gonadotropins were higher in the oligozoospermic group than in the normozoospermic group: 3.8 versus 1.8 ng/ml and 3.3 versus 2.2 ng/ml for FSH and LH, respectively. Seminal FSH levels were comparable in the normozoospermic and oligozoospermic groups (0.8 versus 0.8 ng/ml, respectively) and were constantly lower than serum FSH levels in both groups. Seminal LH values were constantly higher than serum LH values in the normozoospermic group, whereas in the oligozoospermic group seminal LH values were higher, similar, or lower than serum LH values. However, no significant difference was noted between the two groups for seminal LH values: 3.6 (normozoospermic group) versus 4.1 ng/ml (oligozoospermic group).