More Relaxation by Deep Breath on Methacholine- Than on Exercise-Induced bronchoconstriction during the Routine Testing of Asthmatic Children

Deep inspiration (DI) dilates normal airway precontracted with methacholine. The fact that this effect is diminished or absent in asthma could be explained by the presence of bronchial inflammation. The hypothesis was tested that DI induces more relaxation in methacholine induced bronchoconstriction—solely determined by the smooth muscle contraction—than in exercise induced bronchoconstriction, which is contributed to by both smooth muscle contraction and airway wall inflammation. The respiratory conductance (Grs) response to DI was monitored in asthmatic children presenting a moderately positive airway response to challenge by methacholine (n = 36) or exercise (n = 37), and expressed as the post- to pre-DI Grs ratio (GrsDI). Both groups showed similar change in FEV1 after challenge and performed a DI of similar amplitude. GrsDI however was significantly larger in methacholine than in exercise induced bronchoconstriction (p < 0.02). The bronchodilatory effect of DI is thus less during exercise- than methacholine-induced bronchoconstriction. The observation is consistent with airway wall inflammation—that characterizes exercise induced bronchoconstriction—rendering the airways less responsive to DI. More generally, it is surmised that less relief of bronchoconstriction by DI is to be expected during indirect than direct airway challenge. The current suggestion that airway smooth muscle constriction and airway wall inflammation may result in opposing effects on the bronchomotor action of DI opens important perspective to the routine testing of asthmatic children. New crossover research protocols comparing the mechanical consequences of the DI maneuver are warranted during direct and indirect bronchial challenges

Evaluation de la survenue de troubles visuels et auditifs chez les patients de réanimation (Etude pilote)

Objectifs : Apprécier la faisabilité d'une étude visant à évaluer la survenue de troubles visuels et auditifs chez des patients de réanimation. Type d'étude : Etude monocentrique prospective de cohorte. Patients et méthodes : Les patients ventilés mécaniquement plus de 48 heures ont bénéficié de la réalisation d'un potentiel évoqué auditif, en réanimation, avant la 48ème heure de ventilation. Un mois après la sortie de réanimation, les patients étaient revus afin de réaliser un bilan ophtalmologique et audiologique associé à l'enregistrement d'un second PEA et à une consultation de post réanimation visant à évaluer la qualité de vie. Résultats : Sur un effectif total de 230 patients ventilés plus de 48 heures, 48 patients ont été inclus dans l'étude. La réalisation des premiers PEA était impossible chez 17 patients (35,4%), 6 examens étaient inexploitables (12,5%). Seuls 7 patients ont pu terminer les investigations. Une cécité unilatérale suite à une névrite optique rétrobulbaire et une surdité bilatérale ont été diagnostiquées chez deux patients au sein de cet échantillon. Conclusion : Cette étude montre des difficultés organisationnelles et techniques dans la réalisation de potentiels évoqués auditifs en réanimation. L'incidence de troubles sensoriels dans notre population est élevée, mais le faible effectif en limite l'interprétation. Une étude de puissance supérieure est nécessaire afin de confirmer ces résultats préliminaires.NANCY1-SCD Medecine (545472101) / SudocNANCY1-Bib. numérique (543959902) / SudocSudocFranceF

Pertinence du bilan sanguin (groupe sanguin, test de Coombs) réalisé en prédiction de l'hyperbilirubinémie sévère chez le nouveau-né à terme

[Résumé en français]Les sorties précoces de maternité sont de plus en plus fréquentes et ont réactualisé le problème de diagnostic et de prise en charge des ictères sévères. Actuellement, nous n avons pas de méthodes prédictives validées à notre disposition permettant de dépister les enfants à risque d ictère. L objectif de ce travail est d évaluer la pertinence du bilan sanguin (groupe sanguin, test de Coombs et élution) réalisé en 2005 chez les nouveau-nés à terme de mère ayant un groupe O ou un rhésus négatif à la maternité régionale de Nancy en prédiction de l hyperbilirubinémie sévère. 1092 nouveau-nés ont été inclus dans cette étude rétrospective. Nous avons mis en évidence une association significative entre l hyperbilirubinémie sévère et la présence d une incompatibilité foeto-maternelle du système ABO avec un test de Coombs positif . La réalisation du groupe sanguin et du test de Coombs permet donc de prédire l hyperbilirubinémie sévère dans notre population.[Résumé en anglais]The number of early discharges of newborns is growing in our country. This practice induces an increasing number of misdiagnosis and made the care of severe hyperbilirubinemia more complex. There are no validated procedures to screen efficiently high-risk children. The aim of the study is to evaluate the relevancy of blood tests (blood group, direct antiglobulin test) for assessment of hyperbilirubinemia requesting phototherapy in full-term newborns, delivered from mothers with rhesus negative or O group.This study was performed during one year in a teaching hospital (Maternité Régionale de Nancy). 1092 children were included in this retrospective study. We showed a significant association between hyperbilirubinemia and forceps delivery or vacuum extraction, hematoma, gestational age and presence of ABO incompatibility with direct antiglogulin test positive.The performance of a ABO determination and a direct antiglobulin test allows the assessment of severe hyperbilirubinemia in the studied population.NANCY1-SCD Medecine (545472101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Real-world assessment of LCI following lumacaftor-ivacaftor initiation in adolescents and adults with cystic fibrosis

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Health‐related quality of life in infants and children with interstitial lung disease

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Clinical problems in rare interstitial lung diseases

International audienceIntroduction: Interstitial lung disease ( LD) in children (chlLD) is rare and Often severe. This study aims at analyzing the ep demiology of chlLD in France from 2000 to 2022.Methods: This study was retrospective and multicentric, A questionnaire was sent to all the RespiRare centers to collect the clinical, radiological, biological, histological and genetic data of the patients.Results: 617 patients (0-18 years) were included in 42 centers. 84 patients were excluded. The median age at diagnosis was 0.3 years with 17% of familial forms, The main investigations performed were: chest CT scan (92%), bronchoalveolar avage (52%), genetic ana ysis (78%), lung biopsy (23%). The main treatments were: corticosteroids (93%), oxygen therapy (52.2%), enteral nutrition (29%), hydroxychloroqu•ne (16%), azThromycin (26%), immunosuppressive drugs (210/0). The follovFup time was from O to 18,9 years (median duration 3,5years). The survival rate at 5 years was 68%. The overall incidence and preva ence were estimated at 38/million and 35/million children respectively.Conclusion: This arge chlLD epidemiological study confirms the Span •sh data with a higher incidence and prevalence than previous y described. The arge amount Of phenotypic data collected will allow better understanding ch LD and harmonizing their management

Clinical problems in rare interstitial lung diseases

International audienceIntroduction: Interstitial lung disease ( LD) in children (chlLD) is rare and Often severe. This study aims at analyzing the ep demiology of chlLD in France from 2000 to 2022.Methods: This study was retrospective and multicentric, A questionnaire was sent to all the RespiRare centers to collect the clinical, radiological, biological, histological and genetic data of the patients.Results: 617 patients (0-18 years) were included in 42 centers. 84 patients were excluded. The median age at diagnosis was 0.3 years with 17% of familial forms, The main investigations performed were: chest CT scan (92%), bronchoalveolar avage (52%), genetic ana ysis (78%), lung biopsy (23%). The main treatments were: corticosteroids (93%), oxygen therapy (52.2%), enteral nutrition (29%), hydroxychloroqu•ne (16%), azThromycin (26%), immunosuppressive drugs (210/0). The follovFup time was from O to 18,9 years (median duration 3,5years). The survival rate at 5 years was 68%. The overall incidence and preva ence were estimated at 38/million and 35/million children respectively.Conclusion: This arge chlLD epidemiological study confirms the Span •sh data with a higher incidence and prevalence than previous y described. The arge amount Of phenotypic data collected will allow better understanding ch LD and harmonizing their management

Clinical problems in rare interstitial lung diseases

International audienceIntroduction: Interstitial lung disease ( LD) in children (chlLD) is rare and Often severe. This study aims at analyzing the ep demiology of chlLD in France from 2000 to 2022.Methods: This study was retrospective and multicentric, A questionnaire was sent to all the RespiRare centers to collect the clinical, radiological, biological, histological and genetic data of the patients.Results: 617 patients (0-18 years) were included in 42 centers. 84 patients were excluded. The median age at diagnosis was 0.3 years with 17% of familial forms, The main investigations performed were: chest CT scan (92%), bronchoalveolar avage (52%), genetic ana ysis (78%), lung biopsy (23%). The main treatments were: corticosteroids (93%), oxygen therapy (52.2%), enteral nutrition (29%), hydroxychloroqu•ne (16%), azThromycin (26%), immunosuppressive drugs (210/0). The follovFup time was from O to 18,9 years (median duration 3,5years). The survival rate at 5 years was 68%. The overall incidence and preva ence were estimated at 38/million and 35/million children respectively.Conclusion: This arge chlLD epidemiological study confirms the Span •sh data with a higher incidence and prevalence than previous y described. The arge amount Of phenotypic data collected will allow better understanding ch LD and harmonizing their management

Contribution of mutations in genes of the surfactant system to idiopathic interstitial pneumonia (IIP)

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