595 results on '"Emmanuel Andrès"'
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2. Nephrocalcinosis fortuitously discovered: the role of surreptitious self administration of diuretics
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Nery Sablon Gonzalez, Liliana Moran Caicedo, Maria Belen Alonso Ortiz, Yanet Parodis Lopez, Angelica Laurin, Emmanuel Andrès, and Noel Lorenzo Villalba
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nephrocalcinosis ,hypokalemia ,furosemide ,Internal medicine ,RC31-1245 - Abstract
Background: Furosemide is a drug widely used for several medical conditions and could be used without medical prescription. Furosemide-related nephrocalcinosis can occur regardless of age, although the risk is higher in premature infants. The defining characteristic of nephrocalcinosis is generalized calcium deposition in the kidney. The most useful imaging studies for evaluation are ultrasonography and computed tomography (more effective in detecting calcification). Case Presentation: A 32-year-old woman with a history of depressive syndrome was admitted for evaluation of fortuitously discovered nephrocalcinosis and hypokalemia. The studies performed revealed the presence of a metabolic alkalosis with discrete hyperreninism/hyperaldosteronism but normal ratio, normotension and urinary study showed elevated sodium, chloride, potassium and calcium fluctuating in different determinations. Surreptitious diuretic intake was suspected and urine analysis revealed doses equivalent to 80-120 mg. The patient was advised to discontinue all diuretic treatment; she was adequately supplemented with potassium and she was followed-up in outpatient clinics. During the follow-up, clinical and analytical improvement was noted, which led to the discontinuation of supplementation. Conclusion: Surreptitious diuretic intake is a clinical condition to rule out in patients with chronic hypokalemia, metabolic alkalosis with elevated urinary sodium and chloride. The relation between surreptitious diuretic intake and nephrocalcinosis has not been fully elucidated in adults.
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- 2024
3. Malignant hypercalcemia revealing a diffuse large B‐cell lymphoma in a patient with a previous diagnosis of chronic myelomonocytic leukemia: An uncommon hematological coexistence
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Alpha Oumar Diallo, Amelie Marcou, Jérémie Lespinasse, Zaida Cordoba‐Sosa, Emmanuel Andrès, Léa Docquier, and Noel Lorenzo‐Villalba
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chronic myelomonocytic leukemia ,diffuse large B‐cell lymphoma ,hypercalcemia ,parathyroid hormone‐related protein ,Medicine ,Medicine (General) ,R5-920 - Abstract
Key Clinical Message A 76‐year‐old patient previously admitted to the cardiology department for replacement of a right ventricular lead on a double‐chamber pacemaker was admitted to the internal medicine department 15 days after for bronchopneumopathy. His past medical history was relevant for Type 2 diabetes mellitus, heart failure due to dilated hypokinetic heart disease, transcatheter aortic valve implantation (TAVI), and chronic myelomonocytic leukemia (CMML‐0) diagnosed in 2021. Twenty‐four hours after admission, the patient's general condition deteriorated abruptly, with the onset of drowsiness and psychomotor retardation. Laboratory exams revealed hypercalcemia at 4.18 mmol/L. Intensive hydration, calcitonin, and zoledronic acid were initiated and the patient was transferred to the nephrology intensive care unit where he underwent two sessions of hemodialysis to normalize serum calcium levels before readmission to internal medicine. Laboratory exams revealed low parathyroid hormone, normal 1‐25‐OH vitamin D, and increased parathyroid hormone‐related peptide. Thoracoabdominal and positron emission tomography (PET) scan showed diffuse abdominopelvic peritoneal carcinosis associated with low‐grade pleural effusion and multiple supra‐ and sub‐diaphragmatic adenopathies, leading to a search for a solid tumor. The patient's clinical condition worsened leading to a transfer to the intensive care unit. The biopsy of a peritoneal carcinosis nodule confirmed the diagnosis of diffuse large B‐cell lymphoma. Specific treatments were unsuccessful and the patient expired.
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- 2023
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4. A logical alarm for misaligned binary classifiers
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Corrada-Emmanuel, Andrés, Parker, Ilya, and Bharadwaj, Ramesh
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Computer Science - Machine Learning ,Computer Science - Artificial Intelligence ,62G99 (Primary), 14Q99 (Secondary) ,I.2.3 - Abstract
If two agents disagree in their decisions, we may suspect they are not both correct. This intuition is formalized for evaluating agents that have carried out a binary classification task. Their agreements and disagreements on a joint test allow us to establish the only group evaluations logically consistent with their responses. This is done by establishing a set of axioms (algebraic relations) that must be universally obeyed by all evaluations of binary responders. A complete set of such axioms are possible for each ensemble of size N. The axioms for $N = 1, 2$ are used to construct a fully logical alarm - one that can prove that at least one ensemble member is malfunctioning using only unlabeled data. The similarities of this approach to formal software verification and its utility for recent agendas of safe guaranteed AI are discussed., Comment: 17 pages, 7 figures, under review
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- 2024
5. A Real-World Cost-Effectiveness Study Evaluating Imaging Strategies for the Diagnostic Workup of Renal Colic in the Emergency Department
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Sabrina Kepka, Kevin Zarca, Mickaël Ohana, Anne Hoffmann, Joris Muller, Pierrick Le Borgne, Emmanuel Andrès, Pascal Bilbault, and Isabelle Durand Zaleski
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tomography ,ultrasound ,emergency department length of stay ,cost-effectiveness analysis ,renal colic ,urolithiasis ,Medicine (General) ,R5-920 - Abstract
Introduction Both non-contrast Computed Tomography (CT) and ultrasound (US) are used for the diagnosis of renal colic in the emergency department (ED). Although US reduces radiation exposure, its diagnostic accuracy is inferior to that of CT. In this context, data regarding the cost and organizational impact of these strategies represent essential elements in the choice of imaging; however, they remain poorly documented. Aim of the study The aim of this study was to compare the costs and effectiveness of diagnostic workup by US and CT for patients consulting with renal colic in the ED. Methods We conducted a monocentric real-life retrospective study of patients consulting for a renal colic in an ED between 1 July 2018 and 31 December 2018. We estimated length of stay (LOS), total hospital costs at 60 days including ED, and initial and repeat admissions. Patients with initial US in the ED were compared to patients with initial CT using inverse probability weighting of the propensity score calculated from demographic variables, vital parameters, and clinical presentation. We calculated the incremental cost effectiveness ratio as the difference in costs by the difference in LOS. The variability of the results was assessed using non-parametric bootstrapping. Results In this study, of the 273 patients included, 67 were patients assessed with US and 206 with CT. The average costs were €1159 (SD 1987) and €956 (SD 1462) for US and CT, respectively, and the ED LOS was 8.9 [CI 95% 8.1; 9.4] and 8.7 [CI 95% 7.9; 9.9] hours for US and CT, respectively. CT was associated with a decreased LOS by 0.139 [CI 95% −1.1; 1.5] hours and was cost-saving, with a €199 [CI 95% −745; 285] reduction per patient. Conclusion When imaging is required in the ED for suspected renal colic as recommended, there is real-life evidence that CT is a cost-effective strategy compared to US, reducing costs and LOS in the ED.
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- 2023
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6. Hearing Loss and Sixth Cranial Nerve Paresis after COVID-19
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Noel Lorenzo Villalba, Léa Pierre, Javier Guerrero-Niño, Xavier Jannot, and Emmanuel Andrès
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sixth nerve paresis ,auditory acuity ,mri ,Medicine - Abstract
An 80-year-old patient was admitted to the internal medicine department for binocular diplopia and hearing loss with sudden onset. The patient had presented with SARS-CoV-2 infection 3 weeks previously and had been admitted to hospital. Complete work-up including autoimmunity, serum and LCR viral serology and MRI did not allow a diagnosis to be established. The hypothesis of a microvascular origin or the previous SARS-CoV-2 infection was considered. The latter was retained in light of the temporal relationship, the absence of other pathologies after exhaustive work-up, and the clinical evolution.
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- 2022
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7. Report of a ‘consensus’ on the lines of therapy for primary immune thrombocytopenia in adults, promoted by the Italian Gruppo di Studio delle Piastrine
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Lorenzo Cirasino, Anna M. Robino, GianMarco Podda, Emmanuel Andrès, Jenny M. Despotovic, Mohsen Elalfy, Andreas Holbro, Tadakazu Kondo, Michele P. Lambert, Sandra R. Loggetto, Keith R. McCrae, Jong Wook Lee, and Marco Cattaneo
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classification ,consensus ,goal ,immune thrombocytopenia ,itp ,therapy ,Diseases of the blood and blood-forming organs ,RC633-647.5 - Abstract
Despite the publication in 2009 of a paper on ‘terms and definitions of immune thrombocytopenia’ (ITP), some unresolved issues remain and are reflected by the disagreement in the treatment suggested for primary ITP in adults. Considering that these disagreements could be ascribed to non-shared goals, we generated a ‘consensus’ on some terms, definitions, and assertions useful for classifying the different lines of treatment for primary ITP in adults according to their indications and goals. Agreement on the appropriateness of the single assertions was obtained by consensus for the following indicators: 1. classification of four ‘lines of therapy’; 2. acceptance of the expression ‘sequences of disease’ for the indications of the respective four lines of treatment; 3I. practicability of splenectomy; 3Ib. acceptance, with only some exceptions, of a ‘timing for elective splenectomy of 12 months’; and 4a-d. ‘goals of the four lines of therapy.’ On the basis of the consensus, a classification of four lines of treatment for primary ITP in adults was produced. In our opinion, this classification, whose validity is not influenced by the recently published new guidelines of the American Society of Hematology (ASH) and reviews, could reduce the disagreement that still exists regarding the treatment of the disease.
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- 2020
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8. Glycemic Disorder Risk Remote Monitoring Program in the COVID-19 Very Elderly Patients: Preliminary Results
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Abrar-Ahmad Zulfiqar, Delwende Noaga Damien Massimbo, Mohamed Hajjam, Bernard Gény, Samy Talha, Jawad Hajjam, Sylvie Ervé, Amir Hajjam El Hassani, and Emmanuel Andrès
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diabetes risk ,COVID-19 ,remote monitoring ,MyPrediTM platform ,GER-e-TEC study ,prevention ,Physiology ,QP1-981 - Abstract
Introduction: The coronavirus disease 2019 (COVID-19) pandemic has necessitated the use of new technologies and new processes to care for hospitalized patients, including diabetes patients. This was the basis for the “GER-e-TEC COVID study,” an experiment involving the use of the smart MyPrediTM e-platform to automatically detect the exacerbation of glycemic disorder risk in COVID-19 older diabetic patients.Methods: The MyPrediTM platform is connected to a medical analysis system that receives physiological data from medical sensors in real time and analyzes this data to generate (when necessary) alerts. An experiment was conducted between December 14th, 2020 and February 25th, 2021 to test this alert system. During this time, the platform was used on COVID-19 patients being monitored in an internal medicine COVID-19 unit at the University Hospital of Strasbourg. The alerts were compiled and analyzed in terms of sensitivity, specificity, positive and negative predictive values with respect to clinical data.Results: 10 older diabetic COVID-19 patients in total were monitored remotely, six of whom were male. The mean age of the patients was 84.1 years. The patients used the telemedicine solution for an average of 14.5 days. 142 alerts were emitted for the glycemic disorder risk indicating hyperglycemia, with an average of 20.3 alerts per patient and a standard deviation of 26.6. In our study, we did not note any hypoglycemia, so the system emitted any alerts. For the sensitivity of alerts emitted, the results were extremely satisfactory, and also in terms of positive and negative predictive values. In terms of survival analysis, the number of alerts and gender played no role in the length of the hospital stay, regardless of the reason for the hospitalization (COVID-19 management).Conclusion: This work is a pilot study with preliminary results. To date, relatively few projects and trials in diabetic patients have been run within the “telemedicine 2.0” setting, particularly using AI, ICT and the Web 2.0 in the era of COVID-19 disease.
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- 2021
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9. Effects of Rehabilitation on Long-COVID-19 Patient’s Autonomy, Symptoms and Nutritional Observance
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Jeyniver Ghanem, Anne Passadori, François Severac, Alain Dieterlen, Bernard Geny, and Emmanuel Andrès
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COVID-19 ,rehabilitation ,autonomy ,malnutrition ,long-haul symptoms ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Background: Despite significant improvements in COVID-19 therapy, many patients still present with persistent symptoms and quality-of-life alterations. The aim of this study was to simultaneously investigate the long-term evolution of autonomy, malnutrition and long-lasting symptoms in people infected with COVID-19 and hospitalized in the ICU. Method: Patients’ clinical characteristics; extent of their loss of autonomy based on “Autonomie Gérontologie Groupes Iso-Ressources” (AG-GIR) classification; nutritional status while following the French and Global Leadership Initiative on Malnutrition (GLIM) recommendations; and symptom evolutions before infection, during hospitalization and rehabilitation, and up to 6 months after returning home were determined in thirty-seven patients. Results: Prior to a COVID-19 infection, all patients were autonomous, but upon admission to the rehabilitation center (CRM), 39% of them became highly dependent. After discharge from the center and 6 months after returning home, only 6 and 3%, respectively, still required considerable assistance. Of these thirty-seven patients, 11% were moderately malnourished and 81% presented with severe malnutrition, with a significant correlation being observed between malnutrition and autonomy (p < 0.05). Except for fatigue, which persisted in 70% of the patients 6 months after discharge from rehabilitation, all other symptoms decreased significantly. Conclusions: This study shows a striking decrease in autonomy associated with malnutrition after hospitalization for a COVID-19 infection and a clear beneficial effect from personalized rehabilitation. However, although almost all patients regained autonomy 6 months after returning home, they often still suffer from fatigue. Patient compliance with their nutritional recommendations deserves further improvement, preferably through personalized and persistent follow-up with the patient.
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- 2022
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10. First Test of an Automated Detection Platform to Identify Risk of Decompensation in Elderly Patients
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Abrar-Ahmad Zulfiqar, Orianne Vaudelle, Mohamed Hajjam, Dominique Letourneau, Jawad Hajjam, Sylvie Ervé, Anna Karen Garate Escamilla, Amir Hajjam, and Emmanuel Andrès
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telemonitoring ,geriatric risks ,mypredi ,e-platform ,ger-e-tec study ,Medicine - Abstract
Introduction: We tested the MyPrediTM e-platform which is dedicated to the automated, intelligent detection of situations posing a risk of decompensation in geriatric patients. Objective: The goal was to validate the technological choices, to consolidate the system and to test the robustness of the MyPrediTM e-platform through daily use. Results: The telemedicine solution took 3,552 measurements for a hospitalized patient during her stay, with an average of 237 measurements per day, and issued 32 alerts, with an average of 2 alerts per day. The main risk was heart failure which generated the most alerts (n=13). The platform had 100% sensitivity for all geriatric risks, and had very satisfactory positive and negative predictive values. Conclusion: The present experiment validates the technological choices, the tools and the solutions developed.
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- 2020
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11. Cutaneous Complications Secondary to Haemostasis Abnormalities in COVID-19 Infection
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Noel Lorenzo-Villalba, Yasmine Maouche, Aneska Syrovatkova, Felix Pham, Jean-Baptiste Chahbazian, Pierre Pertoldi, Emmanuel Andrès, and Abrar-Ahmad Zulfiqar
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covid-19 ,dissecting haematoma ,dermatoporosis ,coagulation abnormalities ,Medicine - Abstract
We describe the case of a patient hospitalized for acute decompensated heart failure in a standard medical ward. During hospitalization, he was diagnosed with COVID-19 and transferred to a special unit. The clinical course was marked by worsening of the respiratory disease, the development of right parotiditis and thrombosis of the left internal jugular vein. Therapeutic anticoagulation was initiated and 2 days later, the minimal dermatoporosis lesions previously present in the upper extremities evolved to haemorrhagic bullae with intra-bullae blood clots and dissecting haematomas. Surgical management of the dissecting haematomas was difficult in the context of haemostasis abnormalities. The patient died 29 days after hospital admission.
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- 2020
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12. Classification models for heart disease prediction using feature selection and PCA
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Anna Karen Gárate-Escamila, Amir Hajjam El Hassani, and Emmanuel Andrès
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Machine learning ,Heart disease ,Apache spark ,PCA ,Feature selection ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
The prediction of cardiac disease helps practitioners make more accurate decisions regarding patients' health. Therefore, the use of machine learning (ML) is a solution to reduce and understand the symptoms related to heart disease. The aim of this work is the proposal of a dimensionality reduction method and finding features of heart disease by applying a feature selection technique. The information used for this analysis was obtained from the UCI Machine Learning Repository called Heart Disease. The dataset contains 74 features and a label that we validated by six ML classifiers. Chi-square and principal component analysis (CHI-PCA) with random forests (RF) had the highest accuracy, with 98.7% for Cleveland, 99.0% for Hungarian, and 99.4% for Cleveland-Hungarian (CH) datasets. From the analysis, ChiSqSelector derived features of anatomical and physiological relevance, such as cholesterol, highest heart rate, chest pain, features related to ST depression, and heart vessels. The experimental results proved that the combination of chi-square with PCA obtains greater performance in most classifiers. The usage of PCA directly from the raw data computed lower results and would require greater dimensionality to improve the results.
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- 2020
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13. The logic of NTQR evaluations of noisy AI agents: Complete postulates and logically consistent error correlations
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Corrada-Emmanuel, Andrés
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Computer Science - Artificial Intelligence - Abstract
In his "ship of state" allegory (\textit{Republic}, Book VI, 488) Plato poses a question -- how can a crew of sailors presumed to know little about the art of navigation recognize the true pilot among them? The allegory argues that a simple majority voting procedure cannot safely determine who is most qualified to pilot a ship when the voting members are ignorant or biased. We formalize Plato's concerns by considering the problem in AI safety of monitoring noisy AI agents in unsupervised settings. An algorithm evaluating AI agents using unlabeled data would be subject to the evaluation dilemma - how would we know the evaluation algorithm was correct itself? This endless validation chain can be avoided by considering purely algebraic functions of the observed responses. We can construct complete postulates than can prove or disprove the logical consistency of any grading algorithm. A complete set of postulates exists whenever we are evaluating $N$ experts that took $T$ tests with $Q$ questions with $R$ responses each. We discuss evaluating binary classifiers that have taken a single test - the $(N,T=1,Q,R=2)$ tests. We show how some of the postulates have been previously identified in the ML literature but not recognized as such - the \textbf{agreement equations} of Platanios. The complete postulates for pair correlated binary classifiers are considered and we show how it allows for error correlations to be quickly calculated. An algebraic evaluator based on the assumption that the ensemble is error independent is compared with grading by majority voting on evaluations using the \uciadult and and \texttt{two-norm} datasets. Throughout, we demonstrate how the formalism of logical consistency via algebraic postulates of evaluation can help increase the safety of machines using AI algorithms., Comment: 18 pages, 9 figures, under review
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- 2023
14. Severe Neutropenia and Agranulocytosis Related to Antithyroid Drugs: A Study of 30 Cases Managed in A Single Reference Center
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Emmanuel Andrès, Noel Lorenzo-Villalba, Rachel Mourot-Cottet, Frédéric Maloisel, Martine Tebacher, Jacques-Eric Gottenberg, Bernard Goichot, Raoul Herbrecht, and Abrar-Ahmad Zulfiqar
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neutropenia ,agranulocytosis ,antithyroid drug ,carbimazole ,propylthiouracil ,diagnosis ,fever ,infection ,hematopoietic growth factor ,granulocyte colony-stimulating factor ,Medicine - Abstract
Background: The most important series devoted to antithyroid drug-induced severe neutropenia and agranulocytosis are Japanese studies, almost specifically in relation to the intake of methimazole. The clinical data of 30 Caucasian patients followed up for antithyroid drug-induced neutropenia at a third-level hospital are reported. Methods: The data of 30 patients with idiosyncratic antithyroid drug-induced neutropenia and agranulocytosis from a cohort study on drug-induced neutropenia and agranulocytosis conducted at the University Hospital of Strasbourg (France) were retrospectively reviewed. Results: The mean patient age was 61.7 years old (range: 20−87), and the gender ratio (F/M) was 4. Several comorbidities were reported in 23 patients (76.7%), with the mean Charlson comorbidity index of 1. The causative drugs were carbimazole and benzylthiouracil, in 28 (93.3%) and 2 cases, respectively, prescribed primarily for multi-hetero-nodular goiter or thyroid nodule to 18 patients (60%). Sore throat and acute tonsillitis (40%), isolated fever (20%), septicemia (13.3%), documented pneumonia (6.7%), and septic shock (6.7%) were the main clinical features upon admission. The mean neutrophil count at nadir was 0.02 and 0 × 109/L (range: 0−0.3). Regarding the patients’ hospital course: 13 cases (43.3%) worsened during hospitalization, severe sepsis was found in 26.7%, systemic inflammatory response syndrome—in 13.3%, and septic shock—in 3.3% of the cases, respectively. Broad-spectrum antibiotics were indicated for all the patients, and 21 (73.3%) of them received hematopoietic growth factors. Hematological recovery (neutrophil count ≥ 1.5 × 109/L) was seen at 8.3 days (range: 2−24), but faster in those receiving hematopoietic growth factors (4.9 days, p = 0.046). Two patients died during hospitalization, and the rest had a favorable clinical outcome. Conclusions: Antithyroid drug-induced neutropenia represents a serious complication resulting from the rates of severe infections especially in those cases severe neutropenia. In this setting, an established procedure for the management of patients seems useful or even indispensable in view of potential mortality.
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- 2020
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15. Streaming algorithms for evaluating noisy judges on unlabeled data -- binary classification
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Corrada-Emmanuel, Andrés
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Statistics - Machine Learning ,Computer Science - Machine Learning ,Mathematics - Algebraic Geometry - Abstract
The evaluation of noisy binary classifiers on unlabeled data is treated as a streaming task: given a data sketch of the decisions by an ensemble, estimate the true prevalence of the labels as well as each classifier's accuracy on them. Two fully algebraic evaluators are constructed to do this. Both are based on the assumption that the classifiers make independent errors. The first is based on majority voting. The second, the main contribution of the paper, is guaranteed to be correct. But how do we know the classifiers are independent on any given test? This principal/agent monitoring paradox is ameliorated by exploiting the failures of the independent evaluator to return sensible estimates. A search for nearly error independent trios is empirically carried out on the \texttt{adult}, \texttt{mushroom}, and \texttt{two-norm} datasets by using the algebraic failure modes to reject evaluation ensembles as too correlated. The searches are refined by constructing a surface in evaluation space that contains the true value point. The algebra of arbitrarily correlated classifiers permits the selection of a polynomial subset free of any correlation variables. Candidate evaluation ensembles are rejected if their data sketches produce independent estimates too far from the constructed surface. The results produced by the surviving ensembles can sometimes be as good as 1\%. But handling even small amounts of correlation remains a challenge. A Taylor expansion of the estimates produced when independence is assumed but the classifiers are, in fact, slightly correlated helps clarify how the independent evaluator has algebraic `blind spots'., Comment: 25 pages, 5 figures. Added extensive discussion about the Platanios agreement equations and how the independent solution from them is not correct
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- 2023
16. Cobalamin Deficiency in Elderly Patients: A Personal View
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Emmanuel Andrès, Thomas Vogel, Laure Federici, Jacques Zimmer, Ecaterina Ciobanu, and Georges Kaltenbach
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Geriatrics ,RC952-954.6 - Abstract
Cobalamin (vitamin B12) deficiency is particularly common in the elderly (>65 years of age) but is often unrecognized because its clinical manifestations are subtle; however, they are also potentially serious, particularly from a neuropsychiatric and hematological perspective. In the elderly, the main causes of cobalamin deficiency are pernicious anemia and food-cobalamin malabsorption. Food-cobalamin malabsorption syndrome is a disorder characterized by the inability to release cobalamin from food or its binding proteins. This syndrome is usually caused by atrophic gastritis, related or unrelated to Helicobacter pylori infection, and long-term ingestion of antacids and biguanides. Management of cobalamin deficiency with cobalamin injections is currently well documented but new routes of cobalamin administration (oral and nasal) are being studied, especially oral cobalamin therapy for food-cobalamin malabsorption.
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- 2008
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17. Analysis of Respiratory Sounds: State of the Art
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Sandra Reichert, Raymond Gass, Christian Brandt, and Emmanuel Andrès
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Diseases of the respiratory system ,RC705-779 - Abstract
Objective This paper describes state of the art, scientific publications and ongoing research related to the methods of analysis of respiratory sounds. Methods and material Review of the current medical and technological literature using Pubmed and personal experience. Results The study includes a description of the various techniques that are being used to collect auscultation sounds, a physical description of known pathologic sounds for which automatic detection tools were developed. Modern tools are based on artificial intelligence and on technics such as artificial neural networks, fuzzy systems, and genetic algorithms… Conclusion The next step will consist in finding new markers so as to increase the efficiency of decision aid algorithms and tools.
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- 2008
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18. Phenotypic studies of natural killer cell subsets in human transporter associated with antigen processing deficiency.
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Jacques Zimmer, Huguette Bausinger, Emmanuel Andrès, Lionel Donato, Daniel Hanau, François Hentges, Alessandro Moretta, and Henri de la Salle
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Medicine ,Science - Abstract
Peripheral blood natural killer (NK) cells from patients with transporter associated with antigen processing (TAP) deficiency are hyporesponsive. The mechanism of this defect is unknown, but the phenotype of TAP-deficient NK cells is almost normal. However, we noticed a high percentage of CD56(bright) cells among total NK cells from two patients. We further investigated TAP-deficient NK cells in these patients and compared them to NK cells from two other TAP-deficient patients with no clinical symptoms and to individuals with chronic inflammatory diseases other than TAP deficiency (chronic lung diseases or vasculitis). Peripheral blood mononuclear cells isolated from venous blood were stained with fluorochrome-conjugated antibodies and the phenotype of NK cells was analyzed by flow cytometry. In addition, (51)Chromium release assays were performed to assess the cytotoxic activity of NK cells. In the symptomatic patients, CD56(bright) NK cells represented 28% and 45%, respectively, of all NK cells (higher than in healthy donors). The patients also displayed a higher percentage of CD56(dim)CD16(-) NK cells than controls. Interestingly, this unusual NK cell subtype distribution was not found in the two asymptomatic TAP-deficient cases, but was instead present in several of the other patients. Over-expression of the inhibitory receptor CD94/NKG2A by TAP-deficient NK cells was confirmed and extended to the inhibitory receptor ILT2 (CD85j). These inhibitory receptors were not involved in regulating the cytotoxicity of TAP-deficient NK cells. We conclude that expansion of the CD56(bright) NK cell subtype in peripheral blood is not a hallmark of TAP deficiency, but can be found in other diseases as well. This might reflect a reaction of the immune system to pathologic conditions. It could be interesting to investigate the relative distribution of NK cell subsets in various respiratory and autoimmune diseases.
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- 2007
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19. New insight in the auscultation of respiratory sounds
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Emmanuel Andrès
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Diseases of the respiratory system ,RC705-779 - Published
- 2015
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20. Independence Tests Without Ground Truth for Noisy Learners
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Corrada-Emmanuel, Andrés, Pantridge, Edward, Zahrebelski, Eddie, Chaganti, Aditya, and Simeonov, Simeon
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Statistics - Machine Learning ,Computer Science - Machine Learning - Abstract
Exact ground truth invariant polynomial systems can be written for arbitrarily correlated binary classifiers. Their solutions give estimates for sample statistics that require knowledge of the ground truth of the correct labels in the sample. Of these polynomial systems, only a few have been solved in closed form. Here we discuss the exact solution for independent binary classifiers - resolving an outstanding problem that has been presented at this conference and others. Its practical applicability is hampered by its sole remaining assumption - the classifiers need to be independent in their sample errors. We discuss how to use the closed form solution to create a self-consistent test that can validate the independence assumption itself absent the correct labels ground truth. It can be cast as an algebraic geometry conjecture for binary classifiers that remains unsolved. A similar conjecture for the ground truth invariant algebraic system for scalar regressors is solvable, and we present the solution here. We also discuss experiments on the Penn ML Benchmark classification tasks that provide further evidence that the conjecture may be true for the polynomial system of binary classifiers., Comment: 18 pages, 3 figures
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- 2020
21. Algebraic Ground Truth Inference: Non-Parametric Estimation of Sample Errors by AI Algorithms
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Corrada-Emmanuel, Andrés, Pantridge, Edward, Zahrebelski, Edward, Chaganti, Aditya, and Simeonov, Simeon
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Statistics - Machine Learning ,Computer Science - Machine Learning - Abstract
Binary classification is widely used in ML production systems. Monitoring classifiers in a constrained event space is well known. However, real world production systems often lack the ground truth these methods require. Privacy concerns may also require that the ground truth needed to evaluate the classifiers cannot be made available. In these autonomous settings, non-parametric estimators of performance are an attractive solution. They do not require theoretical models about how the classifiers made errors in any given sample. They just estimate how many errors there are in a sample of an industrial or robotic datastream. We construct one such non-parametric estimator of the sample errors for an ensemble of weak binary classifiers. Our approach uses algebraic geometry to reformulate the self-assessment problem for ensembles of binary classifiers as an exact polynomial system. The polynomial formulation can then be used to prove - as an algebraic geometry algorithm - that no general solution to the self-assessment problem is possible. However, specific solutions are possible in settings where the engineering context puts the classifiers close to independent errors. The practical utility of the method is illustrated on a real-world dataset from an online advertising campaign and a sample of common classification benchmarks. The accuracy estimators in the experiments where we have ground truth are better than one part in a hundred. The online advertising campaign data, where we do not have ground truth data, is verified by an internal consistency approach whose validity we conjecture as an algebraic geometry theorem. We call this approach - algebraic ground truth inference., Comment: 9 pages, 3 figures
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- 2020
22. Error Correcting Algorithms for Sparsely Correlated Regressors
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Corrada-Emmanuel, Andrés, Zahrebelski, Edward, and Pantridge, Edward
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Statistics - Machine Learning ,Computer Science - Machine Learning - Abstract
Autonomy and adaptation of machines requires that they be able to measure their own errors. We consider the advantages and limitations of such an approach when a machine has to measure the error in a regression task. How can a machine measure the error of regression sub-components when it does not have the ground truth for the correct predictions? A compressed sensing approach applied to the error signal of the regressors can recover their precision error without any ground truth. It allows for some regressors to be \emph{strongly correlated} as long as not too many are so related. Its solutions, however, are not unique - a property of ground truth inference solutions. Adding $\ell_1$--minimization as a condition can recover the correct solution in settings where error correction is possible. We briefly discuss the similarity of the mathematics of ground truth inference for regressors to that for classifiers.
- Published
- 2019
23. Heart failure and in-hospital mortality in elderly patients after elective noncardiac surgery in Spain
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Manuel Méndez-Bailón, José Luis Bernal Sobrino, Javier Marco-Martínez, Javier Elola-Somoza, María García Márquez, Cristina Fernández-Pérez, Javier Azana-Gómez, José Luis García-Klepzig, Emmanuel Andrès, Antonio Zapatero-Gaviria, Raquel Barba-Martin, Jesus Canora-Lebrato, and Noel Lorenzo-Villalba
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Aged, 80 and over ,Heart Failure ,Postoperative Complications ,Elective Surgical Procedures ,Spain ,Humans ,Female ,Hospital Mortality ,General Medicine ,Aged ,Retrospective Studies - Abstract
Patients with heart failure (HF) undergoing noncardiac surgical procedures is rising worldwide. This study was aiming at analyzing the impact of heart failure (HF) on the outcomes (mortality, complications, readmissions, and length of stay) of elderly patients undergoing elective major noncardiac surgical procedures in Spain.A retrospective observational study of patients undergoing noncardiac surgery was conducted. The Minimum Basic Data Set (MBDS) was used to collect information about the demographic characteristics of patients discharged from hospitals of the Spanish National Health System (SNHS), variables related to patients' medical conditions and surgeries conducted during the episode.A total of 996,986 selected procedures in the discharge record were identified in the period 2007-2015. HF was recorded as a secondary diagnosis in 22,367 discharges (2.24%). The mean age of patients was 76.6±7.27 years, with a difference in patients without and with HF: 76.5 (95% CI: 76.47-76.50) vs 82.8 (95% CI: 82.71-82.90). The number of selected surgical procedures increased by 13.2% (117,487 in 2015 vs. 103,744 in 2007), and the proportion of presence HF as a comorbidity increased by 24.4% (2.4% in 2015 v 1.9% in 2007). The proportion of women was higher in the HF group: 53.2% (95% CI: 53.18-53.22) vs 64.3% (95% CI: 64.20-64.44), with a longer average length of stay: 7.9 (95% CI: 7.9-7.9) vs 14.9 (95% CI 14.7-15.0) days, and women had a higher proportion of comorbidities. HF was found to be an independent risk factor in-hospital mortality in the multilevel risk adjustment model (OR=2.3; 95% CI: 2.2-2.4).Patients with HF undergoing any of the selected surgical procedures are older; there was women predominance and there is also an important burden of comorbidities than patients without HF undergoing these surgical procedures. HF in the selected procedures, increasing in-hospital mortality, mean length of stay, and the occurrence of adverse events in the Spanish population. The percentage of patients with HF who underwent the selected surgical procedures increased in the study period.
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- 2022
24. Sarilumab in adults hospitalised with moderate-to-severe COVID-19 pneumonia (CORIMUNO-SARI-1): An open-label randomised controlled trial
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Anatole Harrois, Florence Patin, Anaïs Razurel, Laure Allanic, Grégoire Martin de Frémont, Vincent Jachiet, Gonçalo Boleto, Eric D'Ortenzio, Xavier Mariette, Philippe Dieudé, Etienne Canouï, Z Julia, Nathalie Dournon, Jean-Sébastien Hulot, David Lebeaux, Eric Mariotte, Dorothee Vallois, Laurence Berard, Nicolas Gambier, Christiane Verny, Mathilde Le Marchand, Mitja Jevnikar, Jean-Jacques Mourad, Marjolaine Morgand, Bertrand Guidet, Alexandre Moores, Prissile Bakouboula, Frédéric Pène, Pascal Richette, Martine Meunier, Juliette Camuset, Stéphane Jauréguiberry, Lynda Chalal, Mamadou Salif Cisse, Marie-Hélène Legros, Yann Nguyen, Damien Roux, Robin Deleris, Maxence Decavele, Patrice Cacoub, Isabelle Dusanter, Patricia Senet, Nassim Mahtal, Raphael Borie, Philippe Benoit, Blandine Denis, Luca Semerano, Sebastien Abad, Marie Dubert, Marie Lachatre, Marine Livrozet, Nathan Ebstein, Lakhdar Mameri, Adrien Michon, Olivier Sanchez, Aurélien Guffroy, Pierre Dupland, Jérôme Pacanowski, Yasmina Ferfar, Tassadit Hadjam, Anne-Marie Roques, Celine Comparon, Solaya Chalal, A Soria, Isabelle Lehir, Anne Gysembergh-Houal, Stéphanie Alary, Valérie Dejean, Elena Kiouris, Estelle Henry, Sophie Diemunsch, Jonathan London, Fanny Charbonnier, Alexandre Demoule, Louise Bondeelle, Samira Saleh-Mghir, Lise Bernard, Brigitte Sabatier, Anne Jacolot, Aurelie Sautereau, Pierre Faye, Benjamin Fournier, Noémie Abisror, Awa Ndiaye, Ruben Benainous, Damien Sène, Emmanuelle Sacco, Isabelle Debrix, Gabriel Nisand, Régis Peffault de Latour, Anne Sophie Korganow, Kévin Cardet, Perrine Guillaume-Jugnot, Soumeya Hammal, B. Duchemann, Elena Fois, Jean-Benoit Arlet, Christine Broissand, Yaël Amara, Matheus Vieira, Sophie Caillat-Zucman, Madona Sakkal, Juliette Djadi-Prat, Jean-Louis Teboul, Hélène François, Stéphane Renaud, Sylviane Ravato, Alaki Thiemele, Gabrielle Archer, Alain Fourreau, David Boutboul, Arsène Mekinian, Antoine Gros, Morgane Faure, Anne Pattyn, Camille Petit-Hoang, Jessica Krause le Garrec, Antony Canellas, Jean-Michel Molina, Zakaria Ait Hamou, Eric Oksenhendler, Ilias Koumis, Marie-Aude Penet, Catherine Boussard, Vincent Fallet, Guillaume Geri, Loic Kassegne, Bernard Cholley, Lucie Biard, Elodie Perrodeau, Tomas Urbina, David Schmitz, johann Cailhol, Elise Morawiec, Audrey Phibel, Sophie Renet, Emmanuel Weiss, Faouzi Saliba, Kristina Beziriganyan, Abdellatif Tazi, Isabelle Peigney, Bertrand Dunogue, Rémy Gauzit, Damien Bergerot, Bob Heger, Ines Ben-Mabrouk, Jade Ghosn, Benjamin Planquette, Alexis Régent, François Weill, Yasmina Mekid, Rosa Da Silva, Victor Lancon, Marc Michel, Nadia Anguel, Anne Claire Desbois, François Danion, Brigitte Ranque, Mohamed Belloul, Nadège Lemarié, Amélie Cransac, Marine Nadal, Lalia Djaghout, Anne Tréhan, Samy Figueiredo, Hakim Meddah, Aurélie Clan Hew Wai, Julie Delemazure, Soraya Fellahi, Jacques-Eric Gottenberg, Matthieu Uzzan, Jean-Charles Duclos-Vallée, Tabassome Simon, Vanessa Rathouin, Yves Hansmann, Hélène Gros, Syllia Belazouz, Nathalie Marin, Camille Rolland-Debord, Edouard Lefèvre, Sophie-Rym Hamada, Tristan Martin, Annabelle Stoclin, Frédéric Duée, Helene Chambrin-Lauvray, Ramdane Meftali, Miguel Alejandro Vasquez-Ibarra, Isabelle Madeleine, Simon Valayer, Anne Adda, Marie-Thérèse Tremorin, Nicolas Meyer, Vixra Keo, Lara Zafrani, Caroline Semaille, Maxime Dougados, Olivier Olivier, Emeline Colomba, Florence Morin, Claire Rouzaud, Paul Michel Mertes, Claire Montlahuc, Anne Blanchard, Valérie Pourchet-Martinez, Constance Delaugerre, Nicolas Carlier, Jacques Cadranel, Nicolas Noel, Kahina Cheref, Bao Phung, Moez Jallouli, Ulrich Clarac, Marthe Rigal, Mireille Adda, Lionel Galicier, Fanny Domont, Lee S. Nguyen, Férial Berbour, Fanny Pommeret, Celine Dupré, Gaël Leprun, Jean-Luc Diehl, Laetitia Languille, Philippe Blanche, Abolfazl Mohebbi, Mathilde Noaillon, Olivier Collange, Paul Jaubert, Anne Daguenel-Nguyen, Sandrine Briois, Anne-Lise Pouliquen, Coralie Bloch Queyrat, Clément Jourdaine, Cédric Pierron, Geoffrey Rossi, Chloe McAvoy, Claire Courtin, Mathias Cornic, C Rioux, Christine Lemagner, Martin Dres, Emmanuelle Guillot, Marc Garnier, Safaa Nemlaghi, Guillaume Grailles, Yazdan Yazdanpanah, Veronique Joly, Thiziri Sadaoui, Marion Bouhris, Vincent Castelain, Muriel Fartoukh, Sébastien Cavelot, Sophie Ohlmann-Caillard, Valentina Isernia, Bruno Crestani, Thinhinane Bariz, Benjamin Chaigne, Emmanuel Andrès, Frédéric Blanc, Alain Wynckel, Louise-Laure Mariani, Yasmine Messaoudi, Naima Sguiouar, Amina Kebir, Asmaa Mamoune, Caroline Gaudefroy, Victoire De Lastours, Pierre Diemunsch, Etienne Lengliné, Claire Tantet, Julien Mayaux, Benjamin G. Chousterman, Arthur Pavot, Anne Rachline, Gwenaël Lorillon, Hassan Joumaa, Nicolas Lefebvre, Elodie Baudry, Nicolas Bonnet, Fanny Defrancq, Véronique Vigna, Yves Cohen, Amira Benattia, Martin Siguier, Sophie Georgin-Lavialle, Emmanuelle Bugnet, Lamiae Grimaldi, Olivia Daconceicao, Olivier Hermine, Mathieu Vautier, Florence Tubach, Marion Licois, Anaïs Codorniu, Fanny Alby-Laurent, Jérémie Zerbit, Aude Jacob, Benedicte Giroux-Leprieur, Carine Karachi, Laurent Cylly, Edouard Flamarion, Gladys Aratus, Charléne Jouve, Robin Dhote, Claire Davoine, Valentin Greigert, Gaelle Leroux, Cécile Kedzia, Guillaume Lefèvre, Catherine Metzger, Olivier Benveniste, Clairelyne Dupin, Marie-Alexandra Alyanakian, Mathieu Oberlin, Julien Poissy, Linda Gimeno, Adrien Contejean, Segolene Toquet, Jeanne CHAUFFiER, Mathieu Jozwiak, Laurent Savale, Virginie Zarrouk, Cécile Yelnik, Mandy Nizard, Mourad Djadel, F-Xavier Lescure, Agnes Maurer, Geoffroy Liégeon, Arthur Neuschwander, Hélène Lafoeste, Gaëtan Deslée, Frédéric De Blay, Claire Pernin, Cloé Comarmond, Anne Hutt, Ridha Belilita, Laurence Lecomte, Sophie-Caroline Sacleux, Nathalie Rozensztajn, Jean-Jacques Tudesq, Benjamin Terrier, Solène Fabre, Lelia Escaut, Eva Chatron, Emmanuelle Blin, Pauline Jouany, Sara Sambin, Chistophe Willekens, Nabil Raked, Jean-Simon Rech, Serge Bureau, Boris Bienvenu, Elisabeth Coupez, Tali-Anne Szwebel, Lydia Suarez, Chaouki Bouras, Kamyl Baghli, Emilia Stan, Valérie Camara-Clayette, Fanette Denies, Nathalie Menage, Paul Legendre, Axelle Fuentes, Oriane Puéchal, Charlotte Kaeuffer, Guillaume Becker, Clara Campos-Vega, Armand Mekontso-Dessaps, Pernelle Vauboin, Yurdagul Uzunhan, F Louni, Marie hélène Pari, Myriam Virlouvet, Nicolas Belaube, Hugues Cordel, Nathalie Chavarot, Olivier Sitbon, Jean-Daniel Lelievre, Matthieu Mahévas, Julie Smati, Olivier Clovet, Marc Bardou, Ada Clarke, Gilles Garcia, Anouk Walter-Petrich, Hala Semri, Vasco Honsel, Giovanna Melica, Pierre Mora, Olivier Fain, A Gervais, Marc Humbert, Yves Allenbach, Céline Verstuyft Verstuyft, Blandine Lehmann, Pascal Martel, Aida Zahrate-Ghoul, Karine Martin, Alexandre Bourgoin, Baptiste Duceau, Philippe Ravaud, Celine Wilpotte, Sylvie Le Gac, Michaël Darmont, Aurélie Durel Maurisse, Younes Keroumi, Aude Rigolet, Julie Chas, Pierre-Louis Tharaux, Caroline Morbieu, Valérie Paquet, Eric Vicaut, Pascaline Choinier, Samir Hamiria, Elsa Feredj, Frédéric Schlemmer, Gilles Pialoux, Zeina Louis, Marion Parisey, David Montani, Jean-Pierre Riveline, Jean-Marie Michot, Pascal Lim, Eliane Bertrand, Gaelle Clavere, Julie Jambon, Stéphane Brin, Saskia Flamand, Jeanne Meunier, Geoffroy Volle, Martin De Sarcus, Marie Vayssettes, Thomas Papo, Caroline Hauw-Berlemont, Gabriel Baron, Jeremy Arzoine, Loren Soyez-Herkert, Maria Pereira, Antoine Parrot, Johanna Oziel, Carole Burger, Eric Noll, Paul Vermes, Jeanne Goupil de Bouille, Xavier Monnet, Paul Crespin, Sarah Dalibey, Thierno Dieye, Renaud Felten, Jean-Philippe Bastard, Younes El Amine, Timothee Bironne, Damien Vanhoye, Amine Ghembaza, Laure Berton, Yvon Ruch, Thomas Volpe, Thomas Gorget, Jaouad Benhida, Julien Saussereau, Elodie Issorat, Virginie Elisee, Adrien Mirouse, Cecile Larcheveque, Laurène Deconinck, A. Dossier, Félix Ackermann, Greggory Ducrocq, Anne Bergeron, Laurence Annonay, Camille Knosp, Laurence Drouard, Adrien Joseph, Hilario Nunes, Hanane Fodil, Sabrine Ouamri, Belkacem Asselate, Julie Fillon, Dominique Dautel, Isabelle Brindele, Robin Charreteur, S Lariven, Elie Azoulay, Sami Kolta, Cédric Sublon, Florence Bellenfant, Melissa Clément, Lola-Jade Palmieri, Bruno Mourvillier, Ewa Kozaliewicz, Vincent Provitolo, Marie Lecronier, Julien Chabert, Matthieu Resche-Rigon, Stéphan Pavy, Naura Gamany, Dorothée Chopin, Aïcha Bah, Moustafa Benafla, Corinne Guerin, Pierre Tissieres, Nathalie Costedoat-Chalumeau, Nessima Yelles, Emmanuel Chatelus, Jean-Christophe Corvol, Luc Mouthon, Marie Gilbert, Matthieu Lemoine, Lucie Aunay, Candice Estellat, Laure Choupeaux, Dhiaa Meriem Hai, Bernard Goichot, Céline Louapre, Roza Rahli, Nathalie De Castro, Christian Richard, Malikhone Chansombat, Kamil Chitour, Joseph Emmerich, Elodie Drouet, Julien Pottecher, Eric Demonsant, Alexandra Beurton, Raphaël Porcher, Lauren Demerville, Amélie Servettaz, Annabelle Pourbaix, Philippe Manivet, Pierre-Grégoire Guinot, Nicolas Champtiaux, Caroline Pradon, Annick Tibi, Julien Le Marec, Nawal Derridj, Mohamad Zaidan, Eric Marquis, Mickael Henriques, Bruno Mégarbane, Aline Frazier, Ramon Junquera, Diane Le Pluart, Coralie Gernez, Yacine Boudali, Dimitri Fremont, Pierrick Le Borgne, Corinne Pernot, Mélanie Dehais, Claire Madelaine, Dominique Roulot, Georgina Maalouf, Constance Guillaud, Corine Nyanou, Karine Celli Lebras, Sophie Granville, Sabrina Brahmi, Catherine Le Bourlout, Hassan Tarhini, Asmaa Mabrouki, Hakim Tayebi, Sophie Ismael, Jonathan Marey, Sophie Bayer, Gabriel Steg, Antoine Fayol, Catherine Fauvaux, Delphine Feyeux, Côme Bureau, Alexandre Morel, Agathe Bounhiol, Alexandre Buffet, Souad Benarab, Luc Haudebourg, Pierre Le Guen, Damien Vimpere, Xavier Jaïs, Clotilde Le Tiec Le Tiec, Sophie Bulifon, Pélagie Thibaut, Alison Klasen, Claire Pacheco, Anne Godier, Marie Antignac, Domitille Molinari, Philippe Durand, Olivier Lambotte, Paul Henri Grisot, Anne Lise Jegu, Vincent Poindron, Ruxandra Burlacu, Denis Jesuthasan, Sarah Benghanem, Solen Kernéis, Antoine Bachelard, Jacques Duranteau, Karine Lacombe, Olivia Lenoir, Mathilde Vallet, Sara Virolle, Léa Resmini, Liem Binh Luong Nguyen, Marie Matignon, Céline Leplay, and Claire Aguilar
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medicine.medical_specialty ,business.industry ,Immunology ,Hazard ratio ,Absolute risk reduction ,Articles ,medicine.disease ,law.invention ,Clinical trial ,Pneumonia ,Sarilumab ,Rheumatology ,Randomized controlled trial ,law ,Internal medicine ,Cohort ,medicine ,Immunology and Allergy ,Adverse effect ,business - Abstract
Summary Background Patients with COVID-19 pneumonia can have increased inflammation and elevated cytokines, including interleukin (IL)-6, which might be deleterious. Thus, sarilumab, a high-affinity anti-IL-6 receptor antibody, might improve the outcome of patients with moderate-to-severe COVID-19 pneumonia. Methods We did a multicentric, open-label, Bayesian randomised, adaptive, phase 2/3 clinical trial, nested within the CORIMUNO-19 cohort, to test a superiority hypothesis. Patients 18 years or older hospitalised with COVID-19 in six French centres, requiring at least 3L/min of oxygen but without ventilation assistance and a WHO Clinical Progression Scale [CPS] score of 5 were enrolled. Patients were randomly assigned (1:1) via a web-based system, according to a randomisation list stratified on centre and with blocks randomly selected among 2 and 4, to receive usual care plus 400 mg of sarilumab intravenously on day 1 and on day 3 if clinically indicated (sarilumab group) or usual care alone (usual care group). Primary outcomes were the proportion of patients with WHO-CPS scores greater than 5 on the 10-point scale on day 4 and survival without invasive or non-invasive ventilation at day 14. This completed trial is closed to new participants and is registered with ClinicalTrials.gov , NCT04324073 . Findings 165 patients were recruited from March 27 to April 6, 2020, and 148 patients were randomised (68 patients to the sarilumab group and 80 to the usual care group) and followed up for 90 days. Median age was 61·7 years [IQR 53·0–71·1] in the sarilumab group and 62·8 years [56·0–71·7] in the usual care group. In the sarilumab group 49 (72%) of 68 were men and in the usual care group 59 (78%) of 76 were men. Four patients in the usual care group withdrew consent and were not analysed. 18 (26%) of 68 patients in the sarilumab group had a WHO-CPS score greater than 5 at day 4 versus 20 (26%) of 76 in the usual care group (median posterior absolute risk difference 0·2%; 90% credible interval [CrI] −11·7 to 12·2), with a posterior probability of absolute risk difference greater than 0 of 48·9%. At day 14, 25 (37%) patients in the sarilumab and 26 (34%) patients in the usual care group needed ventilation or died, (median posterior hazard ratio [HR] 1·10; 90% CrI 0·69–1·74) with a posterior probability HR greater than 1 of 37·4%. Serious adverse events occurred in 27 (40%) patients in the sarilumab group and 28 (37%) patients in the usual care group (p=0·73). Interpretation Sarilumab treatment did not improve early outcomes in patients with moderate-to-severe COVID-19 pneumonia. Further studies are warranted to evaluate the effect of sarilumab on long-term survival. Funding Assistance publique—Hopitaux de Paris
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- 2022
25. Can we still conceive of a modern health system outside of a sustainable development approach?
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Patrick Pessaux and Emmanuel Andrès
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- 2021
26. Giant cell arteritis in the elderly
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Abrar-Ahmad, Zulfiqar, Marine, Richard, Carl, Arndt, Jean-Loup, Pennaforte, and Emmanuel, Andrès
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Aged, 80 and over ,Male ,Aortitis ,Giant Cell Arteritis ,Humans ,Female ,Prognosis ,Aged ,Retrospective Studies - Abstract
Giant cell arteritis (GCA) or Horton’s disease is a segmental and focal inflammation of large and medium-sized arteries mostly seen in patients of 50 years and older. There is also a peak frequency in individuals between the ages of 70 and 80. However, clinical data is scarce in this age group and especially in patients over 80.A retrospective study comprised of patients diagnosed with Horton’s arteritis between 2012 and 2017, according to the American Society of Rheumatology, was conducted at Reims University Hospital. Patients were assigned to two groups according to age (≤ 75 and75) in order to evaluate and compare the impact of age on diagnosis, treatment and prognosis.A total of 67 patients were studied. The mean age upon diagnosis was 75,85 ±8.5 years; 36 patients (53.7%) 75 years or younger and 31 patients older than 75. There was a female predominance (43 patients), 22 patients aged 75 years or younger and 21 older than 75. The mean follow up duration was 43.02 months in patients aged 75 years or younger and 30.99 in patients older than 75. This represents a difference of more than one year in terms of follow up, but is not statistically significant (p = 0.620). Eleven patients (16.4%) died during follow up: 5 patients (13.9%) aged 75 years or younger and 6 patients (19.4%) older than 75 (p = 0.547). Aortitis was significantly less seen in patients older than 75 (p = 0.0410).Our study showed no significant difference in either age group. However, aortitis was less seen in patients older than 75 years. Patients aged 75 or younger seemed more prone to relapses, but their follow up periods were shorter.L’artérite à cellules géantes (ACG) ou maladie de Horton est une artérite inflammatoire segmentaire et focale des artères de gros et moyen calibre du sujet de plus de 50 ans, avec un pic de fréquence chez le sujet très âgé entre 70 et 80 ans. Dans cette classe d’âge et au-delà de 80 ans, les données cliniques concernant l’AGC sont peu nombreuses. Notre objectif est de documenter ces dernières à travers une étude monocentrique menée sur une population avec une AGC avérée.Nous avons mené une étude rétrospective, monocentrique sur les dossiers médicaux de patients diagnostiqués artérite de Horton selon les critères de l’ASR entre 2012 et 2017 au CHU de Reims. Pour évaluer l’influence de l’âge sur le plan diagnostic, thérapeutique, du suivi et du pronostic, nous avons comparé des patients de 75 ans et moins (≤ 75 ans) à ceux de plus de 75 ans (75 ans) sur ces différents points.Soixante-sept patients ont été inclus. L’âge moyen au diagnostic de ces patients était de 75,85 ± 8,5 ans ; 36 patients (53,7 %) étaient âgés de 75 ans ou moins (dont 22 femmes) et 31 patients (46,3 %) étaient âgés de plus de 75 ans (dont 21 femmes). La médiane de suivi était de 43,02 mois chez les patients ≤ 75 ans et de 30,99 mois chez les75 ans, soit près d’un an de différence, mais non significative (p = 0,620). Onze patients (16,4 %) étaient décédés au cours du suivi, 5 (13,9 %) chez les patients ≤ 75 ans et 6 (19,4 %) chez les patients de75 ans (p = 0,547). Les patients75 ans avaient significativement moins d’aortite (p = 0,0410). Il y avait une tendance à moins de rechute chez les patients de75 ans (p = 0,067). Pour les autres symptômes ou anomalies biologiques, les résultats de la biopsie d’artère temporale, la prise en charge thérapeutique, les complications iatrogènes et les décès, aucune différence significative n’était mise en évidence entre les deux groupes (p = ns).Notre étude montre peu de différence en ce qui concerne l’AGC entre les patients75 ans et ceux ≤ 75 ans. Toutefois, les patients75 ans ont moins d’aortite que les sujets plus jeunes. Il semble également y avoir une tendance à davantage de rechute chez les sujets les plus jeunes, sous réserve d’une durée de suivi plus courte d’un an, cliniquement pertinente, chez les sujets les plus âgés.
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- 2022
27. What place could teleconsultation occupy in general medicine after the Covid-19 pandemic?
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Frédéric Hommes, Camille Lépine, Yves Merle, and Emmanuel Andrès
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- 2021
28. Qualities and shortcomings of the Prado-IC system Qualitative study on the appreciation of the system by primary care physicians
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Noel Lorenzo-Villalba, Gérald Roul, Abrar Ahmad Zulfiqar, Emmanuel Andrès, Adeline Walter, and Samy Talha
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Nursing ,Primary care ,Psychology - Published
- 2021
29. Focus on type 2 diabetes in the elderly
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Ali Boulefred, Roumeissa Benlatreche, Jean Doucet, Emmanuel Andrès, Ashveen Rosunee, Abrar-Ahmad Zulfiqar, Ibrahima Dembélé Amadou, Abdel Kader Traoré, and Nouroudine Amadou
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Gerontology ,Focus (computing) ,business.industry ,medicine ,Type 2 diabetes ,medicine.disease ,business - Published
- 2021
30. Prognostic Significance of Lung and Cava Vein Ultrasound in Elderly Patients Admitted for Acute Heart Failure: PROFUND-IC Registry Analysis
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Sara Pérez-Herrero, Noel Lorenzo-Villalba, Elena Urbano, Beatriz Sánchez-Sauce, Fernando Aguilar-Rodríguez, Máximo Bernabeu-Wittel, Rocio Garcia-Alonso, Llanos Soler-Rangel, Francisco Trapiello-Valbuena, Alejandra Garcia-García, Jose Manuel Casas-Rojo, Luis Beltrán-Romero, Lucia De Jorge-Huerta, Juan Igor Molina-Puente, Emmanuel Andrès, Rosario Iguarán-Bermúdez, and Manuel Méndez-Bailón
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clinical ultrasound ,heart failure ,B lines ,inferior vena cava ,mortality ,Medicina ,Diagnóstico por imagen y medicina nuclear ,General Medicine ,Cardiología - Abstract
Introduction: Heart failure is an extremely prevalent disease in the elderly population of the world. Most patients present signs and symptoms of decompensation of the disease due to worsening congestion. This congestion has been clinically assessed through clinical signs and symptoms and complementary imaging tests, such as chest radiography. Recently, pulmonary and inferior vena cava ultrasound has been shown to be useful in assessing congestion but its prognostic significance in elderly patients has been less well evaluated. Objectives: This study aims to compare the clinical and radiological characteristics and predictive values for mortality in patients admitted for heart failure through the determination of B lines by lung ultrasound and the degree of collapsibility of the inferior vena cava (IVC). Secondarily, the study aims to assess the prediction of 30-day mortality based on the diameter of the IVC by means of the ROC curve. Methods: This is an observational cohort study based on data collected in the PROFUND-IC study, a nationwide multicentric registry of patients admitted with decompensated heart failure. Data were collected from these patients between October 2020 and April 2022. Results: A total of 482 patients were entered into the PROFUND-IC registry between October 2020 and April 2022. Bedside clinical ultrasound was performed during admission in 301 patients (64.3%). The number of patients with more than 6 B-lines on lung ultrasound amounted to 194 (66%). Statistically significant differences in 30-day mortality (22.1% vs. 9.2%; p = 0.01) were found in these patients. The sum of patients with IVC collapsibility of less than 50% amounted to 195 (67%). Regarding prognostic value, collapsibility data were significant for the number of admissions in the last year (12.5% vs. 5.5%; p = 0.04), in-hospital mortality (10.1% vs. 3.3%, p = 0.04) and 30-day mortality (22.6% vs. 8.1%; p < 0.01), but not for readmissions. Regarding the prognostic value of IVC diameter for 30-day mortality, the area under the ROC curve (AUC) was 0.73, with a p < 0.01. The curve cut-off point with the highest sensitivity (70%) and specificity (70.3%) was for an IVC value of 22.5 mm. In the logistic regression analysis, we observed that the variable most associated with patient survival at 30 days was the presence of a collapsible inferior vena cava, with more than 50% OR 0.359 (CI 0.139–0.926; p = 0.034). Conclusions: The subgroups of patients analyzed with more than six B lines per field and IVC collapsibility less than or equal to 50%, as measured by clinical ultrasound, had higher 30-day mortality rates than patients who did not fall into these subgroups. IVC diameter may be a good independent predictor of 30-day mortality in patients with decompensated heart failure. Comparing both ultrasound variables, it seems that in our population, the assessment of the inferior vena cava may be more associated with short-term prognosis than the pulmonary congestion variables assessed by B lines.
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- 2022
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31. How to understand the frailty syndrome?
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Salifou Kone, Thomas Vogel, Abrar-Ahmad Zulfiqar, B. Geny, Ibrahima Amadou Dembélé, Ali Boulefred, Nouroudine Amadou, and Emmanuel Andrès
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- 2021
32. Bed-Fall Detection and Prediction: A Generic Classification and Review of Bed-Fall Related Systems
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Emmanuel Andrès, Kabalan Chaccour, Amir Hajjam El Hassani, and Ali Ibrahim
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Risk analysis (engineering) ,Work (electrical) ,Elderly population ,010401 analytical chemistry ,Hospital quality ,Analysis models ,Fall detection ,Electrical and Electronic Engineering ,01 natural sciences ,Instrumentation ,Field (computer science) ,0104 chemical sciences - Abstract
Along with the rapid growth of the elderly population, the hospital quality and the safety of patients have become one of the priority concerns in the past few decades. The majority of injuries in the elderly result from bed -falls since the bed is a major part in his daily life. A single fall can cause severe physical and emotional injuries. Therefore, bed-falls have become a very active area of research in order to minimize their serious consequences. Mainly, there are two research tracks: bed-fall detection and bed-fall prediction. Both of them handle the fall issues with several sensing techniques and analysis models. In fact, there is a lack of reviews on bed-fall related technologies. Therefore, a generic classification of bed-fall related technologies including fall detection and prediction systems based on their sensor apparatus is proposed in this paper. Data processing techniques have been also highlighted. The objective of this work is to provide researchers in this field a good standpoint regarding bed-fall related systems.
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- 2021
33. Prescription médicamenteuse inappropriée chez le sujet âgé : revue des principales échelles thérapeutiques
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Thibault Courtois, Jean Doucet, Abrar-Ahmad Zulfiqar, and Emmanuel Andrès
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business.industry ,Medicine ,General Medicine ,business - Published
- 2021
34. Atrial fibrillation and complex situations
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Sylvain Von Roy, Didier Mutter, Lucas André, Maroun Matar, Valérie Wolff, Thierry Hannedouch, Laurence Jesel, Olivier Feugeas, Romain Kessler, Laurent Meyer, Olivier Morel, and Emmanuel Andrès
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- 2021
35. Caractéristiques des patients admis en médecine interne dans 18 hôpitaux français en aval des urgences et organisation de ces services : enquête transversale de la SNFMI (groupe d’étude SiFMI) en 2015
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S. Gayet, K. Amadou, Emmanuel Andrès, D. Raigniac, A. Didon, Anne Bourgarit, A. Mekininan, A. Froissart, Jean-François Bergmann, Brigitte Ranque, L. Hery, Olivier Steichen, T. Hanslik, B. Cador, Yves Benhamou, S. Sovaila, Bruno Fantin, pour le groupe SiFMI, Jean-Christophe Weber, J Delforge, Eric Rosenthal, Cécile Goujard, L. Alix, Pascal Cathébras, Archives Henri-Poincaré - Philosophie et Recherches sur les Sciences et les Technologies (AHP-PReST), Université de Strasbourg (UNISTRA)-Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), Laboratoire d'Histoire des Sciences et de Philosophie - Archives Henri Poincaré (LHSP), and Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS)
- Subjects
Gynecology ,03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,business.industry ,Gastroenterology ,Internal Medicine ,medicine ,030212 general & internal medicine ,030204 cardiovascular system & hematology ,business ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology ,3. Good health - Abstract
Resume Introduction L’aval des urgences represente une part importante des hospitalisations dans les services de medecine interne. L’objectif de cette etude est de caracteriser les patients et l’organisation d’un echantillon de services de medecine interne metropolitains ayant cette activite. Materiel et methodes Entre le 29 juin et le 26 juillet 2015, les services du groupe SiFMI (situations frequentes en medecine interne) volontaires, ont recueilli prospectivement dans des e-questionnaires anonymises les caracteristiques de tous les patients admis via les urgences sur une periode de 7 jours consecutifs. Resultats Dix-huit services de medecine interne, totalisant 1100 lits et 33 530 sejours annuels, dont 56 % (25–95 %) d’aval des urgences ont inclus 365 patients en provenance des urgences. D’âge moyen de 68 ans, 54 % de femmes, 44 % des patients etaient polymediques avec un score de Charlson moyen egal a 2,6. Les principales causes d’hospitalisation a cette periode etaient infectieuses (29 %) et neurologiques (17 %). La duree moyenne de sejour etait egale a 9,2 (±8,2) jours. De taille et d’organisation variable, l’equipe medicale de ces 18 services etait constituee en valeur mediane de 4,5 [2,75–6,25] equivalents temps-plein seniors, dont 86 % internistes. Tous les services sauf un accueillaient des internes pour 60 % de medecine generale. Conclusion Cette etude met en evidence la variabilite des organisations et des pathologies prises en charge en aval des urgences dans les services de medecine interne. Ceci place la medecine interne comme une specialite avec une capacite de prise en charge integrative/globale des patients permettant d’offrir un vaste champ d’apprentissage aux medecins en formation.
- Published
- 2021
36. Conditions for the seizure of medical records upon request of law enforcement authorities
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Didier Clamer and Emmanuel Andrès
- Published
- 2021
37. Jean-Marie Brogard
- Author
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Jean-Frédéric Blicklé and Emmanuel Andrès
- Published
- 2021
38. Anemia: ¿cuál es su relación con el síndrome de fragilidad en el anciano?
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Abrar Ahmad Zulfiqar, Emmanuel Andrès, and Noel Lorenzo Villalba
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Aging ,Pediatrics ,medicine.medical_specialty ,Weakness ,business.industry ,Frailty syndrome ,Medicine (miscellaneous) ,Context (language use) ,Immunosenescence ,Chest pain ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,hemic and lymphatic diseases ,medicine ,030212 general & internal medicine ,Geriatrics and Gerontology ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Anaemia is often unexpectedly found, or in a context of investigations into a chest pain, dyspnoea, or weakness. This disorder can be considered an indicator of health status in elderly patients, and has been related to the frailty syndrome. A systematic review was conducted on the studies published in PubMed and Google Scholar databases in the period from January 1999 to May 2019. The search was limited to those studies published regarding anaemia and its relationship to the frailty syndrome. Anaemia seems to be part of the immunosenescence process that can explain frailty syndrome in association with other metabolism, endocrine, and inflammatory disorders. It was unable to be determined if anaemia is responsible for frailty or a result of it.
- Published
- 2020
39. Clinical Characteristics and Prognostic Relevance of Different Types of Caregivers for Elderly Patients with Acute Heart Failure-Analysis from the RICA Registry
- Author
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Manuel Méndez-Bailon, Noel Lorenzo-Villalba, Jorge Rubio-Garcia, María Carmen Moreno-García, Guillermo Ropero-Luis, Eduardo Martínez-Litago, Raúl Quirós-López, Sara Carrascosa-García, Alvaro González-Franco, Emmanuel Andrès, Jesús Casado-Cerrada, and Manuel Montero-Pérez-Barquero
- Subjects
caregivers ,hospital readmission ,heart failure ,General Medicine ,mortality - Abstract
Background: Patients with heart failure encompass a heterogeneous group, but they are mostly elderly patients with a large burden of comorbid conditions. Objective: The aim of this study was to compare the clinical characteristics and the prognostic impact on hospital admissions and mortality in a population of patients with HF with different types of caregivers (family members, professionals, and the patient himself). Methods: We conducted an observational study from a prospective registry. Patients from the National Registry of Heart Failure (RICA), which belongs to the Working Group on Heart Failure and Atrial Fibrillation of the Spanish Society of Internal Medicine (SEMI), were included. Patients with heart failure were classified, according to the type of main caregiver, into four groups: the patient himself/herself, a partner, children, or a professional caregiver. A bivariable analysis was performed between the clinical, analytical, therapeutic, and prognostic characteristics of the different groups. The endpoints of the study were all-cause mortality at 1 year; mortality at 120 days; and the readmission rate for HF at 30 days, 120 days, and 1 year of follow-up. In all cases, the level of statistical significance was set at p < 0.05. Results: A total of 2147 patients were enrolled in this study; women represented 52.4%, and the mean age was 81 years. The partner was the caregiver for 703 patients, children were caregivers for 1097 patients, 199 patients had a professional caregiver, and only 148 patients were their own caregivers. Women were more frequently cared for by their children (65.8%) or a professional caregiver (61.8%); men were more frequently cared for by their spouses (68.7%) and more frequently served as their own caregivers (59.5%) (p < 0.001). No statistically significant differences were observed in relation to readmissions or mortality at one year of follow-up between the different groups. A lower probability of readmission and death was observed for patients who received care from a partner or children/relative, with log-rank scores of 11.2 with p= 0.010 and 10.8 with p = 0.013. Conclusions: Our study showed that the presence of a family caregiver for elderly patients with heart failure was associated with a lower readmission rate and a lower mortality rate at 120 days of follow-up. Our study also demonstrated that elderly patients with good cognitive and functional status can be their own caregivers, as they obtained good health outcomes in terms of readmission and mortality. More prospective studies and clinical trials are needed to evaluate the impact of different types of caregivers on the outcomes of patients with heart failure.
- Published
- 2022
40. Prognostic Significance of the PROFUND Index on One Year Mortality in Acute Heart Failure: Results from the RICA Registry
- Author
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Manuel Méndez-Bailon, Rosario Iguarán-Bermudez, Francesc Formiga-Pérez, José Carlos Arévalo Lorido, Iván Suárez-Pedreira, Jose Luis Morales-Rull, Ana Serrado-Iglesias, Pau Llacer-Iborra, Gabriela Ormaechea-Gorricho, Francisco Javier Carrasco-Sánchez, Jesús Casado-Cerrada, Emmanuel Andrès, Jesús Diez-Manglano, Noel Lorenzo-Villalba, and Manuel Montero-Pérez-Barquero
- Subjects
heart failure ,comorbidities ,PROFUND index ,Comorbiditat ,Pronòstic mèdic ,Heart failure ,General Medicine ,Insuficiència cardíaca ,Comorbidity ,Older people ,Cardiología ,Prognosis ,Persones grans - Abstract
Background: Heart failure (HF) is a syndrome with high prevalence, mainly affecting elderly patients, where the presence of associated comorbidities is of great importance. Methods: An observational study from a prospective registry was conducted. Patients identified from the National Registry of Heart Failure (RICA), which belongs to the Working Group on Heart Failure and Atrial Fibrillation of the Spanish Society of Internal Medicine (SEMI), were included. The latter is a prospective, multicenter registry that has been active since 2008. It includes individual consecutive patients over 50 years of age with a diagnosis of HF at hospital discharge (acute decompensated or new-onset HF). Results: In total, 5424 patients were identified from the registry. Forty-seven percent were men and mean left ventricular ejection fraction (LVEF) was 51.4%; 1132 had a score of 0 to 2 according to the PROFUND index, 3087 had a score of 3 to 6, and 952 patients had a score of 7 to 10 points. In the sample, 252 patients had a score above 11 points. At the end of the year of follow-up, 61% of the patients died. This mortality increased proportionally as the PROFUND index increased, specifically 75% for patients with PROFUND greater than 11. The Kaplan-Meier survival curve shows that survival at one year progressively decreases as the PROFUND index value increases. Thus, subjects with scores greater than seven (intermediate-high and high-risk) presented the worst survival with a log rank of 0.96 and a p < 0.05. In the regression analysis, we found a higher risk of death from any cause at one year in the group with the highest risk according to the PROFUND index (score greater than 11 points (HR 1.838 (1.410–2.396)). Conclusions: The PROFUND index is a good index for predicting mortality in patients admitted for acute HF, especially in those subjects at intermediate to high risk with scores above seven. Future studies should seek to determine whether the PROFUND index score is simply a prognostic marker or whether it can also be used to make therapeutic decisions for those subjects with very high short-term mortality.
- Published
- 2022
41. [Physical activity and geriatrics: a literature review]
- Author
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Abrar-Ahmad, Zulfiqar and Emmanuel, Andrès
- Abstract
Physical activity and its performance in the elderly remain a major problem. Numerous studies have shown physical and psychological benefits on quality of life and mortality. Maintaining regular physical activity is a key to maintain the functional abilities necessary for activities of daily living and preserve the quality of life of the elderly.
- Published
- 2022
42. Report of a ‘consensus’ on the lines of therapy for primary immune thrombocytopenia in adults, promoted by the Italian Gruppo di Studio delle Piastrine
- Author
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Gian Marco Podda, Mohsen Saleh Elalfy, Tadakazu Kondo, Jenny M. Despotovic, Marco Cattaneo, Anna M Robino, Lorenzo Cirasino, Andreas Holbro, Jong Wook Lee, Emmanuel Andrès, Sandra R. Loggetto, Michele P. Lambert, and Keith R. McCrae
- Subjects
Adult ,0301 basic medicine ,Purpura, Thrombocytopenic, Idiopathic ,Pediatrics ,medicine.medical_specialty ,Consensus ,business.industry ,Hematology ,General Medicine ,030204 cardiovascular system & hematology ,Immune thrombocytopenia ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Italy ,Risk Factors ,immune system diseases ,Surveys and Questionnaires ,hemic and lymphatic diseases ,Splenectomy ,Humans ,Medicine ,business ,Goals - Abstract
Despite the publication in 2009 of a paper on 'terms and definitions of immune thrombocytopenia' (ITP), some unresolved issues remain and are reflected by the disagreement in the treatment suggested for primary ITP in adults. Considering that these disagreements could be ascribed to non-shared goals, we generated a 'consensus' on some terms, definitions, and assertions useful for classifying the different lines of treatment for primary ITP in adults according to their indications and goals. Agreement on the appropriateness of the single assertions was obtained by consensus for the following indicators
- Published
- 2020
43. Prognostic and therapeutic stratification through the PROFUND scale in patients with heart failure and comorbidities: PROFUND-IC registry
- Author
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Alejandra Garca-Garca, Beatriz Snchez-Sauce, Francisco J. Martn-Snchez, Ignacio Vallejo-Maroto, Luis Manzano-Espinosa, Santiago Fernndez, Miguel Villar-Martnez, Julia Barrado-Cuchillo, Manuel Mndez-Bailn, Jos L. Garca-Klepzig, Jos M. De-Miguel-Yanes, Pau Llacer-Iborra, lvaro Gonzlez-Franco, Pablo Prez-Mateo, Mximo Bernabeu-Wittel, Luis Matas Beltrn-Romero, Jess Dez-Manglano, Lidia Lpez-Garca, Rosario Iguarn-Bermdez, Jos M. Casas-Rojo, Elpidio Calvo-Manuel, Noel Lorenzo-Villalba, and Emmanuel Andrès
- Subjects
medicine.medical_specialty ,Scale (ratio) ,business.industry ,Specialties of internal medicine ,medicine.disease ,Stratification (mathematics) ,RC581-951 ,Heart failure ,Internal medicine ,medicine ,Cardiology ,Heart failure. Comorbidity. Chronic disease ,In patient ,business - Abstract
Introduction: The increase in life expectancy and the aging of the population are associated with an increase in the prevalence of chronic diseases. Comorbidities have an important impact on prognosis and functional capacity leading to a progressive deterioration of autonomy and quality of life and an increase in demand for medical care. Establishment of an accurate prognosis constitutes one of the primary objectives in healthcare. An accurate estimate of prognosis helps clinicians make diagnostic and therapeutic decisions, prevent iatrogenesis, and consider palliative care strategy as needed. It also allows the patient and family members to organize their preferences and priorities. Objective: To evaluate the PROFUND scale in patients with heart failure from a prognostic point of view. Methods: A multicenter cohort study including patients admitted for heart failure to internal medicine departments over a 6-month period will be carried out. Inclusion criteria are patients with a diagnosis of heart failure and at least two criteria of multipathological patients and NT-proBNP >1500 pg/ml upon admission. The PROFUND scale will be applied to all patients. Patients will be then stratified into four groups according to the PROFUND scale: low, moderate, moderate-high and high mortality risk. Conclusion: Our work is a prospective study that aims to apply the PROFUND scale to patients with heart failure in the hospital setting with the purpose of helping in decision-making with our patients, which could lead to improvements in the management of resources in our health system.
- Published
- 2021
44. Lockdown Effect on Elderly Nutritional Health
- Author
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Jeyniver Ghanem, Bruno Colicchio, Alain Dieterlen, Bernard Geny, and Emmanuel Andrès
- Subjects
Gerontology ,Isolation (health care) ,Coronavirus disease 2019 (COVID-19) ,media_common.quotation_subject ,malnutrition ,elderly ,lockdown ,Pandemic ,medicine ,Elderly people ,Social isolation ,media_common ,business.industry ,SARS-CoV-2 ,Communication ,COVID-19 ,General Medicine ,medicine.disease ,Malnutrition ,Medicine ,medicine.symptom ,business ,Body mass index ,Autonomy ,bodyweight - Abstract
Pandemics and lockdowns may be associated with unpremeditated consequences, such as bodyweight changes, isolation, as well as sedentarity. Reports have been published on malnutrition among patients suffering from COVID-19. This study aimed to highlight the short-term effects of the lockdown on the nutritional health of elderly people living at home and benefiting from home care services, yet without any COVID-19 pathology. In 50 subjects displaying weight, body mass index, and MNA score stability two months earlier, we observed significant alterations in these parameters following the lockdown. Thus, malnutrition rose from 28–34% to 58%. Furthermore, trigger factors for malnutrition changed, with social isolation accounting for 64% of the confinement’s deleterious effects among the elderly. In conclusion, despite the elderly being not directly affected by SARS-CoV2, the nutritional status of elderly subjects living at home with no or only mild autonomy loss was greatly and rapidly affected by the lockdown. Moreover, the main trigger factors for malnutrition were essentially related to social isolation and depressive syndromes. Knowing the impact of confinement on the elderly’s health, these results may help further modulate ongoing public health interventions in case of future lockdowns.
- Published
- 2021
45. Results of the Second Phase of the GER-e-TEC Experiment concerning the Telemonitoring of Elderly Patients Affected by COVID-19 Disease to Detect the Exacerbation of Geriatric Syndromes
- Author
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Mohamed Hajjam, Sylvie Ervé, Delwende Noaga Damien Massimbo, Bernard Geny, Emmanuel Andrès, Jawad Hajjam, Amir Hajjam, Samy Talha, and Abrar-Ahmad Zulfiqar
- Subjects
medicine.medical_specialty ,Telemedicine ,Coronavirus disease 2019 (COVID-19) ,Exacerbation ,business.industry ,Public health ,Medicine (miscellaneous) ,COVID-19 ,telemonitoring ,MyPredi platform ,Disease ,medicine.disease ,Article ,Heart failure ,Positive predicative value ,Emergency medicine ,Pandemic ,Medicine ,geriatric syndromes ,business ,alerts - Abstract
Background: Coronavirus disease 2019 (COVID-19) has wreaked health and economic damage globally. This pandemic has created a difficult challenge for global public health. The coronavirus disease 2019 (COVID-19) pandemic has necessitated the use of new technologies and new processes to care for hospitalized patients, including elderly patients. Our team developed a telemonitoring program focused on the prevention of geriatric syndromes, the “GER-e-TEC COVID study”. Methods: This second phase took place during the 3rd wave of the epidemic in France, between 14 December 2020 and 25 February 2021, conducted in the University Hospital of Strasbourg. Results: 30 elderly patients affected by COVID-19 disease were monitored remotely, the mean age was 85.9 years and a male/female ratio of 1.5 to 1. 11 (36.7%) died during the experiment. The patients used the telemedicine solution for an average of 27.3 days. 140,260 measurements were taken while monitoring the geriatric syndromes of the entire patient group. 4675 measurements were recorded per patient for geriatric disorders and risks. 319 measurements were recorded per patient per day. The telemedicine solution emitted a total of 1245 alerts while monitoring the geriatric syndromes of the entire patient group. In terms of sensitivity, the results were 100% for all geriatric risks and extremely satisfactory in terms of positive and negative predictive values. Survival analyses showed that gender played no role in the length of the hospital stay, regardless of the reason for the hospitalization (decompensated heart failure (p = 0.45), deterioration of general condition (p = 0.12), but significant for death (p = 0.028)). The analyses revealed that the length of the hospital stay was not affected by the number of alerts. The results concerning the predictive nature of alerts are satisfactory. Conclusion: The MyPredi™ telemedicine system allows for the generation of automatic, non-intrusive alerts when the health of a COVID-19 elderly patient deteriorates due to risks associated with geriatric syndromes.
- Published
- 2021
46. Prognostic value of B lines detected with lung ultrasound in acute heart failure. A systematic review
- Author
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José Luis García-Klepzig, Ester Emilia Dubón-Peralta, Emmanuel Andrès, Noel Lorenzo-Villalba, and Manuel Méndez-Bailón
- Subjects
Adult ,Heart Failure ,medicine.medical_specialty ,Adolescent ,business.industry ,Ultrasound ,Retrospective cohort study ,medicine.disease ,Prognosis ,Lung ultrasound ,Clinical trial ,Systematic review ,Heart failure ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Risk factor ,Prospective cohort study ,business ,Lung ,Retrospective Studies ,Ultrasonography - Abstract
Pulmonary ultrasound is a simple diagnostic tool with immediate results for the assessment of pulmonary congestion in patients with heart failure (HF), allowing optimization of treatment by monitoring the dynamic changes identified. We aimed to evaluate the prognostic significance of the presence of B lines detected by lung ultrasound during hospitalization for heart failure. A search was conducted for scientific articles in PubMed, Embase, Google Scholar, and Cochrane databases including clinical trials, reviews, systematic reviews, and original articles that were related to the prognostic value of lung ultrasound in patients with HF in the last 5 years from 2016 to 2021. Studies including individuals aged ≥18 years evaluating the prognostic value of lung ultrasound in HF were included. Fourteen articles met inclusion criteria for analysis (three reviews, three systematic reviews with meta-analysis, six prospective studies, and two retrospective studies). The presence of more than 30–40 B lines at admission were considered a risk factor for readmission or mortality as was persistent pulmonary congestion with the presence of ≥15 B-lines. The presence of pulmonary congestion detected by lung ultrasound in acute heart failure has prognostic significance in terms of mortality and hospital readmission. Clinical trials are needed to evaluate whether diuretic therapy guided by lung ultrasound and the presence of B lines can reduce readmission and mortality in these patients.
- Published
- 2021
47. Diagnosis and Management of Heart Failure in Elderly Patients from Hospital Admission to Discharge: Position Paper
- Author
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Patrice Cacoub, Gilles Berrut, Olivier Hanon, Tahar Chouihed, Nicholas Lamblin, Nicholas Delarche, Emmanuel Andrès, Patrick Henry, Thibaud Damy, CHU Henri Mondor, Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Centre d'investigation clinique [Nancy] (CIC), Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] (INI-CRCT), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], French-Clinical Research Infrastructure Network - F-CRIN [Paris] (Cardiovascular & Renal Clinical Trialists - CRCT ), Centre hospitalier de Pau, Pôle hospitalo-universitaire de gérontologie clinique [Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Service d'Immunologie [CHU Pitié-Salpétrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Université de Lille, CHU Strasbourg, AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris], Université de Paris (UP), Novartis provided financial support for logistic management but was not involved in the writing of the manuscript., CHU Henri Mondor [Créteil], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Université Paris Cité (UPCité), and Gestionnaire, HAL Sorbonne Université 5
- Subjects
medicine.medical_specialty ,Hospital setting ,Management of heart failure ,Review ,030204 cardiovascular system & hematology ,elderly ,03 medical and health sciences ,0302 clinical medicine ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Multidisciplinary approach ,Community health care ,medicine ,Transitional care ,030212 general & internal medicine ,Intensive care medicine ,heart failure management ,business.industry ,General Medicine ,medicine.disease ,practical guidance ,[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,3. Good health ,Heart failure ,Hospital admission ,Medicine ,Position paper ,business - Abstract
International audience; Multidisciplinary management of worsening heart failure (HF) in the elderly improves survival. To ensure patients have access to adequate care, the current HF and French health authority guidelines advise establishing a clearly defined HF patient pathway. This pathway involves coordinating multiple disciplines to manage decompensating HF. Yet, recent registry data indicate that insufficient numbers of patients receive specialised cardiology care, which increases the risk of rehospitalisation and mortality. The patient pathway in France involves three key stages: presentation with decompensated HF, stabilisation within a hospital setting and transitional care back out into the community. In each of these three phases, HF diagnosis, severity and precipitating factors need to be promptly identified and managed. This is particularly pertinent in older, frail patients who may present with atypical symptoms or coexisting comorbidities and for whom geriatric evaluation may be needed or specific geriatric syndrome management implemented. In the transition phase, multi-professional post-discharge management must be coordinated with community health care professionals. When the patient is discharged, HF medication must be optimised, and patients educated about self-care and monitoring symptoms. This review provides practical guidance to clinicians managing worsening HF in the elderly.
- Published
- 2021
48. Frostbite and Cold Agglutinin Disease: Coexistence of Two Entities Leading to Poor Clinical Outcomes
- Author
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Emmanuel Andrès, Xavier Jannot, Noel Lorenzo-Villalba, Marie-Pierre Ledoux, Javier Guerrero-Niño, Edward Nasco, and Jessy Cattelan
- Subjects
Bendamustine ,Medicine (General) ,Blood transfusion ,Cold agglutinin disease ,medicine.medical_treatment ,cold agglutinin disease ,Case Report ,frostbite ,03 medical and health sciences ,0302 clinical medicine ,R5-920 ,amputation ,medicine ,Aspirin ,business.industry ,General Medicine ,medicine.disease ,Amputation ,030220 oncology & carcinogenesis ,Frostbite ,Anesthesia ,Rituximab ,business ,030215 immunology ,Iloprost ,medicine.drug - Abstract
An 83-year-old woman was admitted to the emergency department for a 7-day history of fatigue and progressive cyanosis in the feet and hands after cold exposure despite physical protective measures. Upon arrival, the patient presented with necrotic cutaneous lesions in both hands and distal lower extremities. Upon admission, hemoglobin was 7.6 g/dL and laboratory tests were consistent with cold agglutinin disease (CAD), the presence of monoclonal IgM, and flow cytometry consistent with lymphoplasmacytic lymphoma, but MYD88 L265P mutation was negative. The patient required blood transfusion, resulting in stabilized hemoglobin and a decrease in markers of hemolysis. Treatment with aspirin 250 mg daily and intravenous iloprost 0.5 mL/h was initiated with a poor clinical response at day 4. Amputation was required. Plasma exchange was performed and chemotherapy with rituximab and bendamustine was initiated. The clinical course was marked by further necrosis, prompting discussions regarding an additional amputation that was not performed considering the high surgical risk and refusal by the patient. Supportive treatment was initiated, and the patient expired one month after hospital admission.
- Published
- 2021
49. Le syndrome de cavitation ganglionnaire mésentérique, complication rare de la maladie cœliaque de l’adulte : à propos de quatre cas et revue de la littérature
- Author
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Xavier Argemi, Emmanuel Andrès, Nicolas Lefebvre, Yvon Ruch, Yves Hansmann, N. Weingertner, A. Labidi, Yannick Dieudonné, and A. Martin
- Subjects
Gynecology ,03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,business.industry ,030220 oncology & carcinogenesis ,Gastroenterology ,Internal Medicine ,Medicine ,030211 gastroenterology & hepatology ,business - Abstract
Resume Introduction La cavitation ganglionnaire mesenterique est une complication exceptionnelle de la maladie cœliaque. Nous rapportons ici quatre observations originales de ce syndrome, ainsi qu’une revue complete de la litterature. Discussion L’analyse de 38 cas revelait que cette complication survenait exclusivement chez des adultes, avec un âge moyen de 54 ans. Elle etait revelatrice de la maladie cœliaque dans la majorite des cas. Un hyposplenisme etait quasi-systematiquement associe. Le risque de lymphome semblait majore, notamment de type T intestinal associe aux enteropathies. Le pronostic etait sombre avec pres de 50 % de mortalite et paraissait correle a la reponse clinique au regime sans gluten. Conclusion La severite de cette complication merite d’etre connue et doit amener a sa recherche chez les patients atteints de maladie cœliaque, notamment en cas de diagnostic a l’âge adulte ou de pathologie refractaire.
- Published
- 2019
50. Telemonitoring in diabetes: evolution of concepts and technologies, with a focus on results of the more recent studies
- Author
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Jean Doucet, Sylvie Ervé, Bahougne T, M Hajjam, Laurent Meyer, Nathalie Jeandidier, Jawad Hajjam, Samy Talha, Abrar-Ahmad Zulfiqar, Hajjam El Hassani A, and Emmanuel Andrès
- Subjects
Gerontology ,Telemedicine ,media_common.quotation_subject ,Review ,Disease ,Type 2 diabetes ,Appropriation ,Quality of life (healthcare) ,Meta-Analysis as Topic ,Diabetes mellitus ,medicine ,Humans ,Empowerment ,information and communication technology ,media_common ,Internet ,diabetes ,business.industry ,telemonitoring ,General Medicine ,artificial intelligence ,medicine.disease ,Web ,Diabetes Mellitus, Type 2 ,Information and Communications Technology ,Quality of Life ,business ,chronic disease ,Software ,Systematic Reviews as Topic - Abstract
This is a narrative review of telemonitoring (remote monitoring) projects and studies within the field of diabetes, with a focus on results of the more recent studies. Since the beginning of the 1990s, several telemedicine projects and studies focused on type 1 and type 2 diabetes. Over the last 5 years, numerous telemedicine projects based on connected objects and new information and communication technologies (ICT) (elements defining telemedicine 2.0) have emerged or are still under development. Two examples are the DIABETe and Telesage telemonitoring project which perfectly fits within the telemedicine 2.0 framework – the first to include artificial intelligence (AI) with MyPrediTM and DiabeoTM. Mainly, these projects and studies show that telemonitoring diabetic result in: improvements in control of blood glucose (BG) level and significant reduction in HbA1c (e.g., for Telescot et TELESAGE studies); positive impact on co-morbidities (arterial hypertension, weight, dyslipidemia) (e.g., for Telescot and DIABETe studies); better patient’s quality of life (e.g., for DIABETe study); positive impact on appropriation of the disease by patients and/or greater adherence to therapeutic and hygiene-dietary measures (e.g., The Utah Remote Monitoring Project); and at least, good receptiveness by patients and their empowerment. To date, the magnitude of its effects remains debatable, especially with the variation in patients’ characteristics (e.g., background, ability for self-management, medical condition), samples selection and approach for the treatment of control groups. All of the recent studies have been classified as “Moderate” to “High”.
- Published
- 2019
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