Pneumopathies interstitielles diffuses chroniques: elements cliniques et paracliniques utiles au praticien. [Chronic interstitial lung diseases: useful clinical and paraclinical aspects in practice]

Chronic interstitial lung diseases (ILDs) are characterized by: 1) diffuse interstitial inflammation and/or fibrosis, and 2) duration of illness above 3 months. Chronic ILDs of known and unknown aetiology have to be differentiated. The diagnosis of chronic ILDs, which is suggested by clinical and/or pulmonary function test data, is definitely based on the identification of interstitial changes on chest-x ray or thoracic high resolution CT scans. Orientated laboratory evaluation and flexible bronchoscopy with bronchoalveolar lavage and biopsies are also performed. These investigations often allow a secure diagnosis to be made. Sometimes however, a surgical lung biopsy is necessary for the diagnosis, notably when chronic idiopathic interstitial pneumonias are considered

Effets osseux des stéroides inhalés. [Inhaled steroids effect on bones]

Inhaled corticosteroids (ICS) are the mainstay of asthma treatment, when an antiinflammatory agent is warranted. The development of the ICS has permitted to diminish the adverse effects associated with oral steroids and with equipotent doses there are less adverse effects with ICS on bone metabolism compared to oral steroids. There is now reassuring evidence that doses of < or = 400 micrograms for children and < or = 1000 micrograms for adults are safe and do not appear to have clinically significant adverse effect on bone density or bone growth. When exceeding the recommended thresholds for more than 3 months, osteoporosis prevention would be appropriate. Furthermore a mineral bone density measurement might be done in this context in order to identify those persons who are at risk of developing or worsening preexisting osteoporosis. Growth monitoring is justified in any child taking ICS. Biochemical markers of bone formation and resorption might give complementary information to the mineral bone density measurement. The addition of a leukotriene receptor antagonist and or of a chromone may allow a reduction in the requirement for ICS in mild to moderate asthma. Finally the achievement of an increased glucocorticoid potency combined with an improved airway selectivity and a shorter plasmatic half-life of the ICS will further contribute to diminish their effects on bone metabolism

Les antileucotrienes: une nouvelle classe de medicaments a integrer dans la strategie therapeutique de l'asthme. [The anti-leukotrienes: a new class of drugs to integrate into the therapeutic strategy of asthma]

Leukotrienes play an important role in the pathogenesis of asthma, a chronic inflammatory disease. They are potent bronchoconstrictors and chemoattractants; furthermore, they increase vascular permeability and mucus secretion. Early treatment of bronchial inflammation has become an essential element of the therapeutic approach of asthma and relies mainly on inhaled corticosteroids. However, known adverse effects of inhaled corticosteroids raise important long-term questions on their local and systemic tolerance. These safety aspects have encouraged the development of other anti-inflammatory drugs. Antileukotrienes (specific antagonist of receptors and inhibitors of 5-lipoxygenase) display a beta 2-agonist additive effect, confer an effective protection in bronchial provocations, improve both clinical and functional asthma scores and also allow a decreasing in short-acting beta 2-agonist use. They are intended for patients suffering from persistent mild-to-moderate asthma. However, further studies are still required to determine both their long-term efficacity and tolerance, to define their place in the strategy of asthma management and finally to clarify their application in other allergic diseases

Acquisitions thérapeutiques 1998 : allergo-immunologie

Les acquisitions thérapeutiques en allergologie et immunologie clinique en 1998 ont été marquées par la survenue d'un nouveau stéroïde topique, le furoate de mométasone, dont l'avantage principal est son application quotidienne unique et sa très faible biodisponibilité. La famille des anti-leucotriènes dans le traitement de l'asthme s'enrichit progressivement. Les premières expériences cliniques montrent qu'il s'agit d'anti-inflammatoires de relativement faible intensité pour l'instant, qui doivent être le plus souvent utilisés en association avec les stéroïdes topiques, et dont la place dans le traitement de l'asthme doit encore être précisée. Enfin, deux antihistaminiques de deuxième génération viennent élargir l'éventail déjà large de cette classe de médicament: l'acrivastine notamment, par son entrée en action très brève et sa courte demi-vie d'élimination, trouve une place toute particulière dans le traitement de la réaction allergique d'urgence ou sa prévention à court terme. Enfin, ces diverses acquisitions sont mises en perspective chez l'enfant

Syndrome de Muckle-Wells: description de 4 cas sur trois generations. [Muckle-Wells syndrome: 4 cases in three generations]

BACKGROUND: Muckle-Wells syndrome is a hereditary condition with variable penetrance. The main manifestations are urticarial rash, malaise in the evening, joint pain, perception deafness and renal amylosis. CASE REPORT: We describe a family with 4 affected members in 3 successive generations. Clinical expression was variable. DISCUSSION: Despite the absence of renal amylosis in our patients, this family presented the syndrome described by Muckle and Wells in 1962. As for other cases reported in the literature, the clinical course was favorable with low-dose corticosteroid therapy

Evaluation of upper limb perception after stroke with the new Affected Limb Perception Questionnaire (ALPQ): a study protocol.

Following a stroke, patients may suffer from alterations in the perception of their own body due to an acquired deficit in body representations. While such changes may impact their quality of life as well as recovery, they are not systematically assessed in clinical practice. This study aims at providing a better understanding of the rate, evolution, and impact on recovery of upper limb (UL) body perceptions (BPs) alterations following stroke. In addition, we will investigate associations among BPs alterations items, their associations with the sensorimotor functions, UL activity, damages in brain structure and connectivity. We developed a new tool named ALPQ (for Affected Limb Perception Questionnaire) to address the present study objectives. It assesses subjective alterations in the perception of the affected UL following stroke, by measuring several dimensions, namely: anosognosia for hemiplegia, anosodiaphoria for hemiplegia, hemiasomatognosia, somatoparaphrenia, personification of the affected limb, illusion of modification of physical characteristics (temperature, weight, length), illusory movements, super- or undernumerary limb, UL disconnection, misoplegia, and involuntary movement. This study combines a cross-sectional and longitudinal design. The completed data sample will include a minimum of 60 acute and 100 sub-acute stroke patients. When possible, patients are followed up to the chronic stage. Complementary evaluations are administered to assess patients' sensorimotor and cognitive functions as well as UL activity, and brain lesions will be analysed. This study will provide a better understanding of BPs alterations following stroke: their rate and evolution, as well as their associations with sensorimotor deficit, cognitive profile and UL activity, brain lesions and recovery. Ultimately, the results could support the personalization of rehabilitation strategy according to patients' UL perception to maximize their recovery. The protocol for this study has been pre-registered on the Open Science Framework on July the 7th, 2021: https://osf.io/p6v7f

Allergen-specific T-cell tolerance induction with allergen-derived long synthetic peptides: results of a phase I trial

BACKGROUND: There is a need to improve the safety and efficacy of allergen-specific immunotherapy. Long synthetic peptide-based immunotherapy was proven safe, immunogenic, and protective in preclinical trials. OBJECTIVE: To evaluate the safety and immunogenicity of an allergen-derived long synthetic overlapping peptide (LSP) immunotherapy, we designed a double-blind, placebo-controlled phase I clinical trial in patients hypersensitive to bee venom. METHODS: Patients from the active group were injected at day 0 with a mixture of 3 LSPs mapping the entire PLA2 molecule, a major bee venom allergen, in a dose-escalating protocol to a maintenance dose of 100 microg per peptide repeated at days 4, 7, 14, 42, and 70. The control group was injected with human albumin. RESULTS: Whereas specific T-cell proliferation in the peptide group increased up to day 14, a sharp decline was observed thereafter, ending in specific T-cell hyporesponsiveness at day 80. Serum-specific IgG4 response was enhanced, in contrast to anti-PLA2 IgE. Specific T-cell cytokine modulation was marked by increased IL-10 and IFN-gamma secretion. LSP injections were well tolerated in all patients except for mild, late allergic reactions in 2 patients at day 70. CONCLUSIONS: The results of this short-term study demonstrate that LSP-based allergen immunotherapy was safe and able to induce T(H)1-type immune deviation, allergen-specific IL-10 production, and T-cell hyporesponsiveness. LSPs, which offer the advantage of covering all possible T-cell epitopes for any HLA genotype, can be considered candidates for a novel and safe approach of specific immunotherapy

Sharpening of peripersonal space during the COVID-19 pandemic

Our social world has been transformed by the COVID-19 pandemic. Beyond the direct impact of the pandemic on physical health, the social distancing measures implemented worldwide to slow down disease transmission have dramatically impacted social interactions1,2. These measures, including orders to stay at home and to maintain a social distance of at least 2 meters, have been essential to limit the spread of the disease, but they have had severe costs for humans as social animals2. Right before and right after the adoption of the most stringent measures in Switzerland in Spring 2020, we were conducting a series of experiments to measure the representation of the so-called peripersonal space — the space immediately surrounding our body, where we normally interact with objects and other individuals3. We found that the introduction of social distancing measures led to a reduction in the extent of the peripersonal space and enhanced its segregation between individuals, as if the presence of others in close space would activate an implicit form of freezing response