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Background In patients with acute coronary syndromes (ACS) receiving a drug-eluting stent (DES), treatment with dual antiplatelet therapy (DAPT) reduces the risk of recurrent ischemic events. Optimal duration of DAPT depends on patient characteristics and switching to single antiplatelet therapy (SAPT) is recommended after the course of DAPT. Purpose The aim of this study was to evaluate the comparative efficacy and safety of switching to clopidogrel SAPT following DAPT in patients with ACS post DES-implantation. Methods A systematic literature review (SLR) was conducted by searching MEDLINE®, Embase, and CENTRAL up to July 27, 2021. Randomized controlled trials (RCTs) and observational studies that evaluated clopidogrel SAPT following DAPT in adults with ACS post-DES implantation were included. Heterogeneity of included studies was vetted in a feasibility assessment. Random effects meta-analyses were conducted using the metafor package for R. Direct comparisons were conducted for clopidogrel vs. aspirin and clopidogrel vs. DAPT. Using the Bucher method, aspirin vs. DAPT was indirectly compared by taking the difference between their respective pooled treatment effects vs. clopidogrel. A sensitivity analysis was conducted by including studies with a follow-up of 12 months. Results Of 5,349 records identified, seven unique studies (four RCTs and three observational studies) were eligible to be included in the SLR and quantitative treatment comparison. Risk of major adverse cardiovascular events (MACE) was lower in patients who switched to clopidogrel SAPT after DAPT compared with those who switched to aspirin monotherapy (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.54, 0.98), and this difference was significant. No significant difference in risk of MACE was found between switching to clopidogrel SAPT after DAPT and continuation of DAPT (HR: 0.90; 95% CI: 0.65, 1.25). This finding was consistent with the sensitivity analysis representing studies with follow-up of 12 months (HR: 0.95; 95% CI: 0.69, 1.31). Risk of bleeding was not analysed due to insufficient data across included studies for patients with ACS. However, within-study findings from one RCT of 4,136 patients demonstrated a significantly lower risk of bleeding, defined as thrombolysis in myocardial infarction (major and/or minor, for switching to clopidogrel SAPT following DAPT compared with continuation of DAPT (0.54% vs. 1.17% of patients had bleeding [HR: 0.46; 95% CI: 0.23, 0.94]). Conclusion Findings from this SLR suggest switching to clopidogrel SAPT after DAPT in ACS post-DES implantation has a lower risk of MACE compared with switching to aspirin monotherapy, and no difference in the risk of MACE compared with continuation of DAPT. There was insufficient data across the included studies to evaluate the bleeding risk, however, a single study indicated a lower bleeding risk with switching to clopidogrel SAPT. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Sanofi

The aim of this study was to determine the mortality and re-bleeding rates, and the risk factors involved, in a cohort of patients with previous diverticular bleeding (DB).In 2007, data on 2462 patients with lower gastrointestinal (GI) bleeding were collected prospectively at several French hospitals. We studied the follow-up of patients with DB retrospectively. The following data were collected: age, mortality rates and re-bleeding rates, drug intake, surgery and comorbidities.Data on 365 patients, including 181 women (mean age 83.6 ± 9.8 years) were available. The median follow-up time was 3.9 years (IQR 25-75: 1.7-5.4). Of these, 148 patients died (40.5%). Among the 70 patients (19.2%) who had at least one re-bleeding episode, nine died and three underwent surgical procedures. Anticoagulation and antiplatelet therapy was discontinued in 70 cases (19.2%). The independent risk factors contributing to mortality were age 80 years (HR = 3.18 (2.1-4.9);In this cohort, the rates of mortality and DB re-bleeding after a median follow-up time of 3.9 years were 19.2% and 40.5%, respectively. The majority of the deaths recorded were not due to re-bleeding.

ResumeIntroduction Les dermo-hypodermites bacteriennes et fasciites necrosantes (DHBN-FN) sont des infections graves des tissus mous mettant en jeu le pronostic vital. L’objectif est d’evaluer la qualite de vie des patients operes d’une DBHN-FN. Patients et methodes Il s’agit d’une etude monocentrique retrospective des cas de DHBN-FN traites au CHU de Nancy entre 2005 et 2014. Nous avons analyse les donnees perioperatoires (demographiques, cliniques, bacteriologiques), les donnees chirurgicales (excision, reconstruction) et le suivi (sequelles, mortalite). La qualite de vie (QDV) a ete evaluee par le score SF-36, et la satisfaction des patients par une echelle a 4 niveaux. Resultats Nous avons analyse 23 patients, avec un âge moyen de 60 ans (28–84 ans). Les comorbidites principales etaient diabete (43 %) et obesite (39 %). Il y a eu en moyenne 1,9 excisions (1–5), et 5 % (1–16 %) de surface corporelle totale excisee par patient. La mortalite lors du premier sejour hospitalier etait de 17 %. Une plus grande surface excisee etait statistiquement associee a une moindre survie lors du premier sejour hospitalier (p = 0,02) et a long terme (p = 0,003). L’analyse statistique a montre des relations lineaires fortes negatives entre : le nombre d’excisions et le score physique de QDV (p

Objectif Evaluer l’incidence des micro-saignements en IRM a 3 T, pendant le suivi, dans le territoire vasculaire d’une artere intracrânienne stentee lors du traitement d’un anevrisme intracrânien. Materiels et methode Etude retrospective par analyse visuelle qualitative de la presence ou non, et de la quantification de microsaignements dans le territoire de l’artere stentee sur des IRM avec sequences T2* et de susceptibilite magnetique realisees a 3 T a 3, 9, 12 et 24 mois post-operatoire dans le cadre du suivi systematique des patients comparativement a un groupe de patients traites par coils seuls. Les patients traites par stent ont tous recu une double anti-aggregation plaquettaire par Aspirine et Ticagrelor pendant 6 mois minimum apres la pose de stent, et sont sous Aspririne au long cours. Il a ete realise une double lecture par deux radiologues, un junior et un senior. Resultats 97 patients ont ete inclus de 2016 a 2018, et il a ete retrouve des microsaignements dans 27 cas (57,4 %) dans le groupe traite par coils et dans 39 cas (78 %) dans le groupe des patients stentes. La grande majorite des lesions nouvellement apparues se trouvaient dans le territoire arteriel de l’artere stentee. Dans tous les cas ou les patients possedaient une IRM pre-operatoire, ces microsaignements n’etaient pas presents initialement. Lors du suivi il existait dans environ 10 % des cas une majoration de la charge lesionnelle. Une excellente reproductibilite inter-observateur etait retrouvee. Conclusion Cette etude permet de mettre en evidence et faire discuter l’incidence des microsaignements cerebraux apres la pose d’un stent intracrânien chez ces patients sous antiplaquettaires au long cours.

Summary Background and aims According to clinical trials, the treatment of patients with chronic hepatitis C (CHC) with second-generation direct acting antiviral agents (DAAs) is highly efficient and well tolerated. The goal of this study was to investigate the effectiveness and safety of various combinations of these drugs during their first 2 years of use in the real-world practice of French general hospitals. Methods Data from patients treated with all-oral DAAs in 24 French non-academic hospital centers from March 1, 2014 to January 1, 2016, were prospectively recorded. The sustained virological response 12–24 weeks after treatment (SVR 12-24) was estimated and severe adverse events (SAE) were evaluated and their predictive factors were determined using logistic regression. Results Data from 1123 patients were analyzed. The population was 69% genotype (G) 1, 13% G3, 11.5% G4, 5% G2, 49% with cirrhosis and 55% treatment-experienced. The treatment regimens were sofosbuvir/ledipasvir (38%), sofosbuvir/daclatasvir (32%), sofosbuvir/simeprevir (17%), ombitasvir + paritaprevir + ritonavir (5%) (with dasabuvir 3.5%), and sofosbuvir/ribavirin (8%). Ribavirin was given to 24% of patients. The SVR 12-24 was 91.0% (95% CI: 89.2–92.5%). Sofosbuvir-ribavirin was less effective than other regimens. The independent predictors of SVR 12-24 by logistic regression were body weight, albumin, previous hepatocellular carcinoma and treatment regimen (sofosbuvir/ribavirin vs. others). Sixty-four severe adverse events (SAE) were observed in 59 [5.6%] patients, and were independently predicted by cirrhosis and baseline hemoglobin. Serum creatinine increased during treatment (mean 8.5%, [P Conclusions Second generation DAAs combinations are as effective and well tolerated in a « real-world » population as in clinical trials. Further studies are needed on renal tolerance.

Hyper Immunoglobulin D syndrome (HIDS) is a genetic disorder characterized by recurrent attacks of fever and inflammatory symptoms and is most common in those of French or Dutch descent.[1,2]

Health utilities measure patients' preferences for a health state.To assess health utilities for sofosbuvir-containing therapy for chronic hepatitis C.The SF-6D utility scores were derived from the SF-36 instrument administered at baseline, during and post-treatment to participants of the previously reported clinical trials of sofosbuvir. EQ-5D utility scores were also approximated from the SF-36 using a regression model.Nine hundred and ninety-four patients were enrolled. Baseline SF-6D and EQ-5D scores were 0.66 ± 0.13 and 0.71 ± 0.22, respectively (the POSITRON trial), 0.71 ± 0.16 and 0.76 ± 0.23 (FISSION), 0.70 ± 0.14 and 0.75 ± 0.22 (FUSION), 0.72 ± 0.15 and 0.79 ± 0.22 (NEUTRINO). In all studies, SF-6D and EQ-5D scores were highly correlated with each other. (r = 0.83-0.87, P0.0001). After 12 weeks, patients receiving sofosbuvir + ribavirin (POSITRON) had similar utility scores to placebo (P0.05). Patients receiving 12 and 16 weeks of sofosbuvir + ribavirin (FUSION) had similar utility scores (P0.05). In FISSION, patients receiving sofosbuvir + ribavirin had significantly better utilities compared to patients receiving interferon + ribavirin (P0.001). Patients receiving sofosbuvir + ribavirin + interferon (NEUTRINO) had a decrease in utilities during treatment (SF-6D: from 0.72 to 0.62, EQ-5D: 0.79 to 0.65; P0.0001) similar to that observed in patients receiving pegylated interferon + ribavirin for 24 weeks in FISSION (0.72 to 0.62 and 0.77 to 0.65, respectively, P0.0001). After 12 weeks post-treatment, patients with SVR (FUSION) had improvement in SF-6D (+0.026 from baseline, P = 0.013) and EQ-5D (+0.043, P = 0.013). In multivariate analyses, baseline depression, anxiety, fatigue, insomnia and treatment-related anaemia were the most consistent predictors of utilities.Patients' health utilities are minimally impacted by sofosbuvir + ribavirin treatment, as compared to interferon-based, therapy regardless of treatment duration. Clinical trials' numbers: NCT01542788 (POSITRON), NCT01497366 (FISSION), NCT01604850 (FUSION), NCT01641640 (NEUTRINO).

Background Hyper Immunoglobulin D syndrome (HIDS) is a genetic disorder characterized by recurrent attacks of fever and inflammatory symptoms and is most common in those of French or Dutch descent. 1-2 Objectives To understand the impact of HIDS on the lives of patients/caregivers, to describe patient9s journey from first symptoms and to learn what patients hope to emerge in terms of future therapy, support and information. Methods Fifteen patients with HIDS were recruited across US, Europe and Australia. They completed a 20 page pre-interview questionnaire and an in-depth 90 minute in home interview. Patient responses were recorded and summarized; for patients with complete data available (n=13), responses were quantified. The topics covered in the interview were symptoms, patient journey, and unmet needs. Results Patients reported that HIDS was characterised by symptomatic flares and periods of wellness. Flares were individualised in terms of symptoms, frequency and duration. They were typically depicted by high fevers and nausea (especially in paediatrics), as well as pain and were often so severe that patients were bed ridden. In children this led to severely disrupted education. Caregivers and adult patients reported loss of work during attacks and for medical appointments, limiting career choices and progression and leading to financial dependency. HIDS also had an impact on patients9 relationships and social lives by limiting their activities either through being unwell or unable to plan ahead due to fear of an attack. Severity of symptoms, the duration and frequency of flares seemed to decrease with age and treatment. Patients frequently experienced a delay in diagnosis (range, 15 months to 20 years) during which time they were subjected to a variety of diagnostic tests for other conditions. Most patients reported initial treatment with non-steroidal anti-inflammatories, colchicine, or steroids; however, when these were ineffective they were transitioned to biological treatment. Responses to biologic agents were variable; although many reported shorter attack duration and frequency, all respondents continued to experience attacks. Around half of patients have switched biologics due to lack of efficacy. Since little information was provided to patients and parents at diagnosis regarding causes of their condition, the typical symptoms and how to treat it, most seek out information independently, usually via the internet. Patients identified improved treatment efficacy and reduced treatment side effects as the areas in greatest need of improvement in their care. Conclusions HIDS significantly impacts the physical, social, emotional and practical/financial aspects of patients9 and caregivers lives. Greater awareness of HIDS among health care professionals may improve diagnostic delays. Many patients expressed an interest in gaining a greater understanding of their disease and treatment options. There is an unmet need for therapy that prevents or reduces the number of attacks and which has patient-friendly administration. References Van der Hilst JC et al. Curr Rheumatol Rep. 2010;12(2):101-107. Lainka E, et al. Rheumatol Int. 2012;32(10):3253-3260. Disclosure of Interest None declared

P0796 NEW DIRECT ACTING ANTIVIRALS FOR HEPATITIS C TREATMENT: FIRST RESULTS IN A REAL-LIFE SETTING IN FRANCE A. Pariente, A.-J. Remy, J.-P. Arpurt, I. Rosa-Hezode, C. Renou, R. Arotcarena, G. Macaigne, H. Lison, F. Bourhis, X. Causse, A. Pauwels, S. de Montigny-Lenhardt, V. Jouannaud, H. Labadie, E. Maringe, J.-H. Salloum, E. Gagea, H. Hagege, B. Lesgourgues, on behalf of Association Nationale des Gastroenterologues des Hopitaux generaux (ANGH). Service d’Hepatogastroenterologie, Centre Hospitalier, Pau, Service d’Hepatogastroenterologie, Centre Hospitalier, Perpignan, Service d’Hepatogastroenterologie, Centre Hospitalier, Avignon, Service d’Hepatogastroenterologie, Centre Hospitalier Intercommunal, Creteil, Service d’Hepatogastroenterologie, Centre Hospitalier, Hyeres, Service d’Hepatogastroenterologie, Centre Hospitalier, Lagny-Marne la Vallee, Service d’Hepatogastroenterologie, Centre Hospitalier, Creil, Service d’Hepatogastroenterologie, Centre Hospitalier, Chambery, Service d’Hepatogastroenterologie, Centre Hospitalier Regional, Orleans la Source, Service d’Hepatogastroenterologie, Centre Hospitalier, Gonesse, Service d’Hepatogastroenterologie, Centre Hospitalier, Aubagne, Service d’Hepatogastroenterologie, Centre Hospitalier, Montfermeil, Service d’Hepatogastroenterologie, Centre Hospitalier Delafontaine, Saint-Denis, Service d’Hepatogastroenterologie, Centre Hospitalier, Beaune, Service d’Hepatogastroenterologie, Centre Hospitalier, Meaux, Service d’Hepatogastroenterologie, Centre Hospitalier, Cholet, France E-mail: alex.pariente@free.fr

The aim of this study was to determine the prevalence of cannabis and tobacco use in a population attending a Methadone Center.We studied 49 patients over a 3-month period. Urine samples were obtained at three different times from each patient for analysis. We measured urinary cannabinoids using an immunopolarization assay to identify cannabinoid use. Cotinine concentrations were quantified in urine using a colorimetric assay to assess total urinary nicotine metabolites.The prevalence of cannabis use was high in this population. Urinary cannabinoids were present in 63% of the samples. Similarly 90% had high-urinary cotinine concentrations.Measurement of urinary biomarkers showed that tobacco and cannabis use was high among patients attending a Methadone Center.

We report a case of esophageal fistula of a tubercular mediastinal adenopathy revealed by melena and which was diagnosed partly by means of endoscopy and partly by scanning after carrying out endoscopic fistulography. Endoscopic ultrasound, which was carried out as a complementary examination, confirmed this diagnosis.

beta-Endorphin was measured in the plasma of control subjects and 12 chronic alcoholics in the acute stage of ethanol intoxication. Naloxone was administered and the level of beta-endorphin was compared before and after treatment. The increased level of beta-endorphin in the intoxicated subjects supports the presence of ethanol interactions with the opioid system, since pituitary secretion does not seem to be involved. Furthermore, the coexistence of high levels of beta-endorphin and an effective naloxone response suggest a possible link between the two.

Familial Mediterranean Fever (FMF) is a genetic disorder characterized by recurrent attacks of fever and pain, which is most common in those of Sephardic Jewish, Armenian, Turkish or Arabic descent. Although colchicine is the mainstay of treatment for FMF, an estimated 5 to 15% of patients have an incomplete response to colchicine (e.g. colchicine-resistance FMF [cr-FMF]).[1,2]