Supplémentation en fer : indications, limites et modalités

During the past 10 years, the knowledge of iron metabolism has been revolutionized by the discovery of the main regulatory hormone of body iron: hepcidin. Meanwhile, new formulations of intravenous iron have been developed and are already or readily available. In this article, we review the recent pathophysiological mechanisms underlying anemia of chronic disease or due to iron deficiency. We describe the various treatment modalities of iron deficiency anemia using oral or intravenous route and the emerging indications of treatment with iron. Finally, we discuss the situations in which iron supplementation may be harmful

Content of quality-of-life instruments is affected by item-generation methods

Methods used to generate items for complex measurement scales are heterogeneous and probably produce heterogeneous data, yet nothing is known about the advantages of one method over another. Objective. We aimed to compare methods of generating items for tools designed to measure quality-of-life for patients. Methods. We used five methods to develop a quality-of-life instrument for patients with lower-limb osteoarthritis: individual interviews with patients involving two different techniques (semi-structured and cognitive), individual interviews with health professionals, and focus groups of patients and health professionals. The process generated 80 items, of which 37 were excluded after content and psychometric analysis. With the final 43-item scale used as a ‘reference standard’, we estimated the contribution of each method. Results. For health professionals, the focus group and individual interviews produced 35 and 81% of the items, respectively. For patients, the focus groups produced 74% of the items and both interview techniques 100% of the items. Health professionals provided a narrower picture of the effects of the disease on quality-of-life. Focus groups contributed less to social domains than did individual interviews. The two patient interview techniques highlighted different themes. Conclusion. In developing a complex measurement scale for patients, we found individual interviews with patients the best method for formulating items; other methods such as physician interviews and focus groups contributed no additional information. Reports of instrument generation should include details of the item-generation step, the methods used to develop items and the number of people involved

Analytical investigation of turbine erosion phenomena. Volume I - Assembly of analytical model of wet vapor turbine blade erosion Interim technical report

Construction and application of analytical model of wet vapor turbine blad erosio

Relapsing macrophage activating syndrome in a 15-year-old girl with Still's disease: a case report

<p>Abstract</p> <p>Introduction</p> <p>Macrophage activating syndrome is a severe, potentially life-threatening condition that may accompany Still's disease. It is characterized by fever, hepatosplenomegaly, lymphadenopathy, severe cytopenia, serious liver dysfunction, coagulopathy and neurologic involvement. The principal treatment for patients with this syndrome includes etoposide 150 mg/2 M twice a week for two weeks, dexamethasone 10 mg/2 M for two weeks and cyclosporine 3 mg/kg to 5 mg/kg for a longer period. Cases of relapse of macrophage activating syndrome are relatively rare.</p> <p>Case presentation</p> <p>We describe the case of a 15-year-old Iraqi girl with Still's disease who developed macrophage activating syndrome with acute respiratory distress syndrome that required resuscitation and mechanical ventilation. Following intensive treatment, including high dose steroids and cyclosporine, the patient improved significantly. Two weeks after cyclosporine was discontinued, however, she was readmitted with an acute relapse of macrophage activating syndrome manifested by spiking fever, arthralgias, maculopapular rash and leukocytosis. This time the patient recovered following the reintroduction of treatment with cyclosporine and the addition of mycophenolate mofetil (Cellcept).</p> <p>Conclusion</p> <p>We believe that cyclosporine is a cornerstone for the treatment of Still's disease. We recommend continuing this medication for several weeks following the patient's clinical recovery in order to prevent macrophage activating syndrome relapses.</p

PS6:110 Motor and cognitive fatigue in sle is associated with mood and health-related quality of life (hrqol) in patients with sle: results from the patient reported outcomes in lupus (pro-lupus) study

Background Fatigue is a commonly reported problem in systemic lupus erythematosus (SLE) but the cause and impact of this symptom are not fully understood. Clinical, physical and psychosocial aspects may affect fatigue as well as cognitive performance. Of note, the influence of disease status and inflammatory disease activity on fatigue in SLE is poorly understood. We aimed to better understand these associations by studying changes in fatigue over time. Methods 100 SLE patients, all with lupus nephritis, were recruited across 5 European countries. Participants completed assessments examining; fatigue (FSMC: Fatigue Scale for Motor and Cognitive functions), disease activity (SLEDAI, tender joints score), SLICC damage index, cognition (SPRT: Spatial Recall Test, SDMT: Symbol Digits Modalities Test, PASAT: Paced Auditory Serial Addition Test, SRT: Selective Reminding Test, WLG: Word List Generation), pain (pain mannequin), depression (CES-D: Centre for Epidemiological Studies-Depression Scale), steroid dose and HRQoL (SF-36 v2, LupusQoL), at baseline and at follow-up, 3–4 months later. Correlations of score changes between baseline and follow-up were calculated using SPSS 22 and any significant results (p Results All participants met 1997 revised ACR criteria for SLE and had biopsy-proven lupus nephritis (ISN grades II-V). The mean (SD) SLEDAI score was 4.67 (5.05) at baseline and 4.37 (5.55) at follow-up. Cognitive scores were significantly different at baseline compared to follow-up, where all scores improved. When examining the correlations between changes in score from baseline to follow-up, there were significant associations between changes in fatigue (motor and cognitive) scores with mood, the physical subscale of the SF-36 and a number of domains of the LupusQOL including pain and burden to others (Table 1). No significant correlations were found between changes in fatigue and disease activity, damage, steroid dose or cognitive measures. Conclusions In SLE patients the major associations of motor and cognitive fatigue are with mood, pain and poorer HRQoL. We found no significant correlations with disease activity, damage or steroid dose. Self-rated QoL and depression may more directly impact fatigue than disease activity and these psychosocial aspects need to be addressed to help manage fatigue more effectively in SLE

Methods for specifying the target difference in a randomised controlled trial : the Difference ELicitation in TriAls (DELTA) systematic review

Peer reviewedPublisher PD

A comparison of an interferon-gamma release assay and tuberculin skin test in refractory inflammatory disease patients screened for latent tuberculosis prior to the initiation of a first tumor necrosis factor α inhibitor

Treatment with TNFα inhibitors increases risk of reactivating a latent tuberculosis\infection (LTBI). Therefore screening, prior to therapy with TNFα inhibitors, has been recommended, even in low-endemic areas such as well-developed Western Europe countries. We evaluated interferon-gamma release assay (IGRA), as opposed to tuberculin skin test (TST), for detection of LTBI in refractory inflammatory disease patients prior to the initiation of a first TNFα inhibitor. In addition, we evaluated the impact of impaired cellular immunity on IGRA. Patients starting on TNFα inhibition were screened for LTBI by TST and IGRA (Quantiferon-TB Gold). Data on tuberculosis exposure and Bacillus Calmette–Guérin (BCG) vaccination were obtained. Cellular immunity was assessed by CD4+ T lymphocyte cell count. Nine out of 56 patients (16.1%) tested positive for LTBI. A concordant positive result was present in three patients with a medical history of tuberculosis exposure. Six patients with discordant test results had either: (1) a negative TST and positive IGRA in combination with a medical history of tuberculosis exposure (n = 1) or (2) a positive TST and negative IGRA in combination with BCG vaccination (n = 3) or a medical history of tuberculosis exposure (n = 2). CD4+ T lymphocyte cell counts were within normal limits, and no indeterminate results of IGRA were present. IGRA appears reliable for confirming TST and excluding a false positive TST (due to prior BCG vaccination) in this Dutch serie of patients. In addition, IGRA may detect one additional case of LTBI out of 56 patients that would otherwise be missed using solely TST. Immune suppression appears not to result significantly in lower CD4+ T lymphocyte cell counts and indeterminate results of IGRA, despite systemic corticosteroid treatment in half of the patients. Confirmation in larger studies, including assessment of cost-effectiveness, is required