Added Value of Anti-CD74 Autoantibodies in Axial SpondyloArthritis in a Population With Low HLA-B27 Prevalence

Axial spondyloarthritis (axSpA) is often diagnosed late due to the non-specific nature of its main symptom [chronic back pain (CBP)] and to the paucity of diagnostic markers, particularly in regions with low HLA-B27 prevalence, such as the Middle-East. We tested the performance of IgG4 and IgA anti-CD74 antibodies as an early diagnostic marker for axSpA, compared with the performance of HLA-B27, in Lebanon. Sera of axSpA patients diagnosed by the rheumatologist and also fulfilling the imaging arm of the ASAS criteria (patients) and of blood donors (BD) (controls) were analyzed for HLA-B27, IgG4 and IgA anti-CD74, blinded to clinical characteristics. Receiver Operating Characteristic curves were constructed to identify an optimal cut-off point for anti-CD74 antibodies. Diagnostic properties were calculated (sensitivity, specificity, positive, and positive predictive values (PPV, NPV), Likelihood ratios) for each marker. Forty-nine axSpA patients and 102 BD were included in the final analysis. IgA anti-CD74 correlated poorly with axSpA (Area Under the Curve (AUC) 0.657), whereas IgG4 anti-CD74 had a good discriminative value (AUC 0.837). Respectively, for HLA-B27, IgG4 anti-CD74, and the combination of both, we found a sensitivity of 33-92-33%, specificity of 96-79-98%, PPV 80-68-89%, NPV 75-95-75%, and LR+ 8.2-4.4-16.5. IgG4 anti-CD 74 were positive in 88% of HLA-B27 negative axSpA patients, and correlated with BASDAI. In this first study in a population with low HLA-B27 prevalence, IgG4 anti-CD74 antibodies combined with HLA-B27 showed higher diagnostic value than HLA-B27 alone for early axSpA. IgG4 anti-CD74 should be considered for further evaluation as an early axSpA diagnostic marker in future dedicated research, particularly in patients with CBP

Effect of clonidine versus dexmedetomidine on pain control after laparoscopic gastric sleeve: A prospective, randomized, double-blinded study

Background: The use of opioids in surgeries for morbidly obese patients could cause respiratory depression. Therefore, alternative analgesics are needed to improve anesthetic management for obese patients. The objective of this study was to compare the effect of dexmedetomidine and clonidine on pain as well as analgesic consumption at 24 h postoperatively in patients undergoing laparoscopic gastric sleeve. The secondary objective was to compare patients′ and surgeons′ satisfaction. Materials and Methods: A total of 60 obese and morbidly obese patients scheduled to undergo laparoscopic gastric sleeve were randomly assigned into two groups. 10 min after induction of general anesthesia, one group received 0.8-1.2 μg/kg/30 min intravenous (IV) clonidine through 500 mL lactated Ringer′s solution and placebo (normal saline solution) through syringe pump. The second group received IV dexmedetomidine through syringe pump at a rate 0.5-0.8 μg/kg/h and placebo through 500 mL lactated Ringer′s solution. Data on pain, analgesic consumption, and return to normal activity in addition to patients′ and surgeons′ satisfaction were collected. Results: Both groups were similar with respect to demographic and intraoperative hemodynamic characteristics. Fentanyl consumption, surgery duration and hospital stay were similar for the two groups. Pain scores on walking were significantly lower in the clonidine group at 12 h postoperatively (P = 0.014) compared with dexmedetomidine group. The number of patients who consumed pethidine was significantly lower in the clonidine group at 12 h postoperatively (P = 0.045). Conclusion: This study concluded that clonidine and dexmedetomidine yielded similar outcomes with a difference in pain and analgesic consumption at 12 h postoperatively

Reliability Assessment of the Endoscopic Examination in Patients with Allergic Rhinitis

Objective To study if nasal endoscope can be a reliable tool in assessing patients with allergic rhinitis. Materials and Methods A prospective study. Patients who were diagnosed with allergic rhinitis underwent a nasal endoscopic examination performed by two physicians blinded to the scoring of each other. A correlation was made among symptom severity, endoscopic findings, and interrater variability. Results Ninety patients were included in the study: 34 patients had mild disease and 56 had moderate-to-severe allergic rhinitis according to the Allergic Rhinitis and its Impact on Asthma guidelines. Increases in mucosal edema and bluish discoloration were predictive of the severity of allergic rhinitis disease (p < 0.05). The presence of nasal secretions was not predictive of allergic rhinitis. Interrater reliability was fair for mucosal edema, moderate-to-almost perfect for the rest of the endoscopic findings. Conclusion Nasal endoscopy may reveal signs that are predictive of the severity of allergic rhinitis. A detailed checklist is needed for the nasal endoscopic examination to decrease interrater variability

Prévention primaire

Le chapitre prévention primaire se concentre sur les facteurs de risques externes établis comme principaux, liés au mode de vie des personnes, à savoir le tabac, l’alcool, l’alimentation, l’activité physique et la surcharge pondérale et l’obésité, susceptibles d’engendrer un cancer. L’éducation à la santé joue un rôle important, afin d’amener les individus à adopter des comportements préventifs, dans l’objectif de prévenir une maladie ou de la détecter à un stade asymptomatique. Les données des enquêtes European Health Interview Survey (EHIS, étude pilotée par le Ministère de la Santé et le Luxembourg Institute of Health) et Health Behaviour in School-Aged Children (HBSC, enquête coordonnée au Luxembourg par le Ministère de la Santé, le Ministère de l’Education nationale, de l’Enfance et de la Jeunesse, et l’Université de Luxembourg) ont été utilisées dans ce chapitre, pour compiler les données statistiques liées aux facteurs de risques. L’ensemble des comparaisons européennes est réalisé par Eurostat, (https://ec.europa.eu/), par l’étude internationale HBSC (http://www.hbsc.org/) et par le réseau international de chercheurs HBSC. Le chapitre se poursuit sur un descriptif des démarches de prévention mises en place sur le territoire national, au regard des facteurs de risques exposés au paragraphe 1, par exemple pour : Le tabac : Plan National de Lutte contre le Tabagisme (PNLT) 2016-2020, programme de sevrage tabagique (Ministère de la Santé/ Caisse Nationale de Santé), loi du 13 juin 2017 transposant la directive européenne 2014/40/UE sur les produits tabac ; L’alcool : Loi du 22 décembre 2006 portant interdiction de la vente de boissons alcoolisées à des mineurs de moins de seize ans, Plan d’Action Luxembourgeois de réduction du Mésusage de l’Alcool (PALMA) 2020-2024 ; L’alimentation et l’activité physique : Plan Cadre National « Gesond Iessen, Mei Bewegen » (PCN GIMB) 2018-2025. D’autres facteurs de risques additionnels ont par ailleurs été identifiés et font l’objet d’une prise en charge spécifique (ex : exposition au radon, recommandations de prescriptions en imagerie médicale, exposition aux UV, vaccination contre le HPV et l’hépatite B, exposition professionnelle à des agents cancérigènes…). Le rôle et les actions de la Direction de la Médecine Préventive de la Direction de la Santé, et de la Fondation Cancer, sont rappelés, dans ce cadre