Les traitements disponibles pour l’œsophagite à éosinophiles (EoE) comprennent les inhibiteurs de la pompe à protons, les corticostéroïdes topiques avalés, les régimes d’exclusion et la biothérapie. ...La diète élémentaire avec consommation exclusive d’une formule d’acides aminés pendant 8 semaines a un taux de réussite immédiat autour de 90 %. Cependant son efficacité au long cours est peu décrite.
Évaluer si la diète élémentaire exclusive est un traitement efficace à moyen terme après réintroduction des aliments.
Étude rétrospective sur des enfants suivis à l’hôpital Necker entre 2020 et 2022 avec EoE résistante aux traitements habituels, chez qui une diète élémentaire exclusive avec une formule d’acides aminés de 2 mois a été proposée. Les données cliniques sous forme de score, les résultats endoscopiques et histologiques ont été relevés après 2 mois de diète élémentaire exclusive et après 6 mois lors de la réintroduction alimentaire séquentielle.
Les données de 10 enfants (6G/4F) âgés de 12 ans (4–18 ans) d’âge médian ont été analysées. Trois (30 %) enfants ont abandonné le régime quelques jours plus tard, pour dégoût et refus. Sept enfants ont suivi le régime pendant deux mois. Chez ces enfants, le score symptomatique moyen diminuait de 4,57 avant régime à 1,47 après 2 mois de diète (p=0,018) et augmentait lors la réintroduction alimentaire à 2,57 (p=0,026). Après 2 mois de diète, une réponse histologique complète (≤15 Eo/champ) était enregistrée chez n=6 (86 %) enfants. Le nombre d’éosinophiles par champ diminuait de 34 à 5 (p=0,018) après 2 mois de régime, mais après la réintroduction alimentaire, il augmentait à 19 (p=0,176). À 6 mois après la réintroduction alimentaire un seul patient (14 %) maintient une réponse complète.
La diète élémentaire est très efficace à court terme mais ne change pas le profil évolutif de l’EoE qui récidive dans 86 % des cas lors de la réintroduction alimentaire. Cette stratégie thérapeutique est donc peu efficace à moyen terme en cas d’EoE résistante aux traitements médicamenteux.
The aim of this study was to evaluate the risk factors for candidaemia in patients with liver cirrhosis.
This was a case–control–control (1:2:2) study performed in four Italian tertiary centres from ...2006 to 2015. Cases were patients with liver cirrhosis developing candidaemia. For every case of candidaemia we enrolled two additional patients undergoing blood cultures for suspected infection yielding isolation of a bacterial pathogen (control A) and two additional patients undergoing blood cultures for suspected infection yielding negative results (control B). Patients were matched according to age, sex and model for end stage liver disease at hospital admission.
During the study period 90 cases, 180 controls A and 180 controls B were included. At multivariate analysis assessed by means of multinomial conditional regression models, factors independently associated with candidaemia were previous (<30 days) acute-on-chronic liver failure (relative risk ratio (RRR) 2.22 (95% confidence interval (CI) 1.09–4.54), p = 0.046), previous(<30 days) gastrointestinal endoscopy (RRR 2.38 (95% CI 1.19–4.78) p = 0.014), previous(<30 days) antibiotic treatment for at least 7 days (RRR 2.74 (95% CI 1.00–7.48), p = 0.049), presence of central venous catheter (RRR 2.77 (95% CI 1.26–6.09, p = 0.011), total parenteral nutrition (RRR 3.90 (95% CI 1.62–9.40), p = 0.002) at infection onset and length of in-hospital stay >15 days (RRR 4.63 (95% CI 2.11–10.18), p <0.001 Conversely, rifaximin treatment was associated with lower rate of candidaemia (RRR 0.38 (95% CI 0.19–0.77), p = 0.007). Multivariable analysis for 30-day mortality showed that patients with isolation of Candida spp. from blood cultures had worse outcome when compared with controls even though the difference did not reach a statistical significance (hazard ratio 1.64 (95% 0.97–2.75) p = 0.06).
We identified previous antibiotic use, gastrointestinal endoscopy or acute-on-chronic liver failure and presence of central venous catheter especially for parenteral nutrition as independent factors associated with candidaemia. Surprisingly, chronic rifaximin use was a protective factor.
Background
Cardiorespiratory (CR) events (apnea, bradycardia, oxygen desaturation) and gastroesophageal reflux (GER) symptoms often coexist in infants admitted to Neonatal Intensive Care Unit, ...leading to over‐prescription of drugs and delayed discharge. We aimed to evaluate the relationships between CR and GER events.
Methods
The temporal associations between CR and GER events were analyzed in symptomatic infants who underwent synchronized CR and pH‐impedance monitoring. The symptom association probability (SAP) index was used to identify infants with a significant number of temporal associations. Gastroesophageal reflux characteristics and the chronological sequence of CR and GER events occurring within 30 seconds of each other were evaluated according to SAP index.
Key Results
Of the 66 infants enrolled, aged 29 (18‐45) days, 58 had CR events during monitoring. From these 58 patients, a total of 1331 CR events and 5239 GER (24% acidic) were detected. The SAP index was positive in seven (12%) infants. These infants had greater GER frequency, duration, and proximal extent (P < .05). The number of temporal associations was 10 times greater in the positive SAP group. Gastroesophageal reflux events preceded CR events in 83% of these associations. These GER events had a higher proximal extent (P = .004), but showed no differences in pH values.
Conclusions & Inferences
The simultaneous evaluation of CR and GER events could be useful to identify infants with severe GER and significant temporal associations between these events. Treatment of GER could be indicated in these infants, but as the GER events involved are mainly non‐acidic, empirical treatment with antacids is, often, inappropriate.
Through simultaneous synchronized cardiorespiratory and pH‐impedance monitoring this study clarifies the association between cardiorespiratory and gastroesophageal reflux events in a large number of symptomatic infants. Symptom association probability index was used to identify infants with a significant number of temporal associations between cardiorespiratory and reflux events. In these infants, cardiorespiratory events were preceded by reflux events in 83% of the associations. However, the fact that the refluxes involved were mainly non‐acidic suggest that empiric pharmacological treatment with antacids drugs is, in most cases, inappropriate.
To date, the effects of long-term testosterone (T) administration on the human vagina are not completely understood. Thus, the aim of this study was to investigate the effects of long-term T ...treatment on vaginal tissue histology, estrogen receptor alpha (ERα) and beta (ERβ) expression and proliferation in female to male transsexual subjects (FtM). We compared vaginal samples from FtM subjects with those of premenopausal women (PrM) and postmenopausal women (M) not receiving any hormonal treatment for at least 2 years. Vaginal tissue samples from 16 FtM subjects treated with T (intramuscular injections of 100 mg Testoviron Depot/7-10 days for at least 1 year), undergoing sex reassignment surgery, and 16 PrM and 16 M subjects undergoing a vaginal hysterectomy for prolapse, were collected. For each sample, morphology, glycogen content, proliferation (ki-67), ERα and ERβ expression were evaluated. Vaginal samples from FtM showed a loss of normal architecture of the epithelium, intermediate and superficial layers were completely lost, and glycogen content was depleted. T administration resulted in a strong proliferation reduction when compared with both M and PrM subjects. Stromal and epithelial ERα as well as ERβ were significantly decreased in FtM when compared with PrM subjects. In conclusion, our data suggests that systemic T administration at supraphysiological dosage, determines profound changes in histomorphology and reduces ERs expression and proliferation of vaginal epithelium.
Recent data report an important role of testosterone (T) in modulating female sexual responses, but little is known about the expression and distribution of androgen receptor (AR) in the human ...vagina. Therefore, the aims of our study were to evaluate the expression of AR in the human vagina in premenopausal (PrM) and menopausal (M) women and in T-treated women. Vaginal biopsies were obtained from PrM and postmenopausal women and from women with gender identity disorder (female to male (FtM)) receiving exogenous T. AR gene and protein expression levels in vaginal tissues were determined by real-time PCR and western blot analysis, respectively, whereas the localization of AR in vaginal mucosa and stroma was performed by immunohistochemistry. ARs were detected by immunostaining both in the mucosa and stroma. In vaginal mucosa, AR density score decreases with age but does not change with T administration. In stromal tissue, AR density score does not change with age but significantly increases with T administration (P<0.01). AR protein expression was significantly increased in FtM subjects (P<0.001). The expression of AR messenger RNA (mRNA) evaluated by Real-time PCR showed a significantly higher mRNA expression in FtM versus M patients (P<0.01) and in PrM versus M subjects (P<0.05). In conclusion, we found AR protein and mRNA expression both in the epithelium and stroma of the human vagina in all groups of women. A negative correlation exists between age and AR expression in the vaginal mucosa. T administration increases AR expression in both the mucosa and stroma.
To evaluate the contribution of subjects 80 years old or older to the burden of ischemic stroke as compared with subjects younger than 80 years.
All first-ever ischemic strokes occurring in a 5-year ...period (1994 to 1998) in the population-based L'Aquila registry were traced. Incidence, total health care utilization, disability, and mortality were assessed in patients 80 years old or older, and differences with those younger than 80 years were assessed by univariate and survival analyses.
One thousand three hundred sixteen of 3,594 first-ever ischemic strokes (36.6%) occurred in patients 80 years old or older, accounting on average for one-third of health care utilization. The crude annual incidence rate was 21.54 per 1,000 (95% CI 20.42 to 22.72). At the 1-year follow-up, 27.7% of patients had mild or no disability, 20.7% had severe disability, and 51.6% had died. With respect to patients under 80 years of age, older patients showed a higher proportion of women (61.3 vs 47.7%), atrial fibrillation (30.2 vs 20.7%), coronary heart disease (31.0 vs 23.4%), and peripheral arterial disease (14.6 vs 10.8%) and a lower proportion of cigarette smoking (15.3 vs 29.2%) and hypercholesterolemia (20.4 vs 29.4%). Thirty-day (34.6 vs 13.4%) and 1-year (51.6 vs 22.3%) mortality were higher in patients 80 years old or older than in those younger than 80, mostly in the presence of atrial fibrillation (hazard ratio HR was 1.39 for 30-day mortality and 1.37 for 1-year mortality) and diabetes mellitus (HR was 1.39 for 30-day mortality and 1.31 for 1-year mortality).
The burden of ischemic stroke is high in subjects 80 years old or older, contributing about one-third of health care utilization and 59.8% of deaths within 30 days.
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