Les patients suivis pour une maladie coeliaque à l'Hôpital d'enfants de Nancy (évolution à long terme (n=29), impact des recommandations successives)

Nous avons évalué à long terme, la croissance et le métabolisme osseux d'enfants suivis à l'Hôpital d'Enfants de Nancy pour maladie coeliaque (MC), et qui ont bénéficié de protocoles thérapeutiques différents. Nous avons inclus ceux dont le suivi était supérieur à 7 ans. Nous avons relevé les paramètres anthropométriques, ostéodensitométriques, les statuts martial et en vitamine D. Vingt neuf patients ont été étudiés, avec un recul de 7,6 à 25,2 ans. Le gluten a été réintroduit chez 25 patients. Quinze ont bénéficié du protocole 3 biopsies avec une tolérance apparente de 60 % (9/15) ; treize patients dont 5 après rechute sous le premier protocole, ont suivi le protocole dit Schmitz , avec une tolérance globale de 69 % (9/13). Sous RSG, on note une amélioration (p<0,05) de la croissance staturo-pondérale, de la corpulence, du poids pour la taille (PIT), de l'hémoglobine (Hb) et du fer sérique. Les paramètres nutritionnels ne s'aggravent pas à 6 et 12 mois de la réintroduction du gluten. Il n'y a pas de différence significative d'évolution des paramètres des patients selon leur régime à la dernière évaluation. Les ostéodensitométires réalisées chez 19 patients montrent un seul patient, sous régime normalisé, dont le z score lombaire est inférieur à -2 DS. Le suivi de ces patients à long terme n'a pas objectivé d'anomalies. Cependant, le RSG doit être repris chez ceux consommant du gluten du fait du risque augmenté de pathologies autoimmunes, de cancers et d'ostéoporose.NANCY1-SCD Medecine (545472101) / SudocSudocFranceF

Osteitis in Systemic Sclerosis: a nationwide case-control retrospective study (SCLEROS Study)

International audienceOBJECTIVE: Systemic sclerosis (SSc) is an autoimmune (AI) connective tissue disorder characterized by skin fibrosis, vasculopathy and dysimmunity. Data regarding osteitis in SSc are scarce. METHOD: We performed a nationwide multicentre retrospective case-control study including patients with SSc according to the 2013 ACR/EULAR classification, with a diagnosis of osteitis. The objectives of the study were to describe, to characterize, and to identify associated factors for osteitis in patients with SSc. RESULTS: Forty-eight patients were included. Twenty-six patients (54.1%) had osteitis beneath digital tip ulcers. Physical symptoms included: pain (36/48, 75%), erythema (35/48, 73%), and local warmth (35/48, 73%). Thirty-one (65%) patients had C-reactive protein levels &gt;2 mg/L (8 [2.7 - 44.3] mg/L). On X-ray, CT-scans or MRI, osteitis was characterized by swelling or abscess of soft tissues with acro-osteolysis or lysis in 28 patients (58%). Microbiological sampling was performed in 45 (94%) patients. Most pathogens were Staphylococcus aureus (43.8%); anaerobes and Enterobacteriaceae (29.1%) and Pseudomonas aeruginosa (10.4%). Management comprised antibiotics in 37 (77.1%) patients and/or surgery in 26 (54.2%). Fluoroquinolones were used in 22 (45.8%) patients and amoxicillin + beta-lactamase inhibitor in 7 (14.6%). Six (12.6%) patients relapsed, 6 (12.6%) patients had osteitis recurrence, 15 (32%) sequelae, and 2 patients had septic shock and died. CONCLUSION: This study confirmed digital tip ulcers as an associated factor for osteitis, and revealed a high rate of functional sequelae. Antimicrobial therapy with oral fluoroquinolone or intravenous amoxicillin and beta-lactamase inhibitor are used as first-line antibiotherapy in SSc patients with osteitis

Osteitis in Systemic Sclerosis: a nationwide case-control retrospective study (SCLEROS Study)

International audienceOBJECTIVE: Systemic sclerosis (SSc) is an autoimmune (AI) connective tissue disorder characterized by skin fibrosis, vasculopathy and dysimmunity. Data regarding osteitis in SSc are scarce. METHOD: We performed a nationwide multicentre retrospective case-control study including patients with SSc according to the 2013 ACR/EULAR classification, with a diagnosis of osteitis. The objectives of the study were to describe, to characterize, and to identify associated factors for osteitis in patients with SSc. RESULTS: Forty-eight patients were included. Twenty-six patients (54.1%) had osteitis beneath digital tip ulcers. Physical symptoms included: pain (36/48, 75%), erythema (35/48, 73%), and local warmth (35/48, 73%). Thirty-one (65%) patients had C-reactive protein levels &gt;2 mg/L (8 [2.7 - 44.3] mg/L). On X-ray, CT-scans or MRI, osteitis was characterized by swelling or abscess of soft tissues with acro-osteolysis or lysis in 28 patients (58%). Microbiological sampling was performed in 45 (94%) patients. Most pathogens were Staphylococcus aureus (43.8%); anaerobes and Enterobacteriaceae (29.1%) and Pseudomonas aeruginosa (10.4%). Management comprised antibiotics in 37 (77.1%) patients and/or surgery in 26 (54.2%). Fluoroquinolones were used in 22 (45.8%) patients and amoxicillin + beta-lactamase inhibitor in 7 (14.6%). Six (12.6%) patients relapsed, 6 (12.6%) patients had osteitis recurrence, 15 (32%) sequelae, and 2 patients had septic shock and died. CONCLUSION: This study confirmed digital tip ulcers as an associated factor for osteitis, and revealed a high rate of functional sequelae. Antimicrobial therapy with oral fluoroquinolone or intravenous amoxicillin and beta-lactamase inhibitor are used as first-line antibiotherapy in SSc patients with osteitis

Circulating cell-free DNA in patients with alveolar echinococcosis

IF 1.744 (2017)International audienceAlveolar echinococcosis (AE) is a parasitic disease, due to Echinococcus multilocularis. Often compared to liver cancer, it develops by infiltration from its primary site to the surrounding tissue, and can then metastasize to other organs. Detection of circulating cell-free DNA (ccfDNA) is a useful analytical tool in oncology, for diagnosis, prognosis, and therapy monitoring. This study sought to investigate the presence of ccfDNA in patients with AE, and its potential usefulness for the evaluation of treatment efficiency. To achieve these aims, a quantitative PCR and a droplet digital PCR were developed to detect E. multilocularis ccfDNA. An AE animal model identified, for the first time, the presence of large quantities of ccfDNA. Samples from patients with AE (n = 31) were then analyzed twice, at diagnosis, and after three months of chemotherapy: about 25% were positive, almost always with very low concentrations of ccfDNA. These results confirmed that E. multilocularis produces ccfDNA, as solid tumors do, but detection may not yet be sufficient for AE diagnosis nor for the evaluation of treatment efficiency, due to the low levels of ccfDNA detected in patient serum