Facteurs associés à la non-conversion de la bacilloscopie après la phase d’attaque du traitement antituberculeux. Étude réalisée dans trois centres de prise en charge de la tuberculose au Sud Bénin

Publication date: Available online 16 May 2018
Source:Revue des Maladies Respiratoires
Author(s): G. Agodokpessi, A.P. Wachinou, B. Awanou, M. Gninafon
L'objectif de ce travail était de décrire le profil des patients tuberculeux pris en charge en condition de routine et présentant une non-conversion de la bacilloscopie après la phase d'attaque du traitement antituberculeux ainsi que d'analyser les facteurs associés à cette dernière. À cette fin, une étude transversale rétrospective à visée descriptive et analytique a été menée sur une population constituée d'adultes atteints de tuberculoses pulmonaires bacillifères (TPB) entre 2013 et 2014 dans trois villes du sud Bénin (Cotonou, Porto-Novo et Abomey). Les données des patients concernés (TBP+) ont été comparées à celles des autres patients (TBP−). Une analyse multivariée par régression logistique a été effectuée. Sur 1989 (94 %) des cas recensés, 305 (15,3 %) étaient TPB+, avec des différences significatives entre les villes. L'âge moyen était respectivement (38±13ans vs 34±12ans, p=0,091) pour les TPB+ et les TPB−. Au terme de l'analyse multivariée, les facteurs associés à la non conversion étaient la forte charge bacillaire (≥10 BAAR/champ microscopique) au moment du diagnostic, le statut VIH+, et l'issue défavorable à la fin du traitement antituberculeux. Ces patients doivent faire l'objet d'un suivi spécifique.The objective of this work was to describe the profile of routinely managed tuberculosis patients whose sputum smear did not become negative after the initial phase of anti-tuberculous treatment and to analyze the factors associated with this. With this aim a cross-sectional, retrospective, descriptive and analytical study was carried out in a population of adults with pulmonary tuberculosis (PTB) between 2013 and 2014 in three cities in southern Benin (Cotonou, Porto-Novo and Abomey). The data of the patients who did not convert (PTB +) were compared with those who did (PTB−). A multivariate logistic regression analysis was performed. In 1989 (94%) of the cases, 305 (15.3%) were TPB+ with significant differences between the cities. The mean age was 38±13 years vs 34±12 years, respectively, for PTB+and PTB −, P=0.091. At the end of the multivariate analysis, the factors associated with non-conversion were: high bacillary load (≥10 AFB/microscopic field) at diagnosis, HIV+status, and adverse outcome at the end of anti-tuberculous treatment. These patients should be monitored carefully.



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Une pleurésie très inhabituelle

Publication date: Available online 16 May 2018
Source:Revue des Maladies Respiratoires
Author(s): F. Vergne, R. Le Mao, L. Simonin, R. Descourt, F. Couturaud, A. Barnier, C. Tromeur
L'urinothorax correspond à la présence d'urine dans la cavité pleurale. Il s'agit d'une pathologie peu fréquente, sous diagnostiquée et souvent suspectée a posteriori. Habituellement, il s'agit d'un transsudat. Nous rapportons le cas d'une patiente dont l'urinothorax est révélé par une pleurésie purulente. La désobstruction des voies urinaires et l'instauration d'une antibiothérapie adaptée ont permis une régression quasi-complète de l'épanchement pleural. Actuellement, aucun test paraclinique ne semble être spécifique de l'urinothorax. En revanche, il semble que le ratio créatinine pleurale sur créatinine sérique puisse orienter vers ce diagnostic mais des études complémentaires semblent nécessaires pour valider ce paramètre biologique. De manière générale, tout geste urologique récent associé à l'apparition d'une pleurésie doit faire suspecter un urinothorax.Urinothorax refers to the presence of urine in the pleural space. Urinothorax is an infrequent and underdiagnosed pathology, with few cases reported, and these often suspected only with hindsight. It is usually a transudative pleural effusion. We report a case of urinothorax presenting as a purulent pleural effusion. Management of the urinothorax required antibiotics and surgical unblocking of the urinary tract. Currently, no test is available to confirm the diagnosis. The ratio of serum creatinine/pleural creatinine could suggest the presence of urinothorax but this parameter needs to be validated by complementary studies. Urinothorax should be suspected in the context of pleural effusion occurring after a recent urologic surgery.



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Comment régler un ventilateur de domicile ?

Publication date: Available online 16 May 2018
Source:Revue des Maladies Respiratoires
Author(s): L. Grassion, C. Llontop, L. Layachi, E. Hubert, C. Morelot-Panzini, J. Gonzalez-Bermejo




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The global development and clinical efficacy of sublingual tablet immunotherapy for allergic diseases

Publication date: Available online 16 May 2018
Source:Allergology International
Author(s): Hendrik Nolte, Jennifer Maloney
Allergy immunotherapy (AIT) is a treatment option for respiratory allergy that is complementary to pharmacotherapy, with a distinct mechanism of action. Alternative methods to subcutaneous administration of AIT that enable patients to safely self-administer AIT is considered an unmet clinical need.The sublingual immunotherapy tablet (SLIT-tablet) is an orally disintegrating pharmaceutical formulation (oral lyophilisate) containing standardized allergens. SLIT-tablets have been developed for sublingual immunotherapy (SLIT) of cedar-pollen, grass-pollen, ragweed-pollen, tree-pollen, and house dust mite allergies. It is a once-daily tablet treatment to be self-administered after the first dose has been provided under the supervision of a physician with experience in the diagnosis and treatment of allergic diseases. Once the first dose is adequately tolerated, subsequent doses may be self-administered. SLIT-tablets have proven efficacy for allergic rhinitis (AR) with and without conjunctivitis (C) and allergic asthma (AA) in adults, children, and poly-sensitized allergic patients. Meta-analyses indicate that SLIT-tablets have superior or similar efficacy compared with anti-allergic pharmacotherapies for seasonal AR and superior efficacy for perennial AR. SLIT-tablets have also demonstrated clinically relevant improvements of asthma, with significant reductions in the following: daily inhaled corticosteroid use, risk of asthma exacerbations, and asthma symptoms. SLIT-tablets are generally well tolerated, with a low risk of systemic allergic reactions. The most common treatment-related adverse events are mild-moderate oral reactions. Current evidence supports SLIT-tablets to be considered as an alternative or add-on treatment to pharmacotherapy for AR/C and asthma. Future SLIT developments may include early intervention to prevent the development or progression of allergic disease in children.



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Case 15-2018: An 83-Year-Old Woman with Nausea, Vomiting, and Confusion

Presentation of Case. Dr. Andrew S. Hoekzema (Medicine): An 83-year-old woman was admitted to this hospital in the winter because of nausea, vomiting, diarrhea, and confusion. One week before admission, rhinorrhea, sore throat, and nonproductive cough developed. The patient felt feverish but did…

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Cosmetics, Vol. 5, Pages 33: Absorption and Photo-Stability of Substituted Dibenzoylmethanes and Chalcones as UVA Filters

Cosmetics, Vol. 5, Pages 33: Absorption and Photo-Stability of Substituted Dibenzoylmethanes and Chalcones as UVA Filters

Cosmetics doi: 10.3390/cosmetics5020033

Authors: Silvina Quintana Lazópulos Federico Svarc Gabriel Sagrera Lelia Dicelio

There is still an international need to develop broad-spectrum sunscreen products with an adequate UVB/UVA balance, while the approved filters available in the UVA are scarce. Currently, one of the few UVA filters approved in the United States and Europe is tert-butylmethoxydibenzoylmethane (BMDM, avobenzone). However, this compound is unstable from aphotochemical point of view and cannot be used in combination with certain sunscreens. In this paper, we investigate the photochemical behavior of a set of dibenzoylmethanes and chalcones. In particular, we carry out their absorption and emission spectra, evaluate their photochemical degradation, and study their generation of free radicals and singlet oxygen photoproduction. Two compounds resultedin having the basic properties of UVA filters (2′-hydroxy-4-methoxychalcone and 2′-hydroxy-4-methoxydibenzoylmethane). Further studies are proposed, such asformulating the compoundsinto emulsions or other commoncosmetic presentations, as well as combining them with broadly-used UVB filters. We have also considered the need to establish its toxicological profile.

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Malignes Melanom − Früherkennung, Diagnostik und Nachsorge

Zusammenfassung

Hintergrund

Das maligne Melanom ist eine häufige Hautkrebsart mit einer sehr hohen Mortalität. In Europa versterben jährlich etwa 22.000 Menschen daran, davon etwa 2700 Patienten alleine in Deutschland. Die Inzidenz zeigt seit Jahren eine steigende Tendenz. Bedeutende Risikofaktoren für die Entstehung eines malignen Melanoms sind die Anzahl der melanozytären Nävi am Körper, eine positive Familienanamnese für Melanom und genetische Prädisposition.

Ziel

In dieser Arbeit soll auch dem Nichtdermatoonkologen eine Übersicht über die Diagnostik, Behandlung, Stadieneinteilung und Nachsorge des malignen Melanoms vermittelt werden.

Material und Methoden

Es wurde eine selektive Literaturrecherche in Medline über Pubmed erstellt und mit eigenen Erfahrungen der Autoren ergänzt.

Ergebnisse

Es werden 4 klinische Formen des Melanoms unterschieden: superfiziell spreitende Melanome (SSM), Lentigo-maligna-Melanome (LMM), akral-lentiginöse Melanome (ALM) und noduläre Melanome (NM). Diese unterscheiden sich sowohl in ihrem klinischen Erscheinungsbild, ihrer Lokalisation und Entwicklung und letztlich auch ihrer Prognose, die für das ALM und NM am ungünstigsten ist. Zur Diagnosesicherung und zur klinischen und pathologischen Stadieneinteilung ist eine operative Erstversorgung von kutanen Melanomen unerlässlich. Ab einer Tumordicke nach Breslow über 1 mm wird die diagnostische Exzision des Wächterlymphknotens (WLK) empfohlen. Bei Befall des WLK sollte zunächst eine Ausbreitungsdiagnostik mittels Schnittbildgebung erfolgen. Ist eine Exzision und Nachexzision und ggf. die WLK-Biopsie erfolgt, wird eine stadiengerechte Ausbreitungsdiagnostik empfohlen. Die empfohlene Nachsorge des malignen Melanoms gestaltet sich stadienadaptiert und entsprechend der aktuellen Leitlinie.

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