Paroxysmal Sneezing at the Onset of Syncopes and Transient Ischemic Attack Revealing a Papillary Cardiac Fibroelastoma

Sneezing can at times be associated with neurological disorders. The “sneeze center” is localized in the lateral medulla. We report the case of a 50-year-old man who presented three episodes of sneezing, two of them followed by an episode of transient gait instability and dizziness and the third one followed by an episode of transient left hemiparesis due to fibroelastoma of the aortic cardiac valve. To the best of our knowledge, this is the first description of a transient ischemic attack due to cardiac papillary fibroelastoma and revealed by violent episodes of sneezing

Kidd Blood Group and Urea Transport Function of Human Erythrocytes Are Carried by the Same Protein

International audienc

Neurology

The question of the long-term safety of pregnancy is a major concern in patients with multiple sclerosis (MS), but its study is biased by reverse causation (women with higher disability are less likely to experience pregnancy). Using a causal inference approach, we aimed to estimate the unbiased long-term effects of pregnancy on disability and relapse risk in patients with MS and secondarily the short-term effects (during the perpartum and postpartum years) and delayed effects (occurring beyond 1 year after delivery). We conducted an observational cohort study with data from patients with MS followed in the Observatoire Français de la Sclérose en Plaques registry between 1990 and 2020. We included female patients with MS aged 18-45 years at MS onset, clinically followed up for more than 2 years, and with ≥3 Expanded Disease Status Scale (EDSS) measurements. Outcomes were the mean EDSS score at the end of follow-up and the annual probability of relapse during follow-up. Counterfactual outcomes were predicted using the longitudinal targeted maximum likelihood estimator in the entire study population. The patients exposed to at least 1 pregnancy during their follow-up were compared with the counterfactual situation in which, contrary to what was observed, they would not have been exposed to any pregnancy. Short-term and delayed effects were analyzed from the first pregnancy of early-exposed patients (who experienced it during their first 3 years of follow-up). We included 9,100 patients, with a median follow-up duration of 7.8 years, of whom 2,125 (23.4%) patients were exposed to at least 1 pregnancy. Pregnancy had no significant long-term causal effect on the mean EDSS score at 9 years (causal mean difference [95% CI] = 0.00 [-0.16 to 0.15]) or on the annual probability of relapse (causal risk ratio [95% CI] = 0.95 [0.93-1.38]). For the 1,253 early-exposed patients, pregnancy significantly decreased the probability of relapse during the perpartum year and significantly increased it during the postpartum year, but no significant delayed effect was found on the EDSS and relapse rate. Using a causal inference approach, we found no evidence of significantly deleterious or beneficial long-term effects of pregnancy on disability. The beneficial effects found in other studies were probably related to a reverse causation bias.Observatoire Français de la Sclérose en Plaque

The French national prospective cohort of patients co-infected with HIV and HCV (ANRS CO13 HEPAVIH): Early findings, 2006-2010

<p>Abstract</p> <p>Background</p> <p>In France, it is estimated that 24% of HIV-infected patients are also infected with HCV. Longitudinal studies addressing clinical and public health questions related to HIV-HCV co-infection (HIV-HCV clinical progression and its determinants including genetic dimension, patients' experience with these two diseases and their treatments) are limited. The ANRS CO 13 HEPAVIH cohort was set up to explore these critical questions.</p> <p>To describe the cohort aims and organization, monitoring and data collection procedures, baseline characteristics, as well as follow-up findings to date.</p> <p>Methods</p> <p>Inclusion criteria in the cohort were: age > 18 years, HIV-1 infection, chronic hepatitis C virus (HCV) infection or sustained response to HCV treatment. A standardized medical questionnaire collecting socio-demographic, clinical, biological, therapeutic, histological, ultrasound and endoscopic data is administered at enrolment, then every six months for cirrhotic patients or yearly for non-cirrhotic patients. Also, a self-administered questionnaire documenting socio-behavioral data and adherence to HIV and/or HCV treatments is administered at enrolment and yearly thereafter.</p> <p>Results</p> <p>A total of 1,175 patients were included from January 2006 to December 2008. Their median age at enrolment was 45 years and 70.2% were male. The median CD4 cell count was 442 (IQR: 304-633) cells/μl and HIV RNA plasma viral load was undetectable in 68.8%. Most participants (71.6%) were on HAART. Among the 1,048 HIV-HCV chronically co-infected patients, HCV genotype 1 was predominant (56%) and cirrhosis was present in 25%. As of January, 2010, after a median follow-up of 16.7 months (IQR: 11.3-25.3), 13 new cases of decompensated cirrhosis, nine hepatocellular carcinomas and 20 HCV-related deaths were reported, resulting in a cumulative HCV-related severe event rate of 1.9/100 person-years (95% CI: 1.3-2.5). The rate of HCV-related severe events was higher in cirrhotic patients and those with a low CD4 cells count, but did not differ according to sex, age, alcohol consumption, CDC clinical stage or HCV status.</p> <p>Conclusion</p> <p>The ANRS CO 13 HEPAVIH is a nation-wide cohort using a large network of HIV treatment, infectious diseases and internal medicine clinics in France, and thus is highly representative of the French population living with these two viruses and in care.</p

DMTs and Covid-19 severity in MS: a pooled analysis from Italy and France

We evaluated the effect of DMTs on Covid-19 severity in patients with MS, with a pooled-analysis of two large cohorts from Italy and France. The association of baseline characteristics and DMTs with Covid-19 severity was assessed by multivariate ordinal-logistic models and pooled by a fixed-effect meta-analysis. 1066 patients with MS from Italy and 721 from France were included. In the multivariate model, anti-CD20 therapies were significantly associated (OR&nbsp;=&nbsp;2.05, 95%CI&nbsp;=&nbsp;1.39–3.02, p&nbsp;&lt;&nbsp;0.001) with Covid-19 severity, whereas interferon indicated a decreased risk (OR&nbsp;=&nbsp;0.42, 95%CI&nbsp;=&nbsp;0.18–0.99, p&nbsp;=&nbsp;0.047). This pooled-analysis confirms an increased risk of severe Covid-19 in patients on anti-CD20 therapies and supports the protective role of interferon

Dissections artérielles cervicales spontanées (facteurs étiologiques, prise en charge et devenir des patients)

Introduction : Les dissections artérielles cervicales spontanées (DAC) représentent une des causes les plus fréquentes d'accident vasculaire cérébral ischémique (AVC) du sujet jeune. En plus du classique facteur traumatique, d'autres facteurs de prédisposition aux DAC ont été décrits tels que la migraine, une infection récente, le déficit en alpha 1-antitrypsine (A1AT), l'hyperhomocystéinémie (Hcys) , mais restent discutés. Il existe par ailleurs peu de données concernant le suivi des patients et le risque de récidive de DAC. Le but de notre étude était d'analyser les caractéristiques cliniques, les facteurs de prédisposition, la prise en charge en phase aiguë et le devenir de patients avec DAC hospitalisés au CHU de Poitiers entre 2005 et 2012. Matériels et méthodes : Dans une étude rétrospective monocentrique, nous avons inclus les patients hospitalisés dans le service de neurologie du CHU de Poitiers entre le 01/01/2005 et le 31/12/2012 pour une DAC confirmée sur les examens radiologiques. Les patients qui avaient bénéficié du dosage de l'A1AT et de l'Hcys étaient éligibles pour une étude castémoins réalisée dans le but de déterminer la validité de ces 2 paramètres en tant que facteurs de risque de DAC. Résultats : Sur 122 patients éligibles, 26 furent exclus pour raison diagnostique. Dans la population de 96 patients, l'âge moyen au diagnostic était de 46,3 ans, il existait une légère prépondérance masculine (sexe ratio=1,2), la présentation clinique initiale comprenait un syndrome douloureux dans 79,2% des cas et des signes locaux dans 21,9%. On retrouvait un facteur traumatique mineur dans 32,3% des cas et une infection récente dans 10,4%. Un AVC compliquait la DAC dans 65,6% des cas, et le taux de mortalité en phase aiguë était faible (3,1%). Le bilan étiologique restait négatif dans la majorité des cas. Dans l'étude cas-témoins, on ne mettait pas en évidence de déficit en A1AT ni d'HHcys chez les patients par rapport aux témoins. La durée moyenne de suivi était de 29 mois. Le taux de cicatrisation artérielle sur les imageries de contrôle atteignait 76,8% ; les taux de récidive de DAC et de récidive d'AVC étaient chacun de 4,2%. Enfin, 75,8% des patients avaient une évolution fonctionnelle favorable (mRS < 2) et 74,2% avaient pu reprendre une activité professionnelle. Conclusion : Les résultats de notre étude correspondent globalement aux données des études parues dans la littérature en termes de population, de facteurs de prédisposition aux DAC, de pronostic et d'évolution à long terme. Nos données ne viennent pas conforter l'hypothèse d'un rôle majeur des facteurs biologiques (déficit en A1AT et Hcys) dans la physiopathologie des DAC.POITIERS-BU Médecine pharmacie (861942103) / SudocSudocFranceF

Élévation involontaire du membre supérieur chez l'hémiplégique lors d'un bâillement (appelée hémipandiculation)

POITIERS-BU Médecine pharmacie (861942103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Dissection spontanée des artères cervicales et déficit en alpha1-antitrypsine (à propos de 58 dossiers cliniques)

POITIERS-BU Médecine pharmacie (861942103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Troubles veille-sommeil dans la sclérose en plaques

POITIERS-BU Médecine pharmacie (861942103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Thromboses veineuses cérébrales (phase aiguë et pronostic au sein d'une cohorte de 120 patients de la région Poitou-Charentes)

POITIERS-BU Médecine pharmacie (861942103) / SudocSudocFranceF