Pancreatic Metastasis from Prostate Cancer

The pancreas is an unusual location for metastases from other primary cancers. Rarely, pancreatic metastases from kidney or colorectal cancers have been reported. However, a variety of other cancers may also spread to the pancreas. We report an exceptional case of pancreatic metastasis from prostate cancer. Differences in management between primary and secondary pancreatic tumors make recognition of metastases to the pancreas an objective of first importance. Knowledge of unusual locations for metastatic spread will reduce diagnostic delay and lead to a timely delivery of an appropriate treatment

The Clinical Variability of Maternally Inherited Diabetes and Deafness Is Associated with the Degree of Heteroplasmy in Blood Leukocytes

Context: Maternally inherited diabetes and deafness (MIDD) is a rare form of diabetes with a matrilineal transmission, sensorineural hearing loss, and macular pattern dystrophy due to an A to G transition at position 3243 of mitochondrial DNA (mtDNA) (m.3243A>G). The phenotypic heterogeneity of MIDD may be the consequence of different levels of mutated mtDNA among mitochondria in a given tissue. Objective: The aim of the present study was thus to ascertain the correlation between the severity of the phenotype in patients with MIDD and the level of heteroplasmy in the blood leukocytes. Participants: The GEDIAM prospective multicenter register was initiated in 1995. Eighty-nine Europid patients from this register, with MIDD and the mtDNA 3243A>G mutation, were included. Patients with MELAS (mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes) or with mitochondrial diabetes related to other mutations or to deletions of mtDNA were excluded. Results: A significant negative correlation was found between levels of heteroplasmy and age of the patients at the time of sampling for molecular analysis, age at the diagnosis of diabetes, and body mass index. After adjustment for age at sampling for molecular study and gender, the correlation between heteroplasmy levels and age at the diagnosis of diabetes was no more significant. The two other correlations remained significant. A significant positive correlation between levels of heteroplasmy and HbA1c was also found and remained significant after adjustment for age at molecular sampling and gender. Conclusions: These results support the hypothesis that heteroplasmy levels are at least one of the determinants of the severity of the phenotype in MIDD. Heteroplasmy levels are at least one of the determinants of the severity of the phenotype of maternally inherited diabetes and deafness

Prospective : comment traitera-t-on les tumeurs rénales et prostatiques et urothéliales dans 10 ans ?

International audienceForward thinking does not seek to predict the future, to unveil it as if it were already in existence, rather, its aim is to help us to construct it. Although today's epidemiological and therapeutic situations for urogenital tumours can evolve over the next 10~years, diagnostic and therapeutic methods, as well as the treatment and implementation of innovations, are already rapidly changing. Rather than reducing our prospective thinking to the therapeutic treatment of cancer only, we will aim at proposing a global sanitary vision that includes diagnosis, therapies, prevention, routine utilisation of technomedicine, genomics and even nanomedicine. This journey into the near future of tomorrow's cancerology holds the promise of being better adapted to the evolution of the medical thinking process. Imagining the way we will be treating renal, prostatic and urothelial tumours in 10~years' time is as much an introspection into our present day treatment system as a projection into its hoped for future evolution.La prospective n’a pas pour objet de prédire l’avenir, de nous le dévoiler, comme s’il s’agissait d’une chose déjà faite, mais de nous aider à le construire. Si le contexte épidémiologique et thérapeutique actuel de ces tumeurs urogénitales peut évoluer en 10 ans, les méthodes diagnostiques et thérapeutiques d’aujourd’hui, ainsi que les concepts de prise en charge et l’implémentation des innovations sont déjà en pleine mutation. Plutôt que de focaliser la prospective à 10 ans uniquement sur la thérapeutique des cancers, nous chercherons à proposer une vision globale sanitaire incluant diagnostics, thérapeutiques, préventions, et l’utilisation en routine de la technomédecine, la génômique ou encore la nanomédecine. Ce voyage, dans un futur proche dans la cancérologie de demain, promet d’être plus adapté à l’évolution du mode de penser la médecine. L’exercice d’imagination de la manière dont nous traiterons les tumeurs rénales, prostatiques et urothéliales dans 10 ans, est autant une introspection au sein de notre actuel système de soins, que la manière dont nous souhaitons et pouvons le voir évoluer

How did we take care of our older cancer patients during the first COVID-19 wave? The French experience

International audienceBACKGROUND: The management of older cancer patients has been highly challenging for clinicians in a health-care system operating at maximum capacity during the COVID-19 pandemic. PATIENTS AND METHODS: We analyzed data from 9 different institutions. The primary endpoint was to assess the prevalence of adapted patient care during the pandemic for elderly cancer patients. The secondary endpoint was to assess the incidence of hospitalization and mortality due to COVID-19. All patients were older than 65years of age. RESULTS: We analyzed data from 332 outpatients’ case files between 9th of March and 30th of April 2020. The median age was 75years (range: 65-101) and 53% were male. Because of the COVID-19 pandemic, more than half of the outpatients received modified patient care, defined as postponement or cancellation of surgery, irradiation scheme adapted, systemic treatment or the use of telemedicine. Among patients with localized cancer, 60% had a change in management strategy due to the pandemic. Changes in management strategy were made for 53% of patients at the metastatic stage. GCSF was used , in 83% of patients, increasing considerably in the context of the pandemic. Sixty-nine percent of physicians used telemedicine. In the final analysis, only one patient was hospitalized for COVID-19 infection. No deaths due to COVID-19 were reported in elderly cancer patients during this time period. CONCLUSION: Our study is the first to assess modification of patient care in elderly cancer outpatients during an epidemic. With this unprecedented crisis, our objective is to protect our patients from infection via protective barrier measures and social distancing, but also to guarantee the continuity of cancer care without overexposing this fragile population. Physicians were able to adapt their practice and used new forms of management, like telemedicine

Evaluation of medical practices in oncology in the context of the COVID-19 pandemic in France: Physicians' point of view: the PRATICOVID study

International audienceThe cancer population seems to be more susceptible to COVID-19 infection and have worse outcomes. We had to adapt our medical practice to protect our patients without compromising their cancer prognosis. The national PRATICOVID study aims to describe the adaptation of cancer patient care for this population. We analyzed data from nine different institutions. The primary endpoint was to assess the prevalence of adapted patient care during the pandemic. The secondary endpoints were to describe the point of view of clinicians and patients during and after the pandemic. We analyzed 435 medical procedures between 9th of March and 30th of April. Because of the COVID-19 pandemic, 47.6% of the outpatients received modified patient care. Twenty-four percent of scheduled surgeries were postponed, or were performed without perioperative chemotherapy, 18.4% followed a hypofractioned schedule, and 57% had an adaptive systemic protocol (stopped, oral protocol, and spacing between treatments). Seventy percent of physicians used telemedicine. During this period, 67% of the physicians did not feel distressed taking care of their patients. However, 70% of physicians are worried about the aftermath of the lockdown, as regards future patient care. The PRATICOVID study is the first to assess modification of patient care in cancer outpatients during an epidemic. With this unprecedented crisis, physicians were able to adapt their practice in order to protect their patients against the virus while ensuring continuity of patient care. But physicians are worried about the aftereffects of the lockdown specifically in regard to care pathway issues

Sex Differences in the Occurrence of Major Clinical Events in Elderly People with Type 2 Diabetes Mellitus Followed up in the General Practice

International audienceAims The main aim of the present work was to assess if sex influences the occurrence of major clinical events in elderly people with type 2 diabetes followed up in the primary care. Methods 983 subjects aged 65-years with type 2 diabetes were included by 213 general practitioners and followed up prospectively for three years. Major clinical events were recorded every six month. The first endpointwas a composite of all-cause death and majorvascular events (acute coronary syndrome, non-fatal stroke or transient ischemic attack, or revascularization for peripheral artery disease). The second endpoint was all-cause hospitalization. The occurrence of each endpoint was analyzed in orderto estimate the role of sex and determine other predictors of major clinical events. Results At baseline, women were older than men but they had a lower prevalence of coexisting diseases (cardiovascular disease and cancer) and equivalent diabetes control (Glycated hemoglobin A1C: 6.9 %+/- 0.9 vs. 7.0 %+/- 1.1). Overthe follow-up period, women were at lower risk to develop the composite endpoint (HR 0.60, 95% CI 0.40-0.91, p = 0.016) and the hospitalization endpoint (OR 0.71, 95 % CI 0.52-0.96, p = 0.029). Coexisting diseases, functional ability and concomitant medications emerged as significant predictors of both endpoints. Conclusions Elderly women with well-controlled type 2 diabetes were less likely to experience major clinical events than their male counterparts. More studies are needed to determine the reasons for the higher hospitalization rate in men

KRACH SANITAIRE : la crise, à quel prix ?

Aujourd’hui, notre système de protection sociale est malade. Ce ne sont plus seulement les populations auxquelles une association comme Médecins du Monde apporte assistance chaque jour qui sont concernées. A côté des migrants, des sans-logements, des travailleurs du sexe ou encore des usagers de drogues, c’est de plus en plus la population générale qui rencontre des difficultés d’accès aux soins. Prendre la mesure de l’évolution de la précarité chez certaines populations, décrire les tensions et difficultés actuelles auxquelles sont exposés certains dispositifs, comme l’Aide médicale d’Etat ou le Droit au séjour pour maladie, tels sont les objectifs de ce numéro. Il réunit les représentants de structures qui assurent aujourd’hui le « filet de sécurité sociale », des observateurs de cette exclusion sanitaire montante et des acteurs qui innovent au quotidien. Avec eux, dans le contexte de crise économique et financière que nous connaissons, et alors que se dessine une tendance à l’individualisation des risques, il s’agit d’obtenir des éléments de réponse à la question qui surplombe ces problématiques : quel système de santé solidaire souhaitons-nous construire

Villes inondables : prévention, adaptation, résilience

International audienceLes villes européennes, souvent installées le long de fleuves ou sur des rivages maritimes, s’inquiètent de leur vulnérabilité aux inondations, un risque accru aujourd’hui par les dérèglements climatiques, la pression démographique et la compétitivité urbaine. La mise en valeur récréative et environnementale de ces rives par des projets urbains, en cherchant à mieux articuler la ville avec la présence de l’eau, entraîne des débats sur l’acceptabilité de ces aménagements potentiellement inondables. Entre prise en compte du risque et attractivité, de nouvelles stratégies innovantes voient le jour qui, tout en renforçant les techniques de prévention traditionnelles, proposent des dispositifs urbains et des modes de vie mieux adaptés à la présence de l’eau sur le territoire. Les exemples étudiés dans cet ouvrag montrent une forte capacité d’innovation de la part de ces villes pour gérer les ressources liées à l’eau, optimiser des stratégies fonctionnelles et temporelles d’aménagement du territoire, imaginer des dispositifs architecturaux et techniques résistants à l’eau, et mettre en valeur ces nouveaux paysages [d'après éd.

Impact of diabetes on COVID-19 prognosis beyond comorbidity burden: the CORONADO initiative

International audienceAims/hypothesis: Diabetes has been recognised as a pejorative prognostic factor in coronavirus disease 2019 (COVID-19). Since diabetes is typically a disease of advanced age, it remains unclear whether diabetes remains a COVID-19 risk factor beyond advanced age and associated comorbidities. We designed a cohort study that considered age and comorbidities to address this question.Methods: The Coronavirus SARS-CoV-2 and Diabetes Outcomes (CORONADO) initiative is a French, multicentric, cohort study of individuals with (exposed) and without diabetes (non-exposed) admitted to hospital with COVID-19, with a 1:1 matching on sex, age (±5 years), centre and admission date (10 March 2020 to 10 April 2020). Comorbidity burden was assessed by calculating the updated Charlson comorbidity index (uCCi). A predefined composite primary endpoint combining death and/or invasive mechanical ventilation (IMV), as well as these two components separately, was assessed within 7 and 28 days following hospital admission. We performed multivariable analyses to compare clinical outcomes between patients with and without diabetes.Results: A total of 2210 pairs of participants (diabetes/no-diabetes) were matched on age (mean±SD 69.4±13.2/69.5±13.2 years) and sex (36.3% women). The uCCi was higher in individuals with diabetes. In unadjusted analysis, the primary composite endpoint occurred more frequently in the diabetes group by day 7 (29.0% vs 21.6% in the no-diabetes group; HR 1.43 [95% CI 1.19, 1.72], p<0.001). After multiple adjustments for age, BMI, uCCi, clinical (time between onset of COVID-19 symptoms and dyspnoea) and biological variables (eGFR, aspartate aminotransferase, white cell count, platelet count, C-reactive protein) on admission to hospital, diabetes remained associated with a higher risk of primary composite endpoint within 7 days (adjusted HR 1.42 [95% CI 1.17, 1.72], p<0.001) and 28 days (adjusted HR 1.30 [95% CI 1.09, 1.55], p=0.003), compared with individuals without diabetes. Using the same adjustment model, diabetes was associated with the risk of IMV, but not with risk of death, within 28 days of admission to hospital.Conclusions/interpretation: Our results demonstrate that diabetes status was associated with a deleterious COVID-19 prognosis irrespective of age and comorbidity status.Trial registration: ClinicalTrials.gov NCT04324736

Blood glucose levels and COVID-19. Reply to Sardu C, D’Onofrio N, Balestrieri ML et al [letter] and Lepper PM, Bals R, Jüni P et al [letter]

International audienc