BMC Public Health

BACKGROUND: Previous studies on asthma mortality and hospitalizations in Reunion Island indicate that this French territory is particularly affected by this pathology. Epidemiological studies conducted in schools also show higher prevalence rates in Reunion than in Mainland France. However, no estimates are provided on the prevalence of asthma among adults. In 2016, a cross-sectional survey was conducted to estimate the prevalence of asthma and to identify its associated factors in the adult population of Reunion Island. METHODS: A random sample of 2419 individuals, aged 18-44 years, was interviewed by telephone using a standardized, nationally validated questionnaire. Information was collected on the respiratory symptoms, description of asthma attacks and triggering factors for declared asthmatics, as well as data on the indoor and outdoor home environment. "Current asthma" was defined as an individual declaring, at the time of the survey, having already suffered from asthma at some point during his/her life, whose asthma was confirmed by a doctor, and who had experienced an asthma attack in the last 12 months or had been treated for asthma in the last 12 months. "Current suspected asthma" was defined as an individual presenting, in the 12 months preceding the study, groups of symptoms suggestive of asthma consistent with the literature. RESULTS: The estimated prevalence of asthma was 5.4% [4.3-6.5]. After adjustment, women, obesity, a family member with asthma, tenure in current residence and presence of indoor home heating were associated with asthma. The prevalence of symptoms suggestive of asthma was 12.0% [10.2-13.8]. After adjustment, marital status, passive smoking, use of insecticide sprays, presence of mold in the home and external sources of atmospheric nuisance were associated with the prevalence of suspected asthma. CONCLUSION: Preventive actions including asthma diagnosis, promotion of individual measures to reduce risk exposure as well as the development of study to improve knowledge on indoor air allergens are recommended

Posterior Reversible Encephalopathy Syndrome Associated with Sorafenib and Successful Retreatment

Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological syndrome characterized by acute hypertension, headache, decreased level of consciousness, visual disturbances and seizures associated with characteristic neuroimaging changes indicative of vasogenic edema of the posterior cerebral white matter. Several medical conditions have been associated with PRES including hypertensive encephalopathy and eclampsia. The use of cytotoxic and immunosuppressant drugs, such as those which target vascular endothelial growth factor (VEGF), have also been implicated. We report here the case of a 71-year-old woman with metastatic clear cell renal carcinoma who developed PRES 3 months after commencing sorafenib. Elevated blood pressure (BP) was recorded, and MRI of the brain) of the brain showed asymmetric areas of increased signal intensity within the supratentorial white matter suggestive of PRES. Clinical and radiological features rapidly improved with BP control and discontinuation of sorafenib. Sorafenib was resumed with no sign of PRES recurrence. The present case report supports the hypothesis that, in selected patients, the re-introduction of anti-VEGF therapies after PRES is feasible

Palmar fasciitis and polyarthritis, a rare paraneoplastic syndrome related to ovarian cancer

Palmar fasciitis and polyarthritis syndrome (PFPAS) is an uncommon disorder characterized by diffuse inflammation of the palmar fascia, tendon sheaths, and joints of the fingers and wrists, which rapidly progresses to flexion contracture of the hands. This paraneoplastic syndrome, originally linked to ovarian carcinoma, has also been associated with multiple different malignancies. As PFPAS usually precedes the detection of cancer, its symptoms should raise the suspicion of an underlying malignancy and should be thoroughly investigated

Retrospective analysis of definitive chemoradiotherapy with either high-dose or weekly cisplatin in patients with locally advanced squamous cell head and neck cancer : 2-year outcome.

Background: Radical radiotherapy with concurrent high-dose cisplatin (100mg/m2/3 weeks) (HDC) chemotherapy is standard of care in the non-surgical management of locally advanced head and neck squamous cell carcinoma (HNSCC). However, many patients are not eligible to receive this regimen due to poor performance status or medical co-morbidities. Low-dose cisplatin (40mg/m2/week) (LDC) is an alternative, but as robust data is still lacking, it is not known if LDC is as effective as HDC. We aimed to add insight to this matter, by reviewing our experience in treating unresectable locally advanced HNSCC. We presented intermediate results at ESMO 2015 Congress in Vienna: the 1-year overall survival (OS) was improved with HDC compared to LDC. We present the final results with the 2-year disease-free survival (DFS) and OS of these patients. Methods: Patients with locally advanced HNSCC who received radical radiotherapy associated with either HDC or LDC between december 2008 and december 2013 were retrospectively reviewed. Patients who did not complete their radiotherapy course and those who received chemoradiotherapy in adjuvant setting were excluded. Results: 72 patients were analyzed (42 in HDC regimen and 30 in LDC regimen). Most patients had carcinoma of the hypo- and oropharynx (75%). Median age was similar in the two regimens (57 years), as well as median performance status (Karnofsky index of 90%). The median number of administered cycle in the HDC and the LDC was 2 (range 1-3) and 5 (range 3-7), respectively. The estimated median DFS was 21,0 ± 8,5 months in HDC compared to 15,0 ± 11,6 months in LDC regimen (P=0.159) ; the estimated 2-year DFS was 50,0% and 43,3%, respectively. The estimated median OS was 84,0 ± 34,1 months in HDC compared to 24,0 ± 6,1 months in LDC regimen (P=0.042) ; the estimated 2-year OS was 64,3% and 50,0%, respectively. Grade 3 hematologic toxicities were observed at the same frequency (16%) in the two regimens, as well as grade 3 mucitis (34% in HDC versus 30% in LDC). Conclusion: This limited retrospective monocentric analysis showed an improvement of median overall survival with HDC compared to LDC in patients with locally advanced HNSCC treated with definitive chemoradiotherapy. Toxicities appeared similar between the two groups

Definitive chemoradiotherapy with either high-dose or weekly cisplatin in patients with locally advanced squamous cell head and neck cancer: A retrospective analysis.

Background: Radical radiotherapy with concurrent high-dose cisplatin (100mg/m2/3 weeks) chemotherapy remains the standard of care in the non-surgical management of locally advanced head and neck squamous cell carcinoma (HNSCC). However, high-dose cisplatin is an intensive regimen harboring multiple toxicities and many patients are not eligible to receive this regimen due to poor performance status or medical co-morbidities. Weekly cisplatin (40mg/m2) is an alternative regimen during radiotherapy but it is not known whether weekly cisplatin is as effective as high-dose cisplatin. This retrospective analysis compares the toxicities and the early outcome of patients with locally advanced HNSCC treated with exclusive radiotherapy associated with either high-dose cisplatin or weekly cisplatin. Material and methods: We performed a retrospective review of patients with locally advanced HNSCC who received radical radiotherapy associated with either high-dose either weekly cisplatin between december 2010 and december 2013. Patients who did not complete their radiotherapy course and those who received chemoradiotherapy in adjuvant setting were excluded for this analysis. Results: Seventy-three patients were analyzed (43 treated with high-dose cisplatin and 30 with weekly cisplatin). Most patients had carcinoma of the hypo- and oropharynx (75%). Median age was similar in the two regimens (57 years), as well as median performance status (Karnofsky 90). The median number of administered cycle in the high-dose cisplatin and the weekly cisplatin was 2 (range 1-3) and 5 (range 3-7), respectively. The one-year disease free survival for patients who received high-dose and weekly cisplatin was 67.4% and 53.3%, respectively. The one-year overall survival was 81.4% and 70.0%, respectively. Grade 3 hematologic toxicities were observed at same frequency (16%) in the two regimens, as well as grade 3 mucitis (34% in high-dose versus 30% in weekly cisplatin regimen). Conclusion: Although retrospective, our data observed a better early survival with high-dose cisplatin compared to weekly cisplatin in patients with locally advanced HNSCC treated with definitive chemoradiotherapy. Furthermore, toxicities appeared similar between the two groups, suggesting that high-dose cisplatin regimen should be preferred

Prospective randomized study comparing docetaxel, estramustine, and prednisone with docetaxel and prednisone in metastatic hormone-refractory prostate cancer

PURPOSE: To assess the efficacy and toxicity of the addition of estramustine to docetaxel (D) for the treatment of metastatic hormone-refractory prostate cancer. PATIENTS AND METHODS: One hundred fifty patients were randomly assigned to D alone (35 mg/m(2) on days 2 and 9, every 3 weeks) or D in combination with estramustine (D/E; 280 mg orally three times a day on days 1 to 5 and 8 to 12, every 3 weeks). All patients received prednisone (10 mg/d). The primary end point was prostate-specific antigen (PSA) response rate, which was defined as a decrease in PSA >/= 50% from baseline. The study was powered to test the hypothesis that D/E would improve the PSA response rate by 25%. RESULTS: The PSA response rate was not statistically different between the two groups. PSA of less than 4 ng/mL occurred in 29 (41%) of 71 patients receiving D/E and in 17 (25%) of 69 patients receiving D (P = .05). No significant differences were found for median time to PSA progression (D/E, 6.9 months; D, 7.3 months) or median overall survival time (D/E, 19.3 months; D, 21 months). More patients had at least one grade 3 or 4 toxicity with D/E (45%) compared with D (21%; P = .005), mainly as a result of grade 3 or 4 GI toxicity (P = .05). Serious adverse events were more frequent with D/E (n = 20) than with D (n = 9; P = .04). CONCLUSION: The addition of estramustine to weekly D does not provide any clinically relevant advantage. Both regimens are well tolerated, although the toxicity profile favors D without estramustine

A single course of 2-chloro-deoxyadenosine does not eradicate leukemic cells in hairy cell leukemia patients in complete remission

The nucleoside analog 2-chlorodeoxyadenosine (2-CdA) has recently emerged as a most promising treatment for hair-cell leukemia (HCL). The response rates are high regardless of prior therapy, and the duration of complete responses (CR) after a single course of treatment is longer than with any other therapeutic agent. We investigated the presence of minimal residual disease (MRD) in ten HCL patients treated in our institution with 2-CdA. The presence of residual leukemic cells was investigated in patients in CR following one course of treatment, using the polymerase chain reaction (PCR) and heavy-chain immunoglobulin genes (IgH), or TCR delta derived clonospecific probes. Eight patients achieved a complete remission after a single course of treatment, as evaluated at 6 months. Among these patients, seven are still in CR with a median follow-up of 12 months (range, 6-20 months) and one has relapsed after 15 months. Using PCR, all the evaluable patients remaining in CR showed persistent evidence of detectable MRD with no sign of decrease over the observation period. From this small series, we conclude that a single course of 2-CdA does not eradicate HCL and that persistence of residual leukemic cells appears to be common in patients in complete morphologic remission. Whether persistence of MRD will have an impact on long-term outcome, or whether HCL patients in morphologic CR with persistent MRD will remain so, is a matter of longer follow-up