15 research outputs found

    La chimie des élégances (la parfumerie parisienne au XIXe siÚcle)

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    PARIS-CNAM (751032301) / SudocPARIS-BIUP (751062107) / SudocCLUNY-Arts et MĂ©tiers (711372301) / SudocSudocFranceF

    Bacterial keratitis treated by strengthened antibiotic eye drops: An 18 months review of clinical cases and antibiotic susceptibilities

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    International audiencePURPOSE:To describe, in patients treated for infectious keratitis, the microorganisms identified and their antibiotic susceptibility over a period of 18 months.METHOD:Retrospective, descriptive, non-comparative study. Medical and biological data were extracted from the patients' file treated with strengthened antibiotic eye drops at Angers University Hospital between January 2015 and June 2016. The main elements noted were the bacteria involved and their susceptibility to antibiotics. Patients' visual acuity at the start and end of treatment was compared.RESULTS:Forty-eight patients were included. Almost one bacterium was identified in 31 patients, totalling 43 pathogens of 24 different species. The most frequently found microorganisms were Gram-positive cocci (55.8%), including Staphylococcus Aureus (14.0%) and Epidermidis (14.0%). All Gram-negative bacilli amounted to 30.2% of the identified bacteria, including 9.3% of Pseudomonas aeruginosa. None of the Gram-positive cocci were resistant to vancomycin and all Gram-negative bacilli were susceptible to ceftazidime and amikacin. Following treatment with at least one of the three antibiotic eye drops produced by our pharmacy (amikacin at 50mg/mL, ceftazidime at 50mg/mL and vancomycin at 25mg/mL), patients' visual acuity was significantly improved (P=0.043).CONCLUSION:The study helped identify the bacterial ecology of patients admitted for infectious keratitis. Among the bacteria identified, none were found to be resistant to any of the three strengthened antibiotic eye drops produced by the hospital pharmacy. These eye drops allowed for a rapid and effective treatment of patients and the improvement of their visual acuity before even identifying the bacteria.ObjectifDĂ©crire, les microorganismes responsables des kĂ©ratites bactĂ©riennes.MĂ©thodeLes donnĂ©es mĂ©dicales et biologiques ont Ă©tĂ© extraites rĂ©trospectivement des dossiers mĂ©dicaux des patients traitĂ©s pour kĂ©ratites bactĂ©riennes par collyres antibiotiques renforcĂ©s. L’identification des germes ainsi que leur sensibilitĂ© aux antibiotiques ont Ă©tĂ© notĂ©es. Les acuitĂ©s visuelles des patients avant l’instauration du traitement et Ă  la fin de celui-ci ont Ă©tĂ© comparĂ©es.RĂ©sultatsAu total, 48&nbsp;patients ont Ă©tĂ© inclus. Au moins un germe bactĂ©rien a Ă©tĂ© identifiĂ© chez 31&nbsp;patients, soit 43&nbsp;germes parmi 24&nbsp;espĂšces diffĂ©rentes. Les cocci Ă  Gram positif ont Ă©tĂ© les germes les plus frĂ©quemment rencontrĂ©s (55,8&nbsp;%), dont Staphyloccocus aureus (14,0&nbsp;%), et Epidermidis (14,0&nbsp;%). Les bacilles Ă  Gram nĂ©gatif ont reprĂ©sentĂ© 30,2&nbsp;% des germes identifiĂ©s, incluant Pseudomonas aeruginosa (9,3&nbsp;%). Aucun cocci Ă  Gram positif n’a Ă©tĂ© rĂ©sistant Ă  la vancomycine, tous les bacilles Ă  Gram nĂ©gatif ont Ă©tĂ© sensibles Ă  la ceftazidime et l’amikacine. AprĂšs traitement avec au moins l’un des trois collyres antibiotiques renforcĂ©s produits par la pharmacie du CHU d’Angers (amikacine 50&nbsp;mg/mL, ceftazidime 50&nbsp;mg/mL ou vancomycine 25&nbsp;mg/mL), l’acuitĂ© visuelle des patients a Ă©tĂ© significativement amĂ©liorĂ©e (p&nbsp;=&nbsp;0,043).ConclusionL’écologie bactĂ©rienne des patients hospitalisĂ©s pour kĂ©ratite bactĂ©rienne et nĂ©cessitant un traitement par collyre antibiotique renforcĂ© est dĂ©sormais connue. Parmi les bactĂ©ries identifiĂ©es, aucune n’a Ă©tĂ© rĂ©sistante Ă  l’un des trois collyres antibiotiques renforcĂ©s produits par la pharmacie du CHU. Ces antibiotiques ont permis une amĂ©lioration rapide et significative de l’acuitĂ© visuelle des patients.</p

    Prevalence of Enthesopathies in Adults With X-linked Hypophosphatemia: Analysis of Risk Factors

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    International audienceAbstract Context Enthesopathies are the determinant of a poor quality of life in adults with X-linked hypophosphatemia (XLH). Objective To describe the prevalence of patients with enthesopathies and to identify the risk factors of having enthesopathies. Methods Retrospective study in the French Reference Center for Rare Diseases of the Calcium and Phosphate Metabolism between June 2011 and December 2020. Adult XLH patients with full body X-rays performed using the EOSŸ low-dose radiation system and clinical data collected from medical records. The main outcome measures were demographics, PHEX mutation, conventional treatment, and dental disease with the presence of enthesopathies. Results Of the 114 patients included (68% women, mean age 42.2 ± 14.3 years), PHEX mutation was found in 105 patients (94.6%), 86 (77.5%) had been treated during childhood. Enthesopathies (spine and/or pelvis) were present in 67% of the patients (n = 76). Patients with enthesopathies were significantly older (P = .001) and more frequently reported dental disease collected from medical records (P = .03). There was no correlation between the PHEX mutations and the presence of enthesopathies. Sixty-two patients had a radiographic dental examination in a reference center. Severe dental disease (number of missing teeth, number of teeth endodontically treated, alveolar bone loss, and proportion of patients with 5 abscesses or more) was significantly higher in patients with enthesopathies. Conclusion Adult XLH patients have a high prevalence of enthesopathies in symptomatic adults patients with XLH seen in a reference center. Age and severe dental disease were significantly associated with the presence of enthesopathies

    Elastase 2 is expressed in human and mouse epidermis and impairs skin barrier function in Netherton syndrome through filaggrin and lipid misprocessing

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    The human epidermis serves 2 crucial barrier functions: it protects against water loss and prevents penetration of infectious agents and allergens. The physiology of the epidermis is maintained by a balance of protease and antiprotease activities, as illustrated by the rare genetic skin disease Netherton syndrome (NS), in which impaired inhibition of serine proteases causes severe skin erythema and scaling. Here, utilizing mass spectrometry, we have identified elastase 2 (ELA2), which we believe to be a new epidermal protease that is specifically expressed in the most differentiated layer of living human and mouse epidermis. ELA2 localized to keratohyalin granules, where it was found to directly participate in (pro-)filaggrin processing. Consistent with the observation that ELA2 was hyperactive in skin from NS patients, transgenic mice overexpressing ELA2 in the granular layer of the epidermis displayed abnormal (pro-)filaggrin processing and impaired lipid lamellae structure, which are both observed in NS patients. These anomalies led to dehydration, implicating ELA2 in the skin barrier defect seen in NS patients. Thus, our work identifies ELA2 as a major new epidermal protease involved in essential pathways for skin barrier function. These results highlight the importance of the control of epidermal protease activity in skin homeostasis and designate ELA2 as a major protease driving the pathogenesis of NS

    Adjuvant endocrine therapy uptake, toxicity, quality of life, and prediction of early discontinuation

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    Abstract Background Many patients receiving adjuvant endocrine therapy (ET) for breast cancer experience side effects and reduced quality of life (QoL) and discontinue ET. We sought to describe these issues and develop a prediction model of early discontinuation of ET. Methods Among patients with hormone receptor–positive and HER2-negative stage I-III breast cancer of the Cancer Toxicities cohort (NCT01993498) who were prescribed adjuvant ET between 2012 and 2017, upon stratification by menopausal status, we evaluated adjuvant ET patterns including treatment change and patient-reported discontinuation and ET-associated toxicities and impact on QoL. Independent variables included clinical and demographic features, toxicities, and patient-reported outcomes. A machine-learning model to predict time to early discontinuation was trained and evaluated on a held-out validation set. Results Patient-reported discontinuation rate of the first prescribed ET at 4 years was 30% and 35% in 4122 postmenopausal and 2087 premenopausal patients, respectively. Switching to a new ET was associated with higher symptom burden, poorer QoL, and higher discontinuation rate. Early discontinuation rate of adjuvant ET before treatment completion was 13% in postmenopausal and 15% in premenopausal patients. The early discontinuation model obtained a C index of 0.62 in the held-out validation set. Many aspects of QoL, most importantly fatigue and insomnia (European Organization for Research and Treatment of Cancer QoL questionnaire 30), were associated with early discontinuation. Conclusion Tolerability and adherence to ET remains a challenge for patients who switch to a second ET. An early discontinuation model using patient-reported outcomes identifies patients likely to discontinue their adjuvant ET. Improved management of toxicities and novel more tolerable adjuvant ETs are needed for maintaining patients on treatment
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