Search

Objectives Systemic sclerosis (SSc) is a heterogeneous autoimmune disease associated with several antinuclear autoantibodies useful to diagnosis and prognosis. The aim of the present multicentric study was to determine the clinical relevance of anti-fibrillarin autoantibodies (AFA) in patients with SSc. Methods The clinical features of 37 SSc patients positive for AFA (AFA+) and 139 SSc patients without AFA (AFA-) were collected retrospectively from medical records to enable a comparison between AFA- and AFA+ patients. Anti-fibrillarin autoantibodies were screened by an indirect immunofluorescence technique using HEp2 cells and identified by an in-house Western blot technique and/or an EliA test. Results Comparing AFA+ and AFA– patients, AFA+ patients were significantly younger at disease onset (36.9 vs. 42.9; p=0.02), more frequently male (p=0.02) and of Afro-Caribbean descent (65% vs. 7.7%; p

Interviews were conducted with 55 experienced patients with insulin-dependent diabetes with the aim of identifying strategies for coping with diabetes. This study was based on a health-oriented approach known as Antonovsky's salutogenic model, which conceptualizes the person as being actively involved in maintaining biological, psychological, and social homeostasis. All patients had developed some strategy for maintaining biological balance. Twenty-two also had strategies for coping both psychologically and socially with the disease. The remaining 33 patients had developed either a psychological or a social strategy in addition to their biological strategies. The results indicate that it is important for the patient's well-being and self-esteem to establish all three coping strategies-biological, psychological, and social. The diabetes care team could be a valuable resource for the patient in this respect.

A population of 185 type 1 diabetes patients (insulin-dependent, IDDM), 25-45 years old, was studied retro- and prospectively over a 9-year period with the aim of analysing background factors of importance for the ability to perform adequate self-care. Expressed as mean HbA1c, the metabolic control was slightly improved at the end of the study, when the insulin schedule had been changed in 60% of the patients to multidose treatment. The degree of metabolic control remained constant over the years. The impact of residual insulin secretion, measured as 24-hour urinary C peptide, was low. Patients with less good metabolic control often had a poor educational background and made less use of self-monitoring of blood glucose (SMBG); they also experienced difficulties with SMBG. The applied knowledge of diabetes also differed between groups with good and poor control. Subjectively, most patients considered their metabolic control to be good, irrespective of the HbA1c values. When asked about their own diabetes complications, their answers were often discrepant from the medical records. Patients with particularly "good" or "poor" metabolic control were on the whole less satisfied with the education and information received than those with intermediate blood glucose regulation. Development of strategies for individually adjusted education seems important.

Introduction Jusqu’en 2011, le traitement des melanomes avances (stade III et IV inoperables) reposait principalement sur les chimiotherapies conventionnelles (CC) a base de dacarbazine, fotemustine ou temozolomide. La mise a disposition successive de l’ipilimumab (IPI) et des inhibiteurs de BRAF (iBRAF) a bouleverse la prise en charge de ces patients, centree desormais sur la recherche de la mutation BRAF. L’objectif de l’etude AMEL est de decrire la prise en charge du melanome avance depuis l’arrivee de ces nouvelles therapies. Patients et methodes Etude observationnelle retrospective sur dossiers patients menee aupres de 33 medecins repartis sur l’ensemble du territoire francais, qui ont inclus des patients pour lesquels un diagnostic de melanome de stade III ou IV inoperable avait ete retenu entre le 01/01/2012 et le 31/10/2012. Observation Deux cent soixante et onze patients ont ete renseignes, dont 264 analysables apres exclusion de 7 cas ne repondant pas aux criteres d’inclusion. Parmi eux, 91 % (240) etaient metastatiques et 50 % (133) etaient porteurs d’une mutation BRAF. Resultats Au total, 250 patients (95 %) ont recu une premiere ligne de traitement antitumoral systemique. Chez les patients mutes BRAF, 75 % avaient ete traites par un iBRAF, 17 % par CC et 7 % (9) par IPI. Chez les patients sans mutation BRAF, 79 % avaient recu une CC, le plus souvent a base de dacarbazine (64 %) et 13 % avaient recu de l’IPI. En seconde ligne, 165 patients ont recu un traitement, soit un taux de passage en seconde ligne de 66 %. Chez les patients BRAF mutes, le traitement de seconde ligne etait principalement soit une CC (37 %), soit un iBRAF (35 %), soit de l’IPI (24 %). Le choix entre ces 3 options dependait surtout du traitement recu en premiere ligne : 48 % des patients initialement traites avec un iBRAF ont recu une CC et 31 % de l’IPI. En revanche, quand le traitement de premiere ligne consistait en une CC, 85 % recevait un iBRAF en seconde ligne. Chez les patients non porteurs d’une mutation, les sequences les plus frequentes etaient une CC en premiere ligne et en seconde (42 % des sequences), et une CC en premiere ligne puis de l’IPI en seconde ligne (29 % des sequences). Le taux de passage vers une troisieme ligne etait de 43 %. Discussion Realisee sur une periode ou les nouvelles molecules n’etaient pas encore totalement disponibles, l’etude montre toutefois le changement radical des pratiques qui s’est opere en quelques annees. La prescription d’un iBRAF chez les patients porteurs de la mutation, que ce soit en premiere ou seconde ligne de traitement, ainsi que l’utilisation de l’IPI a la fois chez les patients mutes et non mutes en sont les temoins. Conclusion Alors que les indications de l’IPI ont ete etendues, que de nouvelles therapies ciblees ont ete approuvees et que de nouvelles immunotherapies sont desormais disponibles y compris en premiere ligne de traitement et quel que soit le statut BRAF, une evolution majeure de la prise en charge de ces patients est attendue dans les annees a venir.

When health is defined from a holistic view, traditional measures of control in diabetes, such as analysis of blood glucose or HbAlc, are of limited use as indicators of health and unhealth. On the other hand, evaluation of attitudes and certain personality variables might provide guidance both in discovering unhealth and in creating individual self-care programmes for its treatment. In the present study the subjective experience of health and unhealth was studied in a defined population of patients with insulin dependent diabetes mellitus (IDDM). The patients could be divided into three categories: a) those not abandoning important goals because of their diabetes, b) “adapted abandoners” and, c) those abandoning vital aspects of life. On the basis of the findings, the question of how “problem patients” can be identified and treated is discussed.

An instrument for measuring attitudes towards diabetes and self-care was constructed by a semantic differential technique. The instrument contained nine adjective pairs. Factor analysis classified these into four factors: self-esteem/autonomy, object evaluation, quality of life supporting factor and self-strength/vulnerability. The reliability coefficient of test-retest by 28 nurses/nurse tutors was 0.93. Fifty diabetic patients completed the attitude scale for testing the validity of the instrument. Male patients had a more positive attitude towards diabetes than females. Those who had had diabetes for less than 10 years were more positive than those with a longer duration of the disease. A higher degree of education, well-performed self-monitoring of blood glucose and achievement of good metabolic control were all associated with a more negative attitude towards diabetes. A group of nurses/nurse tutors who also completed the attitude scale had a more negative attitude towards diabetes than the investigated groups of patients.