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Objectives: Systemic sclerosis' (SSc) prevalence varies according to geographical location, presumably in link with environmental and genetic factors. We sought to determine SSc prevalence and incidence on Reunion Island, a southern hemisphere territory characterised by multi-ethnic background., Methods: We conducted a retrospective review of SSc cases defined according to ACR/EULAR 2013 classification criteria. Cases were retrieved over the 2005-2021 period through multiple sources, mainly community and hospital follow-up. Patients were assigned to three clinical subsets: sine scleroderma (normal skin) (ss), limited cutaneous (lc) or diffuse cutaneous (dc) SSc. Prospective submission of questionnaires to patients in 2021 enabled determination of patients' self-declared ethnicity and physician-assessed phototype group. Prevalence was calculated for 2021 and mean annual incidence between 2005 and 2021 after adjustment with WHO's standards., Results: Overall, 207 patients were included in the retrospective cohort, including 175 SSc (108 lcSSc, 58 dcSSc and 9 ssSSc) and 32 mixed connective tissue disease. Prevalence and mean annual incidence were estimated to be 30.9 (95 %IC: 26.1-35.8) per 100,000 inhabitants in 2021 and 2.13 (95 %IC: 1.81-2.45) per 100,000 inhabitants/year respectively. The 5- and 10-year survival rates after diagnosis were 0.93 and 0.82 respectively. Phototypes and ethnicity were determined in 102 and 86 patients, respectively. Darker phototypes presented more frequently with pulmonary hypertension, while lighter phototypes had more severe gastro-intestinal manifestations and anti-centromere antibodies positivity., Conclusion: Our study revealed high prevalence and incidence of SSc in Reunion Island which is consistent with the frequently described higher frequency among patients of African origin., Competing Interests: Declaration of competing interest The authors declare no conflict of interest regarding the present work., (Copyright © 2024. Published by Elsevier Inc.)

Leptospirosis is a neglected zoonosis for which investigations assessing host-pathogen interaction are scarce. The aim of this study was to compare the severity and bacterial species involved in human cases of leptospirosis on Reunion and Mayotte islands, territories located in the southwest Indian Ocean that have recorded high human leptospirosis incidence but display fairly distinct epidemiological situations. A retrospective multicentric study including all patients over 18 years of age from Mayotte or Reunion with proven leptospirosis was conducted from January 2018 to April 2020. This study collected demographic, geographical, clinical, and biological data. Overall, 490 patients were included, 222 on Mayotte and 268 on Reunion. More patients were hospitalized on Reunion (n = 215, 80%) compared with Mayotte (n = 102, 46%). Severe disease was more common on Reunion (n = 75, 28%) than on Mayotte (n = 22, 10%). The dominant Leptospira species on Reunion was Leptospira interrogans (79%) followed by Leptospira borgpetersenii (21%), contrasting with the epidemiological situation on Mayotte where L. interrogans was found in only a minority of patients (10%). The high frequency of severe cases on Reunion could be explained not only by higher comorbidities but also by the higher occurrence of L. interrogans infections compared with Mayotte. Finally, the distribution of cases linked to L. borgpetersenii was found almost exclusively on the west coast of Reunion, raising the potential role of a ruminant reservoir.

Leptospirosis is a life-threatening zoonotic disease and it has been hypothesized that the innate immune system fails to control the infection through ill-characterized mechanisms. The aim of this observational study was to better evaluate the activation processes of monocytes at the early stage of the disease. Blood samples were taken from healthy donors (n = 37) and patients hospitalized for either non-severe (n = 25) or severe (n = 32) leptospirosis. Monocyte cell counts and phenotypes were assessed by flow cytometry. We analysed the expression of several cell activation markers: CD14, CD16, HLA-DR, CD69, TLR2, TLR4, CD11b and CD11c. Although monocyte values at admittance were not significantly different from controls, patients experienced significant monocytosis at 1.33 × 10 9 /L (p < 0.0001 compared to controls: 0.56 × 10 9 /L) during their hospital stay. This monocytosis observed during hospital stay was correlated to several surrogate markers of organ injury. Non-classical (CD14-CD16+) and intermediate (CD14+CD16+) monocyte subsets increased compared to controls (p < 0.05). Accordingly, classical monocyte subset (CD14+CD16-) showed decreased percentages (p < 0.0001). Levels of several cell surface activation molecules were decreased: HLA-DR involved in MHC class II antigen presentation, integrins CD11b and CD11c implicated in phagocytosis and cell recruitment (p < 0.0001). None of these parameters had a prognostic value. Results from this study showed that during acute human leptospirosis, patients experienced monocytosis with a switch toward an inflammation-related phenotype contrasted by low expression levels of markers implicated in monocyte function.

Reactive arthritis following Escherichia coli urinary tract infection is very rare. We report a 25-year-old woman with acute oligoarthritis associated with bilateral anterior uveitis after an episode of urinary tract infection due to E. coli. The diagnosis of reactive arthritis was considered and the patient treated with non-steroidal anti-inflammatory agents. Disease course was rapidly successful and at 6-month follow-up the patient was asymptomatic. Reactive arthritis is associated with intestinal infection but also with common urinary tract infection., (Copyright © 2010 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.)

Introduction: Entering prison can feed pre-existent behavior of demands or generate them. Several means of expression are then used. Hunger strike is an average privileged act. It belongs to prison culture., Objective: Estimate how practitioners working in prison take care of the hunger strikers., Methodology: The study, realised in 2008, was led with all the Units of Consultations and Ambulatory Care in France. It is a declarative investigation where a medical testimony by unit was asked., Results: From 174 "maisons d'arrêt" and establishments for punishment in France, 95 answers were obtained. This situation was already seen by 98,8% of the doctors. The motives for hunger strike were mainly judicial for "maisons d'arrêt" (70,1%) and prison motives for detention centers (68,7%). Mainly, doctors opted for a neutral attitude (63% of the cases). The hunger strikes were mostly brief (less than a week in 85% of the cases). Only 5,5% of the doctors proposed written information concerning the risks incurred during a fast. A doctor in 4 approximately (23%) was already witness to complications due to fasting. The fact that a patient may refuse care makes the medical approach difficult. Faced with such a situation, 45% of the doctors privileged their duty of care, 28% respected the patient's wishes, and 27% did not pronounce. From a therapeutic point of view, the place of treatment using vitamins was rarely recognized (32,7%)., Discussion: Hunger strike is rarely severe, but it is rather frequent in prison so that every doctor working there will be confronted with it. The refeeding syndrome seems often ignored. The coverage of hunger strike is governed by the law, but ethical questions stay in the appreciation of every doctor., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)