Lung function in poorly controlled type 1 North African diabetic patients: A case-control study

Aim: To compare the lung function parameters of poorly controlled type-1-diabetes-mellitus (T1DM) patients with age-; height and sex-matched healthy-non-smokers (HNS). Population and methods: Subjects aged 35–60 Yrs who have a poorly controlled T1DM (glycated-Haemoglobin level >7%) with a disease history of more than 10 Yrs (n = 14) and HNS subjects (n = 14) were recruited. Clinical, anthropometric and fasting biological data were collected. Plethysmographic data (flows, volumes, estimated-lung-age (ELA), lung-capacity-to-transfer-carbon-monoxide (DLCO)) were measured. Large-airway-obstructive-ventilatory-defect (LAOVD) was defined as first–second-forced-expiratory-volume (FEV1)/forced-vital-capacity (FVC) below the lower-limit-of-normal (LLN). Restrictive-ventilatory-defect (RVD) was defined as total-lung-capacity (TLC)  upper-limit-of-normal. Student t-test and chi-2 test were used to compare plethysmographic data and profiles of the two groups. Results: The two groups were matched in chronological-lung-age (CLA) (respectively 47 ± 7 vs. 50 ± 8 Yrs) and sex (7 males and 7 females in each group) and height. Compared to the HNS group, the T1DM one had significantly lower FEV1, FVC, slow-vital-capacity and maximal-mid-expiratory-flow (respectively 99 ± 11% vs. 83 ± 11%, 99 ± 9% vs. 86 ± 11%, 80 ± 8% vs. 67 ± 15% and 98 ± 23% vs. 72 ± 23%), had significantly higher TLC and RV (respectively, 105 ± 20% vs. 123 ± 24% and 108 ± 22% vs. 131 ± 24%) and had significantly higher percentage of subjects with lung-hyperinflation (7.1% vs. 43.0%). Both groups had similar percentages of LAOVD and RVD and similar corrected DLCO values. ELA of the T1DM group (57 ± 10 Yrs) was significantly higher than CLA. Conclusion: Poorly controlled T1DM seems to alter ventilatory mechanics without effect on the alveolo-capillary-membrane. In addition, it accelerates the respiratory ageing

New cancer cases at the time of SARS-Cov2 pandemic and related public health policies: A persistent and concerning decrease long after the end of national lockdown

International audienceIntroductionThe dissemination of SARS-Cov2 may have delayed the diagnosis of new cancers. This study aimed at assessing the number of new cancers during and after the lockdown.MethodsWe prospectively collected the clinical data of the 11.4 million patients referred to the Assistance Publique Hôpitaux de Paris Teaching Hospital. We identified new cancer cases between 1st January 2018 and 31st September 2020 and compared indicators for 2018 and 2019 to 2020 with a focus on the French lockdown (17th March to 11th May 2020) across cancer types and patient age classes.ResultsBetween January and September, 28,348, 27,272 and 23,734 new cancer cases were identified in 2018, 2019 and 2020, respectively. The monthly median number of new cases reached 3168 (interquartile range, IQR, 3027; 3282), 3054 (IQR 2945; 3127) and 2723 (IQR 2085; 2,863) in 2018, 2019 and 2020, respectively. From March 1st to May 31st, new cancer decreased by 30% in 2020 compared to the 2018–19 average; then by 9% from 1st June to 31st September. This evolution was consistent across all tumour types: −30% and −9% for colon, −27% and −6% for lung, −29% and −14% for breast, −33% and −12% for prostate cancers, respectively. For patients aged <70 years, the decrease of colorectal and breast new cancers in April between 2018 and 2019 average and 2020 reached 41% and 39%, respectively.ConclusionThe SARS-Cov2 pandemic led to a substantial decrease in new cancer cases. Delays in cancer diagnoses may affect clinical outcomes in the coming years

BNT162b2 vaccine-induced humoral and cellular responses against SARS-CoV-2 variants in systemic lupus erythematosus

International audienceObjectives Our aim was to evaluate systemic lupus erythematosus (SLE) disease activity and SARS-CoV-2-specific immune responses after BNT162b2 vaccination.Methods In this prospective study, disease activity and clinical assessments were recorded from the first dose of vaccine until day 15 after the second dose in 126 patients with SLE. SARS-CoV-2 antibody responses were measured against wild-type spike antigen, while serum-neutralising activity was assessed against the SARS-CoV-2 historical strain and variants of concerns (VOCs). Vaccine-specific T cell responses were quantified by interferon-γ release assay after the second dose.Results BNT162b2 was well tolerated and no statistically significant variations of BILAG (British Isles Lupus Assessment Group) and SLEDAI (SLE Disease Activity Index) scores were observed throughout the study in patients with SLE with active and inactive disease at baseline. Mycophenolate mofetil (MMF) and methotrexate (MTX) treatments were associated with drastically reduced BNT162b2 antibody response (β=−78, p=0.007; β=−122, p<0.001, respectively). Anti-spike antibody response was positively associated with baseline total immunoglobulin G serum levels, naïve B cell frequencies (β=2, p=0.018; β=2.5, p=0.003) and SARS-CoV-2-specific T cell response (r=0.462, p=0.003). In responders, serum neutralisation activity decreased against VOCs bearing the E484K mutation but remained detectable in a majority of patients.Conclusion MMF, MTX and poor baseline humoral immune status, particularly low naïve B cell frequencies, are independently associated with impaired BNT162b2 mRNA antibody response, delineating patients with SLE who might need adapted vaccine regimens and follow-up