Evaluation de la densité osseuse chez les patients BPCO suivis dans les hôpitaux Henri Mondor et CHIC

Introduction Les co-morbidités et les conséquences systémiques de la BPCO restent sous-diagnostiquées et sous traitées malgré un arsenal thérapeutique adapté. Le traitement des co-morbidités semble d ailleurs avoir un impact majeur sur l évolution de la BPCO elle-même. De nombreuses études ont montré que l ostéoporose faisait partie de ces comorbidités. Le but de ce travail était de comparer la densité osseuse des patients atteints de BPCO à celle de sujets fumeurs indemnes de la maladie et de déterminer la prévalence de l ostéoporose dans une population de patients BPCO suivis dans l hôpital Henri Mondor et le Centre Hospitalier Intercommunal de Créteil. Matériel et Méthode Cette étude épidémiologique transversale a comparé des sujets BPCO à des fumeurs sains. En raison des différences de densité osseuse liées au genre, hommes et femmes ont été analysés séparément. La mesure de la DMO s est faite chez tous les patients par osteo-densitomètre avec détermination de la masse osseuse, reportée en gramme par centimètre carrée et en T-score. Le T-score a été utilisé pour classer les patients en DMO normale et ostéoporose. Résultat 133 hommes et 69 femmes ont été inclus dans cette étude. La DMO de la hanche droite et gauche des femmes BPCO était significativement plus basse que celles des fumeuses non BPCO, cette différence n était pas retrouvée chez les hommes. Conclusions La prévalence de l ostéoporose est importante chez les patients BPCO, particulièrement chez les femmes et demande une prise en charge spécifiquePARIS12-Bib. électronique (940280011) / SudocSudocFranceF

Assessment of the Drug Susceptibility of Plasmodium falciparum Clinical Isolates from Africa by Using a Plasmodium Lactate Dehydrogenase Immunodetection Assay and an Inhibitory Maximum Effect Model for Precise Measurement of the 50-Percent Inhibitory Concentration

The extension of drug resistance among malaria-causing Plasmodium falciparum parasites in Africa necessitates implementation of new combined therapeutic strategies. Drug susceptibility phenotyping requires precise measurements. Until recently, schizont maturation and isotopic in vitro assays were the only methods available, but their use was limited by technical constraints. This explains the revived interest in the development of replacement methods, such as the Plasmodium lactate dehydrogenase (pLDH) immunodetection assay. We evaluated a commercially controlled pLDH enzyme-linked immunosorbent assay (ELISA; the ELISA-Malaria antigen test; DiaMed AG, Cressier s/Morat, Switzerland) to assess drug susceptibility in a standard in vitro assay using fairly basic laboratory equipment to study the in vitro resistance of malaria parasites to major antimalarials. Five Plasmodium falciparum clones and 121 clinical African isolates collected during 2003 and 2004 were studied by the pLDH ELISA and the [8-(3)H]hypoxanthine isotopic assay as a reference with four antimalarials. Nonlinear regression with a maximum effect model was used to estimate the 50% inhibitory concentration (IC(50)) and its confidence intervals. The two methods were observed to have similar reproducibilities, but the pLDH ELISA demonstrated a higher sensitivity. The high correlation (r = 0.98) and the high phenotypic agreement (κ = 0.88) between the two methods allowed comparison by determination of the IC(50)s. Recently collected Plasmodium falciparum African isolates were tested by pLDH ELISA and showed drug resistance or decreased susceptibilities of 62% to chloroquine and 11.5% to the active metabolite of amodiaquine. No decreased susceptibility to lumefantrine or the active metabolite of artemisinin was detected. The availability of this simple and highly sensitive pLDH immunodetection assay will provide an easier method for drug susceptibility testing of malaria parasites

Diagnosis and treatment in chronic pancreatitis: an international survey and case vignette study

Background The aim of the study was to evaluate the current opinion and clinical decision-making process of international pancreatologists, and to systematically identify key study questions regarding the diagnosis and treatment of chronic pancreatitis (CP) for future research. Methods An online survey, including questions regarding the diagnosis and treatment of CP and several controversial clinical case vignettes, was send by e-mail to members of various international pancreatic associations: IHPBA, APA, EPC, ESGE and DPSG. Results A total of 288 pancreatologists, 56% surgeons and 44% gastroenterologists, from at least 47 countries, participated in the survey. About half (48%) of the specialists used a classification tool for the diagnosis of CP, including the Mayo Clinic (28%), Mannheim (25%), or Büchler (25%) tools. Overall, CT was the preferred imaging modality for evaluation of an enlarged pancreatic head (59%), pseudocyst (55%), calcifications (75%), and peripancreatic fat infiltration (68%). MRI was preferred for assessment of main pancreatic duct (MPD) abnormalities (60%). Total pancreatectomy with auto-islet transplantation was the preferred treatment in patients with parenchymal calcifications without MPD abnormalities and in patients with refractory pain despite maximal medical, endoscopic, and surgical treatment. In patients with an enlarged pancreatic head, 58% preferred initial surgery (PPPD) versus 42% initial endoscopy. In patients with a dilated MPD and intraductal stones 56% preferred initial endoscopic ± ESWL treatment and 29% preferred initial surgical treatment. Conclusion Worldwide, clinical decision-making in CP is largely based on local expertise, beliefs and disbeliefs. Further development of evidence-based guidelines based on well designed (randomized) studies is strongly encouraged