202 results on '"Behrouz Kassai"'
Search Results
2. Knowledge and beliefs of endocrine disruptors in pediatrics: all hands on deck!
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Aurélie Portefaix, Thomas Loppinet, Laura Tourvieilhe, Giuseppe Balice, Nathan de Veron de La Combe, Behrouz Kassai, and Justine Bacchetta
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ED ,pediatric health professionals ,endocrine disruptor (ECD) ,pediatric health ,knowledge beliefs ,Public aspects of medicine ,RA1-1270 - Abstract
Endocrine disruptors (ED) are ubiquitous pollutants, possibly implicated in chronic disease. Exposure of vulnerable populations; including neonates, infants and children; must therefore be limited. Informing parents is now a public health challenge. We conducted a quantitative cross-sectional study at the Lyon Mother and child Hospital. We used questionnaires to assess the beliefs and knowledge about ED of parents and pediatric healthcare professionals in the pediatric ward in Lyon, France. A total of 746 questionnaires were completed: 444 for professionals and 302 for parents. The majority of both populations had already heard of ED but only 10% of parents and 5% of professionals felt sufficiently informed. Professionals answered better than parents (73% vs. 60%). The main source of information was similar: media. Only 20% of professionals had read a scientific article about ED and 4% have followed a training. Environmental exposure and EDs is an increasing concern for parents but specific knowledge remains scare for parents and professionals. Specific training is needed.
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- 2024
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3. Mushroom Poisoning-Related Cardiac Toxicity: A Case Report and Systematic Review
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Giuseppe Balice, Maxime Boksebeld, Quentin Barrier, Sara Boccalini, Behrouz Kassai-Koupai, Nathalie Paret, and Guillaume Grenet
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mushroom ,poisoning ,troponin ,ECG ,myocarditis ,cardiac toxicity ,Medicine - Abstract
We encountered a case of mushroom intoxication complicated by “toxic-like” myocarditis. Because of the lack of systematized knowledge on this subject, we performed a systematic review of the literature on cardiac toxicity in mushroom poisoning (MP). The aim of this study was to identify and describe the severity, the causal relationship, and the mushroom species involved in other reported cardiac events associated with MP. We included 39 studies in our review. We found 106 cases of cardiac events associated with MP, including 18 deaths. A wide variety of cardiac manifestations were reported, ranging from the simple elevation of cardiac enzymes (n = 61) to ventricular tachycardia (n = 14), acute heart failure (n = 18), and myocarditis (n = 7). Causal relationship between cardiac manifestations and mushroom poisoning was assessed for 42 patients, applying the algorithm validated by the French Toxicovigilance Coordination Committee. Twenty-three cases (54.8%) had a “possible” causal relationship, eight cases (19%) a “probable” relationship, and ten cases (23.8%) a “very probable” relationship. Several fungal genera were involved in reported cases, including Amanita but also rarer ones like Russula and Tricholoma. In conclusion, we showed that cases of cardiac toxicity following MP have been documented in the existing literature, and for some of them, we assessed a strong causal relationship.
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- 2024
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4. Unlicensed/Off-Label Drug Prescriptions at Hospital Discharge in Children: An Observational Study Using Routinely Collected Health Data
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Elham Jaberi, Inesse Boussaha, Xavier Dode, Guillaume Grenet, Behrouz Kassai, and Kim An Nguyen
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children ,drug prescription ,discharge ,unlicensed ,off-label ,Medicine - Abstract
Background: Unlicensed and off-label (UL/OL) prescriptions have been associated with an increased risk of drug-related problems. Data of their prevalence at hospital discharge remain insufficient. We aimed to describe the prevalence of UL/OL drugs in outpatient prescriptions at discharge in children. Methods: We conducted a retrospective study using the routinely collected health data of children at discharge from 2014 to 2016. The primary reference source for determining licensed labelling was the summaries of product characteristics (SPCs) in a French industry-independent formulary named Thériaque. We described the characteristics of UL/OL prescriptions at discharge and looked for predictors of UL/OL prescriptions. Results: We included 2536 prescriptions of 479 children. Licensed, OL, and UL prescriptions accounted for 58.6% (95% CI: 56.7–60.5), 39.2% (95% CI: 37.3–41.1), and 2.3% (95% CI: 1.7–2.9), respectively. A total of 323 (74%) children received at least one UL/OL drug. Among the licensed drugs, bronchodilators (8.8%) and analgesics (8.6%), and among the OL drugs, antibiotics (2.8%), were the most prescribed. The younger age of the children and higher number of drugs they received increased the probability of UL/OL prescriptions (unadjusted p-value of ≤0.05). Conclusion: The prevalence of UL/OL prescriptions is about 40% at discharge from a pediatric university hospital in France.
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- 2024
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5. Predictive Value of Optic Nerve Sheath Diameter for Diagnosis of Intracranial Hypertension in Children With Severe Brain Injury
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Fleur Cour-Andlauer, Aurélie Portefaix, Isabelle Wroblewski, Muriel Rabilloud, Fabienne Bordet, Bérengère Cogniat, Capucine Didier, Robin Pouyau, Frédéric V. Valla, Behrouz Kassai-Koupai, Gaëlle Siméon, Tiphanie Ginhoux, Sonia Courtil-Teyssedre, and Etienne Javouhey
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children ,brain injury ,intracranial hypertension ,ultrasonography ,optic nerve ,Pediatrics ,RJ1-570 - Abstract
Background and AimsIntracranial Hypertension (ICH) is a life-threatening complication of brain injury. The invasive measurement of intracranial pressure (ICP) remains the gold standard to diagnose ICH. Measurement of Optic Nerve Sheath Diameter (ONSD) using ultrasonography is a non-invasive method for detecting ICH. However, data on paediatric brain injury are scarce. The aim of the study was to determine the performance of the initial ONSD measurement to predict ICH occurring in children with severe brain injury and to describe the ONSD values in a control group.MethodsIn this cross-sectional study, ONSD was measured in children aged 2 months-17 years old with invasive ICP monitoring: before placement of ICP probe and within the 60 min after, and then daily during 3 days. ONSD was also measured in a control group.ResultsNinety-nine patients were included, of whom 97 were analysed, with a median (IQR) age of 8.7 [2.3–13.6] years. The median (IQR) PIM 2 score was 6.6 [4.4–9.7] and the median (IQR) PELOD score was 21 [12–22]. Aetiologies of brain injury were trauma (n = 72), infection (n = 17) and stroke (n = 8). ICH occurred in 65 children. The median (IQR) ONSD was 5.58 mm [5.05–5.85]. ONSD performed poorly when it came to predicting ICH occurrence within the first 24 h (area under the curve, 0.58). There was no significant difference between the ONSD of children who presented with ICH within the first 24 h and the other children, with a median (IQR) of 5.6 mm [5.1–5.9] and 5.4 mm [4.9–5.8], respectively. Infants aged less than 2 years had a median (IQR) ONSD of 4.9 mm [4.5–5.2], significantly different from children aged more than 2 years, whose median ONSD was 5.6 mm [5.2–5.9]. Age, aetiology or ICP levels did not change the results. Thirty-one controls were included, with a median age of 3.7 (1.2–8.8) years. The median (IQR) of their ONSD measurement was 4.5 mm [4.1–4.8], significantly lower than the patient group.ConclusionIn a paediatric severe brain injury population, ONSD measurement could not predict the 24 h occurrence of ICH. Severity of patients, timing and conditions of measurements may possibly explain these results.
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- 2022
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6. Protocol of controlled odorant stimulation for reducing apnoeic episodes in premature newborns: a randomised open-label Latin-square study with independent evaluation of the main endpoint (PREMODEUR)
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Delphine Maucort-Boulch, Jean Iwaz, Behrouz Kassai, Olivier Claris, Franck Plaisant, Hélène Gauthier-Moulinier, Patricia Duchamp-Viret, Huu Kim Nguyen, Laurent Remontet, Aurore Guyon, Patricia Franco, Andrei Cividjian, Marc Thevenet, Sonia Galletti, and Elise Cornaton
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Medicine - Published
- 2021
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7. Minoxidil versus placebo in the treatment of arterial wall hypertrophy in children with Williams Beuren Syndrome: a randomized controlled trial
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Behrouz Kassai, Philippe Bouyé, Brigitte Gilbert-Dussardier, François Godart, Jean-Benoit Thambo, Massimiliano Rossi, Pierre Cochat, Pierre Chirossel, Stephane Luong, André Serusclat, Isabelle Canterino, Catherine Mercier, Muriel Rabilloud, Christine Pivot, Fabrice Pirot, Tiphanie Ginhoux, Stéphanie Coopman, Guillaume Grenet, François Gueyffier, Sylvie Di-Fillippo, and Aurélia Bertholet-Thomas
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Children ,Randomized Controlled Trials ,Rare Disease ,Pediatrics ,RJ1-570 - Abstract
Abstract Background Insufficient elastin synthesis leads to vascular complications and arterial hypertension in children with Williams-Beuren syndrome. Restoring sufficient quantity of elastin should then result in prevention or inhibition of vascular malformations and improvement in arterial blood pressure. Methods The aim of this study was to assess the efficacy and safety of minoxidil on Intima Media Thickness (IMT) on the right common carotid artery after twelve-month treatment in patient with Williams-Beuren syndrome. We performed a randomized placebo controlled double blind trial. All participants were treated for 12 months and followed for 18 months. The principal outcome was assessed by an independent adjudication committee blinded to the allocated treatment groups. Results The principal outcome was available for 9 patients in the placebo group and 8 patients in the minoxidil group. After 12-month treatment, the IMT in the minoxidil group increased by 0.03 mm (95% CI -0.002, 0.06) compared with 0.01 mm (95%CI - 0.02, 0.04 mm) in the placebo group (p = 0.4). Two serious adverse events unrelated to the treatment occurred, one in the minoxidil and 1 in the placebo group. After 18 months, the IMT increased by 0.07 mm (95% CI 0.04, 0.10 mm) in the minoxidil compared with 0.01 mm (95% CI -0.02, 0.04 mm) in the placebo group (p = 0.008). Conclusion Our results suggest a slight increase after 12 and 18-month follow-up in IMT. More understanding of the biological changes induced by minoxidil should better explain its potential role on elastogenesis in Williams-Beuren syndrome. Trials registration US National Institutes of Health Clinical Trial Register (NCT00876200). Registered 3 April 2009 (retrospectively registered).
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- 2019
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8. Available medications used as potential therapeutics for COVID-19: What are the known safety profiles in pregnancy.
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Anick Bérard, Odile Sheehy, Jin-Ping Zhao, Evelyne Vinet, Caroline Quach, Behrouz Kassai, and Sasha Bernatsky
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Medicine ,Science - Abstract
BackgroundMedications already available to treat other conditions are presently being studied in clinical trials as potential treatments for COVID-19. Given that pregnant women are excluded from these trials, we aimed to investigate their safety when used during pregnancy within a unique population source.MethodsUsing the population-based Quebec Pregnancy Cohort, we identified women who delivered a singleton liveborn (1998-2015). Taking potential confounders into account including indications for use, the risk of prematurity, low birth weight (LBW), small for gestational age (SGA), and major congenital malformation (MCM) associated with COVID-19 repurposed drug use during pregnancy were quantified using generalized estimation equations.ResultsOf the 231,075 eligible pregnancies, 107 were exposed to dexamethasone (0.05%), 31 to interferons (0.01%), 1,398 to heparins (0.60%), 24 to angiotensin-receptor blockers (ARB) (0.01%), 182 to chloroquine (0.08%), 103 to hydroxychloroquine (0.05%), 6,206 to azithromycin (2.70%), 230 to oseltamivir (0.10%), and 114 to HIV medications (0.05%). Adjusting for potential confounders, we observed an increased risk of prematurity related to dexamethasone (aOR 1.92, 95%CI 1.11-3.33; 15 exposed cases), anti-thrombotics (aOR 1.58, 95%CI 1.31-1.91; 177 exposed cases), and HIV medications (aOR 2.04, 95%CI 1.01-4.11; 20 exposed cases) use. An increased risk for LBW associated with anti-thrombotics (aOR 1.72, 95%CI 1.41-2.11; 152 exposed cases), and HIV medications (aOR 2.48, 95%CI 1.25-4.90; 21 exposed cases) use were also found. Gestational exposure to anti-thrombotics (aOR 1.20, 95%CI 1.00-1.44; 176 exposed cases), and HIV medications (aOR 2.61, 95%CI 1.51-4.51; 30 exposed cases) were associated with SGA. First-trimester dexamethasone (aOR 1.66, 95%CI 1.02-2.69; 20 exposed cases) and azithromycin (aOR 1.10, 95%CI 1.02-1.19; 747 exposed cases) exposures were associated with MCM.ConclusionsMany available medications considered as treatments for COVID-19 are associated with adverse pregnancy outcomes. Caution is warranted when considering these medications during the gestational period.
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- 2021
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9. Worldwide view of nephropathic cystinosis: results from a survey from 30 countries
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Aurélia Bertholet-Thomas, Julien Berthiller, Velibor Tasic, Behrouz Kassai, Hasan Otukesh, Marcella Greco, Jochen Ehrich, Rejane de Paula Bernardes, Georges Deschênes, Sally-Ann Hulton, Michel Fischbach, Kenza Soulami, Bassam Saeed, Ehsan Valavi, Carlos Jose Cobenas, Bülent Hacihamdioglu, Gabrielle Weiler, Pierre Cochat, and Justine Bacchetta
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Nephropathic cystinosis ,Cysteamine ,Developing nations ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Abstract Background Nephropathic cystinosis is a rare inherited metabolic disorder leading to progressive renal failure and extra-renal comorbidity. The prognosis relies on early adherence to cysteamine treatment and symptomatic therapies. Developing nations [DiN] experience many challenges for management of cystinosis. The aim of this study was to assess the management characteristics in DiN compared with developed nations [DeN]. Methods A questionnaire was sent between April 2010 and May 2011 to 87 members of the International Pediatric Nephrology Association, in 50 countries. Results A total of 213 patients were included from 41 centres in 30 nations (109 from 17 DiN and 104 from 13 DeN). 7% of DiN patients died at a median age of 5 years whereas no death was observed in DeN. DiN patients were older at the time of diagnosis. In DiN, leukocyte cystine measurement was only available in selected cases for diagnosis but never for continuous monitoring. More patients had reached end-stage renal disease in DiN (53.2 vs. 37.9%, p = 0.03), within a shorter time of evolution (8 vs. 10 yrs., p = 0.0008). The earlier the cysteamine treatment, the better the renal outcome, since the median renal survival increased up to 16.1 [12.5−/] yrs. in patients from DeN treated before the age of 2.5 years of age (p = 0.0001). However, the renal survival was not statistically different between DeN and DiN when patients initiated cysteamine after 2.5 years of age. The number of transplantations and the time from onset of ESRD to transplantation were not different in DeN and DiN. More patients were kept under maintenance dialysis in DiN (26% vs.19%, p = 0.02); 79% of patients from DiN vs. 45% in DeN underwent peritoneal dialysis. Conclusions Major discrepancies between DiN and DeN in the management of nephropathic cystinosis remain a current concern for many patients living in countries with limited financial resources.
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- 2017
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10. The French Pregnancy Cohort: Medication use during pregnancy in the French population.
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Anick Bérard, Fatima Abbas-Chorfa, Behrouz Kassai, Thierry Vial, Kim An Nguyen, Odile Sheehy, and Anne-Marie Schott
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Medicine ,Science - Abstract
PurposeWe described the medication use during pregnancy in the French population using the French Pregnancy Cohort (FPC).MethodsThe FPC was built with the sampling of all pregnant women included in the French Echantillon généraliste des bénéficiaires (EGB), which is a 1/97th representative sample of the population covered by the French health insurance. The EGB includes anonymized information on the socio-demographic and medical characteristics of beneficiaries, and the health care services they have received such as diagnoses and procedure codes as well as data on filled reimbursed medication; EGB also includes data on hospital stays in all public and private French health facilities. Each filled prescription record contains information on drug brand and generic names, date of prescription and date of dispensing, quantity dispensed, mode of administration, duration of prescription, dosage, and prescribing physician specialty. FPC includes data on all pregnancies of women in the EGB (2010-2013). Date of entry in the FPC is the first day of pregnancy regardless of pregnancy outcome (spontaneous abortions or planned abortions (with or without medical reasons), deliveries), and data on women are collected retrospectively for a period of one year before pregnancy, and prospectively during pregnancy, and up to one year after delivery. The prevalence of prescribed medications before, during and after pregnancy was compared; comparison was also done between trimesters. Pregnancy outcomes are described and include spontaneous and planned abortions, livebirths, and stillbirths.ResultsFPC includes data on 36,065 pregnancies. Among them, 27,253 (75.6%) resulted in a delivery including 201 stillbirths (0.7%). The total number of spontaneous abortions was 6,718 (18.6%), and planned abortions 2,094 (5.8%). The prevalence of filled medication use was 91.1%, 89.9%, and 95.6% before, during and after pregnancy, respectively. Although there was a statistically significant decrease in the proportion of use once the pregnancy was diagnosed (first trimester exposure, 76.4% vs. exposure in the year prior to pregnancy, 91.1% (p < .01)), post-pregnancy medication use was above the pre-pregnancy level (95.6%). Maternal depression was the most prevalent comorbidity during pregnancy (20%), and post-partum depression was higher in those who delivered a stillborn infant (38.8%) as well as in those with a spontaneous (19.5%) or planned abortion (22.4%) compared to those with a liveborn (12.0%).ConclusionFPC is an excellent tool for the study of the risk and benefit of drug use during the perinatal period. FPC has the advantage of including a representative sample of French pregnant women, and study medications only available in France in addition to others available worldwide.
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- 2019
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11. GLUcose COntrol Safety & Efficacy in type 2 DIabetes, a systematic review and NETwork meta-analysis.
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Guillaume Grenet, Shams Ribault, Giao Bao Nguyen, Faustine Glais, Augustin Metge, Thomas Linet, Behrouz Kassai-Koupai, Catherine Cornu, Théodora Bejan-Angoulvant, Sylvie Erpeldinger, Rémy Boussageon, Aurore Gouraud, Fabrice Bonnet, Michel Cucherat, Philippe Moulin, and François Gueyffier
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Medicine ,Science - Abstract
BackgroundThe last international consensus on the management of type 2 diabetes (T2D) recommends SGLT-2 inhibitors or GLP-1 agonists for patients with clinical cardiovascular (CV) disease; metformin remains the first-line glucose lowering medication. Last studies suggested beneficial effects of SGLT-2 inhibitors or GLP-1 agonists compared to DPP-4 inhibitors, in secondary CV prevention. Recently, a potential benefit of SGLT-2 inhibitors in primary CV prevention also has been suggested. However, no comparison of all the new and the old hypoglycemic drugs is available on CV outcomes. We aimed to compare the effects of old and new hypoglycemic drugs in T2D, on major adverse cardiovascular events (MACE) and mortality.Methods and findingsWe conducted a systematic review and network meta-analysis of clinical trials. Randomized trials, blinded or not, assessing contemporary hypoglycemic drugs on mortality or MACE in patients with T2D, were searched for in Medline, the Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov. References screening and data extraction were done by multiple observers. Each drug was analyzed according to its therapeutic class. A random Bayesian network meta-analysis model was used. The primary outcomes were overall mortality, cardiovascular mortality, and MACE. Severe adverse events and severe hypoglycemia were also recorded. 175,966 patients in 34 trials from 1970 to 2018 were included. No trials evaluating glinides or alpha glucosidase inhibitors were found. 17 trials included a majority of patients with previous cardiovascular history, 16 trials a majority of patients without. Compared to control, SGLT-2 inhibitors were associated with a decreased risk of overall mortality (OR = 0.84 [95% CrI: 0.74; 0.95]), SGLT-2 inhibitors and GLP-1 agonists with a decreased risk of MACE (OR = 0.89 [95% CrI: 0.81; 0.98] and OR = 0.88 [95% CrI: 0.81; 0.95], respectively). Compared to DPP-4 inhibitors, SGLT-2 inhibitors were associated with a decreased risk of overall mortality (OR = 0.82 [95% CrI: 0.69; 0.98]), GLP-1 agonists with a decreased risk of MACE (OR = 0.88 [95% CrI: 0.79; 0.99]). Insulin was also associated with an increased risk of MACE compared to GLP-1 agonists (OR = 1.19 [95% CrI: 1.01; 1.42]). Insulin and sulfonylureas were associated with an increased risk of severe hypoglycemia. In the trials including a majority of patients without previous CV history, the comparisons of SGLT-2 inhibitors, metformin and control did not showed significant differences on primary outcomes. We limited our analysis at the therapeutic class level.ConclusionsSGLT-2 inhibitors and GLP-1 agonists have the most beneficial effects, especially in T2D patients with previous CV diseases. Direct comparisons of SGLT-2 inhibitors, GLP-1 agonists and metformin are needed, notably in primary CV prevention.Trial registrationPROSPERO CRD42016043823.
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- 2019
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12. A Novel Analog Reasoning Paradigm: New Insights in Intellectually Disabled Patients.
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Aurore Curie, Amandine Brun, Anne Cheylus, Anne Reboul, Tatjana Nazir, Gérald Bussy, Karine Delange, Yves Paulignan, Sandra Mercier, Albert David, Stéphanie Marignier, Lydie Merle, Bénédicte de Fréminville, Fabienne Prieur, Michel Till, Isabelle Mortemousque, Annick Toutain, Eric Bieth, Renaud Touraine, Damien Sanlaville, Jamel Chelly, Jian Kong, Daniel Ott, Behrouz Kassai, Nouchine Hadjikhani, Randy L Gollub, and Vincent des Portes
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Medicine ,Science - Abstract
BACKGROUND:Intellectual Disability (ID) is characterized by deficits in intellectual functions such as reasoning, problem-solving, planning, abstract thinking, judgment, and learning. As new avenues are emerging for treatment of genetically determined ID (such as Down's syndrome or Fragile X syndrome), it is necessary to identify objective reliable and sensitive outcome measures for use in clinical trials. OBJECTIVE:We developed a novel visual analogical reasoning paradigm, inspired by the Progressive Raven's Matrices, but appropriate for Intellectually Disabled patients. This new paradigm assesses reasoning and inhibition abilities in ID patients. METHODS:We performed behavioural analyses for this task (with a reaction time and error rate analysis, Study 1) in 96 healthy controls (adults and typically developed children older than 4) and 41 genetically determined ID patients (Fragile X syndrome, Down syndrome and ARX mutated patients). In order to establish and quantify the cognitive strategies used to solve the task, we also performed an eye-tracking analysis (Study 2). RESULTS:Down syndrome, ARX and Fragile X patients were significantly slower and made significantly more errors than chronological age-matched healthy controls. The effect of inhibition on error rate was greater than the matrix complexity effect in ID patients, opposite to findings in adult healthy controls. Interestingly, ID patients were more impaired by inhibition than mental age-matched healthy controls, but not by the matrix complexity. Eye-tracking analysis made it possible to identify the strategy used by the participants to solve the task. Adult healthy controls used a matrix-based strategy, whereas ID patients used a response-based strategy. Furthermore, etiologic-specific reasoning differences were evidenced between ID patients groups. CONCLUSION:We suggest that this paradigm, appropriate for ID patients and developmental populations as well as adult healthy controls, provides an objective and quantitative assessment of visual analogical reasoning and cognitive inhibition, enabling testing for the effect of pharmacological or behavioural intervention in these specific populations.
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- 2016
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13. Reappraisal of metformin efficacy in the treatment of type 2 diabetes: a meta-analysis of randomised controlled trials.
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Rémy Boussageon, Irène Supper, Theodora Bejan-Angoulvant, Nadir Kellou, Michel Cucherat, Jean-Pierre Boissel, Behrouz Kassai, Alain Moreau, François Gueyffier, and Catherine Cornu
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Medicine - Abstract
BackgroundThe UK Prospective Diabetes Study showed that metformin decreases mortality compared to diet alone in overweight patients with type 2 diabetes mellitus. Since then, it has been the first-line treatment in overweight patients with type 2 diabetes. However, metformin-sulphonylurea bitherapy may increase mortality.Methods and findingsThis meta-analysis of randomised controlled trials evaluated metformin efficacy (in studies of metformin versus diet alone, versus placebo, and versus no treatment; metformin as an add-on therapy; and metformin withdrawal) against cardiovascular morbidity or mortality in patients with type 2 diabetes. We searched Medline, Embase, and the Cochrane database. Primary end points were all-cause mortality and cardiovascular death. Secondary end points included all myocardial infarctions, all strokes, congestive heart failure, peripheral vascular disease, leg amputations, and microvascular complications. Thirteen randomised controlled trials (13,110 patients) were retrieved; 9,560 patients were given metformin, and 3,550 patients were given conventional treatment or placebo. Metformin did not significantly affect the primary outcomes all-cause mortality, risk ratio (RR)=0.99 (95% CI: 0.75 to 1.31), and cardiovascular mortality, RR=1.05 (95% CI: 0.67 to 1.64). The secondary outcomes were also unaffected by metformin treatment: all myocardial infarctions, RR=0.90 (95% CI: 0.74 to 1.09); all strokes, RR=0.76 (95% CI: 0.51 to 1.14); heart failure, RR=1.03 (95% CI: 0.67 to 1.59); peripheral vascular disease, RR=0.90 (95% CI: 0.46 to 1.78); leg amputations, RR=1.04 (95% CI: 0.44 to 2.44); and microvascular complications, RR=0.83 (95% CI: 0.59 to 1.17). For all-cause mortality and cardiovascular mortality, there was significant heterogeneity when including the UK Prospective Diabetes Study subgroups (I(2)=41% and 59%). There was significant interaction with sulphonylurea as a concomitant treatment for myocardial infarction (p=0.10 and 0.02, respectively).ConclusionsAlthough metformin is considered the gold standard, its benefit/risk ratio remains uncertain. We cannot exclude a 25% reduction or a 31% increase in all-cause mortality. We cannot exclude a 33% reduction or a 64% increase in cardiovascular mortality. Further studies are needed to clarify this situation.
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- 2012
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14. Schwartz formula: is one k-coefficient adequate for all children?
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Vandrea Carla De Souza, Muriel Rabilloud, Pierre Cochat, Luciano Selistre, Aoumeur Hadj-Aissa, Behrouz Kassai, Bruno Ranchin, Ulla Berg, Maria Herthelius, and Laurence Dubourg
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Medicine ,Science - Abstract
BACKGROUND/OBJECTIVE: Plasma-creatinine-based equations to estimate the glomerular filtration rate are recommended by several clinical guidelines. In 2009, Schwartz et al. adapted the traditional Schwartz equation to children and adolescents but did not find different k-coefficients between children and adolescents (k = 36.5 for all patients). We reevaluated the coefficient of the 2009-Schwartz formula according to sex and age in a pediatric population. PATIENTS/METHODS: We used linear mixed-effects models to reestimate the 2009-Schwartz k-coefficient in 360 consecutive French subjects aged 1 to 18 years referred to a single centre between July 2003 and July 2010 (965 measurements). We assessed the agreement between the estimated glomerular filtration rate obtained with the new formula (called Schwartz-Lyon) and the rate measured by inulin clearance. We then compared this agreement to the one between the measured glomerular filtration rate and 2009-Schwartz formula, first in the French then in a Swedish cohort. RESULTS: In Schwartz-Lyon formula, k was estimated at 32.5 in boys
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- 2012
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15. Trigger tools to identify adverse drug events in hospitalised children: A systematic review
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Rama Arab, Catherine Cornu, Roubi Kilo, Aurélie Portefaix, Beatriz Fretes-Bonett, Fanny Hergibo, Behrouz Kassai, and Kim An Nguyen
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Drug-Related Side Effects and Adverse Reactions ,Adverse Drug Reaction Reporting Systems ,Humans ,Pharmacology (medical) ,Child ,Child, Hospitalized ,Hospitals - Abstract
To identify all available trigger tools applicable to the pediatric population in hospital settings to detect adverse drug events (ADEs) and to describe their performances by positive predictive value (PPV).PubMed® was searched until December 2021. The reference sections were also consulted for new articles. Studies were selected when they used one or more triggers to identify AEs and used data on pediatric inpatient settings. Studies mentioning triggers related to AEs that were only caused by care procedures were excluded. Only triggers related to ADEs were included. PPVs of triggers were reported. Mean PPVs were calculated for multi-study triggers. The interest of each trigger in a real-time detection system was assessed.Thirty studies were included. A total of 271 unique triggers were identified, 179 of which were related to drug-induced harms. Among them, 68 could be used for prevention of ADEs, 80 for verification and 31 for reporting. Nineteen triggers (11%) had a mean PPV between 50% and 100%, including 5 that had a 100% PPV.The performances of individual triggers need to be more adequately studied. The detection of ADEs through computerized triggers and/or real-time detection systems remains an emerging field, very much needed in children especially, due to frequent off-label use.
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- 2022
16. Project Rebuild the Evidence Base (REB): a method to interpret randomised clinical trials and their meta-analysis to present solid benefit-risk assessments to patients
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Rémy, Boussageon, Clara, Blanchard, Elodie, Charuel, Thibault, Menini, Bruno, Pereira, Florian, Naudet, Behrouz, Kassai, François, Gueyffier, Michel, Cucherat, Hélène, Vaillant-Roussel, Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Collège National des Généralistes Enseignants (CNGE), Université de Poitiers, AutomédiCation aCcompagnement Pluriprofessionnel PatienT (ACCePPT), Université Clermont Auvergne (UCA), Direction de la recherche clinique et de l’innovation [CHU Clermont-Ferrand] (DRCI), CHU Clermont-Ferrand, Centre d'Investigation Clinique [Rennes] (CIC), and Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)
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Evidence-based medicine ,Meta-analysis ,Patient safety ,Communication ,Pharmacology (medical) ,Health-policy ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
International audience; Evidence-based medicine is the cornerstone of shared-decision making in healthcare today. The public deserves clear, transparent and trust-worthy information on drug efficacy. Yet today, many drugs are prescribed and used without solid evidence of efficacy. Clinical trials and randomized clinical trials (RCTs) are the best method to evaluate drug efficacy and side effects. In a shared medical decision-making approach, general practitioners need drug assessment to be based on patient-important outcomes. The aim of project Rebuild the Evidence Base (REB) is to bridge the gap between the data needed in clinical practice and the data available from clinical research. The drugs will be assessed on clinical patient important outcomes and for a population. Using the Cochrane tools, we propose to analyse for each population and outcome : 1) a meta-analysis based on RCTs with a low risk of bias overall ; 2) an evaluate of results of confirmatory RCTs; 3) a statistical analysis of heterrogeneity between RCTs, and 4) an analysis of publication bias. Depending on the results of these analyses, the evidence will be categorised in 4 different levels: firm evidence, evidence (to be confirmed), signal or absence of evidence. Project REB proposes a method for reading and interpreting randomized clinical trials and their meta-analysis to produce quality data for general practitioners to focus on benefit-risk assessment in the interest of patients. If this data does not exist, it could enable clinical research to better its aim.
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- 2022
17. The Impact of COVID-19 on Maternal Mental Health during Pregnancy: A Comparison between Canada and China within the CONCEPTION Cohort
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Nicolas Pagès, Jessica Gorgui, Chongjian Wang, Xian Wang, Jin-Ping Zhao, Vanina Tchuente, Anaïs Lacasse, Sylvana Côté, Suzanne King, Flory Muanda, Yves Mufike, Isabelle Boucoiran, Anne Monique Nuyt, Caroline Quach, Ema Ferreira, Padma Kaul, Brandace Winquist, Kieran J. O’Donnell, Sherif Eltonsy, Dan Chateau, Gillian Hanley, Tim Oberlander, Behrouz Kassai, Sabine Mainbourg, Sasha Bernatsky, Évelyne Vinet, Annie Brodeur-Doucet, Jackie Demers, Philippe Richebé, Valerie Zaphiratos, and Anick Bérard
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Canada ,Adolescent ,Depression ,SARS-CoV-2 ,Health, Toxicology and Mutagenesis ,Public Health, Environmental and Occupational Health ,COVID-19 ,Anxiety ,COVID-19 pandemic ,maternal mental health ,pregnancy ,Edinburgh Perinatal Depression Scale (EPDS) ,Generalized Anxiety Disorders (GAD-7) ,stress ,Mental Health ,Pregnancy ,Communicable Disease Control ,Humans ,Female ,Pandemics - Abstract
The effect of the COVID-19 pandemic on maternal mental health has been described in Canada and China but no study has compared the two countries using the same standardized and validated instruments. In this study, we aimed to evaluate and compare the impact of COVID-19 public health policies on maternal mental health between Canada and China, as we hypothesize that geographical factors and different COVID-19 policies are likely to influence maternal mental health. Pregnant persons >18 years old were recruited in Canada and China using a web-based strategy. All participants recruited between 26 June 2020 and 16 February 2021 were analyzed. Self-reported data included sociodemographic variables, COVID-19 experience and maternal mental health assessments (Edinburgh Perinatal Depression Scale (EPDS), Generalized Anxiety Disorders (GAD-7) scale, stress and satisfaction with life). Analyses were stratified by recruitment cohort, namely: Canada 1 (26 June 2020–10 October 2020), Canada 2 and China (11 October 2020–16 February 2021). Overall, 2423 participants were recruited, with 1804 participants within Canada 1, 135 within Canada 2 and 484 in China. The mean EDPS scores were 8.1 (SD, 5.1) in Canada 1, 8.1 (SD, 5.2) in Canada 2 and 7.7 (SD, 4.9) in China (p-value Canada 2/China: p = 0.005). The mean GAD-7 scores were 2.6 (SD, 2.9) in China, 4.3 (SD, 3.8) in Canada 1 (p < 0.001) and 5.8 (SD, 5.2) in Canada 2 (p < 0.001). When adjusting for stress and anxiety, being part of the Chinese cohort significantly increased the chances of having maternal depression by over threefold (adjusted OR 3.20, 95%CI 1.77–5.78). Canadian and Chinese participants reported depressive scores nearly double those of other crises and non-pandemic periods. Lockdowns and reopening periods have an important impact on levels of depression and anxiety among pregnant persons.
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- 2022
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18. Drug-related risk of hospital readmission in children with chronic diseases, a systematic review
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Elham Jaberi, Behrouz Kassai, Anick Berard, Guillaume Grenet, and Kim An Nguyen
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Pharmacology (medical) - Abstract
Drug-related problems (DRPs) are one of the leading causes of hospital readmissions. Children with chronic diseases are more likely to experience DRPs than adults. The burden and characteristics of drug-related readmissions at and after hospital discharge in children remain unclear.We aimed to summarize the impact of DRPs at and after hospital discharge on the risk of readmissions in children with chronic diseases.We conducted a systematic review searching PubMed from inception until January 2022. Study selection criteria were studies assessing the impact of different factors at discharge and after discharge on the risk of hospital readmissions in children with chronic diseases, reporting an assessment of DRPs. DRP could be the only risk factor assessed or one among others. Included studies were assessed with the Risk of Bias in Non-Randomized Studies - of Exposure (ROBINS-E) tool. We summarized the qualitative impact of the reported DRPs on hospital readmission as conclusive (significant association) or inconclusive.Of the 4734 studies initially identified, 13 met inclusion criteria. Eleven studies were retrospective, using electronic health records. The studies assessed the impact of DRPs at or after discharge according to the type of medication (in 6 studies), number of medication (in 5 studies) and medication nonadherence (in 2 studies). From the 44 reported associations between DRPs and the risk of readmission 26 (59% [95% CI, 43%-73%]) were conclusive, of which 81% increased the risk and 19% decreased the risk, and 17 (39% [95% CI, 24%-55%]) were inconclusive.The impact of DRPs on hospital readmissions in children with chronic diseases displayed conflicting results, estimated associations having potentially a serious risk of bias. We need more evidence with a lower risk of bias.
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- 2022
19. The COVID-19 pandemic impacted maternal mental health differently depending on pregnancy status and trimester of gestation
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Anick Bérard, Jessica Gorgui, Vanina Tchuente, Anaïs Lacasse, Yessica-Haydee Gomez, Sylvana Côté, Suzanne King, Flory Muanda, Yves Mufike, Isabelle Boucoiran, Anne Monique Nuyt, Caroline Quach, Ema Ferreira, Padma Kaul, Brandace Winquist, Kieran J. O’Donnell, Sherif Eltonsy, Dan Chateau, Jin-Ping Zhao, Gillian Hanley, Tim Oberlander, Behrouz Kassai, Sabine Mainbourg, Sasha Bernatsky, Évelyne Vinet, Annie Brodeur-Doucet, Jackie Demers, Philippe Richebé, and Valerie Zaphiratos
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Mental Health ,Pregnancy ,SARS-CoV-2 ,Health, Toxicology and Mutagenesis ,Public Health, Environmental and Occupational Health ,Infant, Newborn ,COVID-19 ,Humans ,Premature Birth ,Female ,COVID-19 pandemic ,maternal mental health ,pregnancy and delivery ,trimester of pregnancy ,Edinburgh Perinatal Depression Scale (EPDS) ,Generalized Anxiety Disorders (GAD-7) ,stress ,Child ,Pandemics - Abstract
Introduction: We aimed to measure the impact of the COVID-19 pandemic on maternal mental health, stratifying on pregnancy status, trimester of gestation, and pandemic period/wave.Methods: Pregnant persons and persons who delivered in Canada during the pandemic, >18 years, were recruited, and data were collected using a web-based strategy. The current analysis includes data on persons enrolled between 06/2020-08/2021. Maternal sociodemographic indicators, mental health measures (Edinburgh Perinatal Depression Scale (EPDS), Generalized Anxiety Disorders (GAD-7), stress) were self-reported. Maternal mental health in pregnant women (stratified by trimester, and pandemic period/wave at recruitment) was compared with mental health of women who had delivered; determinants of severe depression were identified with multivariate logistic regression models.Results: 2,574 persons were pregnant and 626 had already delivered at recruitment. Participants who had delivered had significantly higher mean depressive symptom scores compared to those pregnant at recruitment (9.1 (SD, 5.7) vs. 8.4 (SD, 5.3), p=0.009). Among those who were pregnant at recruitment, depressive symptoms were significantly higher in women recruited in their third trimester, and those recruited during the 2nd wave of the pandemic. Maternal anxiety (aOR 1.51; 95%CI 1.44-1.59) and stress (aOR 1.35; 95%CI 1.24-1.48) were the most significant predictors of severe maternal depression (EDPS˃13) in pregnancy. Conclusion: The COVID-19 pandemic had a significant impact on maternal depression during pregnancy and in the post-partum period. Given that gestational depression/anxiety/stress have been associated with preterm birth and childhood cognitive problems, it is essential to continue following women/children, and develop strategies to reduce COVID-19’s longer-term impact.
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- 2022
20. Preoperative Topical Estrogen Treatment vs Placebo in 244 Children With Midshaft and Posterior Hypospadias
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Daniela Gorduza, Alaa Cheikhelard, Fabrice Pirot, Ségolène Gaillard, Meriem El Jani, Pascal Roy, Pierre Chatelain, Yves Morel, Alaa El Ghoneimi, Behrouz Kassai, Laurent Remontet, Marc-David Leclair, Thomas Blanc, Ingrid Plotton, Pierre Mouriquand, and Yanis Mimouni
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Male ,medicine.medical_specialty ,Urologic Surgical Procedures, Male ,Fistula ,Administration, Topical ,Endocrinology, Diabetes and Metabolism ,Urethroplasty ,medicine.medical_treatment ,Clinical Biochemistry ,030232 urology & nephrology ,Dehiscence ,Lower risk ,Placebo ,Biochemistry ,03 medical and health sciences ,chemistry.chemical_compound ,Postoperative Complications ,0302 clinical medicine ,Endocrinology ,Double-Blind Method ,Internal medicine ,Preoperative Care ,Surgical Wound Dehiscence ,Urethral Diseases ,medicine ,Humans ,Prospective Studies ,Promestriene ,Bone growth ,Hypospadias ,Estradiol ,business.industry ,Biochemistry (medical) ,Infant ,Plastic Surgery Procedures ,medicine.disease ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,chemistry ,030220 oncology & carcinogenesis ,business ,Penis - Abstract
Purpose Urethral fistula and dehiscence are common after hypospadias surgery. Preoperative androgens have been considered to reduce these complications although this consideration is not evidence-based. Dermatologists have reported the benefits of topical estrogens on skin healing. We investigated whether the preoperative use of topical promestriene could reduce healing complications in hypospadias surgery. Our primary objective was to demonstrate a reduction of healing complications with promestriene vs placebo. Impact on reoperations and other complications, clinical tolerance, bone growth, and biological systemic effects of the treatment were also considered. Methods We conducted a prospective, randomized, placebo-controlled, double-blind, parallel group trial between 2011 and 2015 in 4 French centers. One-stage transverse preputial island flap urethroplasty (onlay urethroplasty) was selected for severe hypospadias. Promestriene or placebo was applied on the penis for 2 months prior to surgery. The primary outcome was the presence of postoperative urethral fistula or dehiscence in the first year postsurgery. For safety reasons, hormonal and anatomical screenings were performed. Results Out of 241 patients who received surgery, 122 patients were randomized to receive placebo, and 119 patients received promestriene. The primary outcome was unavailable for 11 patients. Healing complications were assessed at 16.4% (19/116) in the placebo vs 14.9% (17/114) in the promestriene arm, and the odds ratio adjusted on center was 0.93 (95% confidence interval 0.45-1.94), P = 0.86. Conclusions and relevance Although we observed an overall lower risk of complications compared to previous publications, postsurgery complications were not different between promestriene and placebo, because of a lack of power of the study or the inefficacy of promestriene.
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- 2020
21. Sécurité des agents biologiques dans les maladies rhumatismales pédiatriques : étude rétrospective multicentrique en situation réelle dans la base de données JIRcohorte
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Véronique Hentgen, Elvira Cannizzaro, Daniela Kaiser, N. Cabrera, Aurélie Chausset, Jean-Christophe Lega, Anne Maes, Salma Malik, Agnès Duquesne, Isabelle Koné-Paut, Michael Hofer, Gerald Berthet, Anuela Kondi, Samuel Roethlisberger, Andreas Woerner, Cyril Jeanneret, Florence Aeschlimann, Behrouz Kassai, Laetitia Higel, Alexandre Belot, and Carine Wouters
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030203 arthritis & rheumatology ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,030212 general & internal medicine - Abstract
Resume Objectif Analyser et decrire l’incidence des effets indesirables des agents biologiques chez des enfants atteints de maladies inflammatoires, dans une cohorte suivie en situation reelle. Methodes Cette etude observationnelle retrospective multicentrique internationale a evalue, par la methode de Kaplan–Meier, la survenue d’effets indesirables chez des enfants recevant un traitement biologique et suivis dans le reseau JIRcohorte de rhumatologie pediatrique (JIR, Juvenile Inflammatory Rheumatism). Un modele de Cox a ete elabore pour identifier des facteurs predictifs independants d’effets indesirables. Resultats Au total, 813 patients totalisant 3439 patients-annee (p-a) d’agents biologiques ont ete inclus. Le principal diagnostic etait l’arthrite juvenile idiopathique (AJI) (84 %). Au total, 222 patients (27,3 %) ont presente 419 effets indesirables, soit un taux d’incidence de 12,2 pour 100 p-a, IC 95 % [11,0 ; 13,4]. L’incidence globale des effets indesirables graves etait de 3,9 pour 100 p-a, IC 95 % [3,2 ; 4,6]. Le tocilizumab et l’infliximab ont ete associes de maniere significative a des effets indesirables et le canakinumab a des effets indesirables graves. L’analyse univariee et multivariee des effets indesirables et des effets indesirables graves a montre qu’ils etaient plus frequents chez les patients prenant des agents biologiques en association avec des immunosuppresseurs (autres que le methotrexate). Conclusion Cette etude suggere que la securite des agents biologiques est globalement acceptable chez les enfants atteints de maladies rhumatismales inflammatoires traites par des agents biologiques. Cependant, la prescription d’immunosuppresseurs associee cree un risque notable d’effets indesirables.
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- 2020
22. Risque des erreurs médicamenteuses liées au méthotrexate à faible dose : données des centres antipoison et de pharmacovigilance français
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réseau français des centres antipoison et de pharmacovigilance, Anne Marie Patat, Hélène Theophile, Behrouz Kassai, Romain Torrents, Delphine Castellan, Antoine Villa, Thierry Vial, and David Boels
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030203 arthritis & rheumatology ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,030212 general & internal medicine - Abstract
Resume Objectif Cette etude vise a decrire avec precision le contexte de survenue des erreurs medicamenteuses liees au methotrexate, d’en detailler les consequences cliniques et les approches therapeutiques, et de determiner le taux de mortalite lie a ces erreurs. Methodes Les donnees sur les erreurs de medicamenteuses liees au methotrexate ont ete obtenues aupres du reseau francais des centres antipoison et de pharmacovigilance qui recueillent et documentent les effets indesirables ou toxiques des medicaments leur ayant ete notifies. Ont ete inclus les cas ou la dose recue etait plus de deux fois superieure a la dose hebdomadaire prevue ou avec une dose hebdomadaire cumulee ≥ 30 mg et comportant un suivi d’au moins 4 jours apres la derniere dose administree. Les caracteristiques demographiques, l’indication therapeutique, la dose prescrite, les interactions medicamenteuses, les complications cliniques et l’evolution ont ete analysees. Resultats Soixante-quatorze patients ont ete inclus. Les causes d’erreurs etaient dues a une erreur lors du renouvellement de l’ordonnance (23,3 %) ou a la non-observance du schema d’administration hebdomadaire par les patients ou un aidant (56,2 %), ou par un professionnel de sante (20,5 %). Sur les 70 patients ayant pris du methotrexate tous les jours, la dose quotidienne moyenne recue pendant la duree de l’erreur etait de 9,6 ± 4,1 mg (extremes : 2,5 a 22,5) avec une duree moyenne de l’erreur de 11,7 ± 12,2 jours (extremes 2 a 90). Treize (18 %) patients sont restes asymptomatiques et 61 (82 %) ont presente des complications, dont 46 (62,2 %) etaient severes. Neuf patients (14,8 %) sont decedes dans les 11 a 45 jours suivant la premiere erreur de dose. Par rapport aux patients asymptomatiques ou presentant des symptomes mineurs, ceux qui presentaient des symptomes severes etaient plus âges (75,6 ± 10,8 ans vs 69,5 ± 12,9 ans) et avaient ete exposes a une dose cumulee plus elevee (94,8 ± 46,2 mg contre 68,0 ± 45,7 mg). Conclusions Cette etude confirme que les erreurs de posologie du methotrexate peuvent etre fatales et persistent malgre plusieurs mises en garde des agences nationales du medicament. De nouvelles mesures sont attendues de l’Agence europeenne des medicaments.
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- 2019
23. Prevalence and duration of prescribed opioid use during pregnancy: a cohort study from the Quebec Pregnancy Cohort
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Behrouz Kassai, Jin-Ping Zhao, Odile Sheehy, Jessica Gorgui, Christelle Berthod, Anick Bérard, CHU Sainte Justine [Montréal], Université du Québec à Montréal = University of Québec in Montréal (UQAM), Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Centre d'Investigation Clinique [Bron] (CIC1407), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupement Hospitalier Est [Bron], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), This work was supported by the Canadian Institutes of Health Research (CIHR)–CAN‑AIM, and Fonds de la recherche du Québec–Santé (FRQS) ‑ Réseau de recherche sur les médicaments., and Malbec, Odile
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medicine.medical_specialty ,Prescription Drugs ,[SDV]Life Sciences [q-bio] ,Strong opioid morphine, hydromorphone, and oxycodone ,Weak opioid codeine ,Cohort Studies ,Pregnancy ,Prevalence ,medicine ,Humans ,hydromorphone ,Duration of Therapy ,Obstetrics ,business.industry ,Research ,Codeine ,Pregnancy Outcome ,Quebec ,Obstetrics and Gynecology ,Prescribed opioids use during pregnancy ,Gynecology and obstetrics ,Hydromorphone ,medicine.disease ,Duration of opioid treatment ,and oxycodone ,Analgesics, Opioid ,[SDV] Life Sciences [q-bio] ,Opioid ,Cohort ,RG1-991 ,Morphine ,Female ,Pregnant Women ,business ,Oxycodone ,Strong opioid morphine ,medicine.drug ,Cohort study - Abstract
Background Recent studies show a rapid growth among pregnant women using high potency opioids for common pain management during their pregnancy. No study has examined the duration of treatment among strong opioid users and weak opioid users during pregnancy. We aimed to investigate the prevalence of prescribed opioid use during pregnancy, in Quebec; and to compare the duration of opioid treatment between strong opioid users and weak opioid users. Methods Using the Quebec Pregnancy Cohort (1998–2015), we included all pregnancies covered by the Quebec Public Prescription Drug Insurance Program. Opioid exposure was defined as filled at least one prescription for any opioid during pregnancy or before pregnancy but with a duration that overlapped the beginning of pregnancy. Prevalence of opioids use was calculated for all pregnancies, according to pregnancy outcome, trimester of exposure, and individual opioids. The duration of opioid use during pregnancy was analyzed according to 8 categories based on cumulative duration ( Results Of 442,079 eligible pregnancies, 20,921 (4.7%) were exposed to opioids. Among pregnancies ending with deliveries (n = 249,234), 5.4% were exposed to opioids; the prevalence increased by 40.3% from 3.9% in 1998 to 5.5% in 2015, more specifically a significant increase in the second and third trimesters of pregnancy. Weak opioid, codeine was the most commonly dispensed opioid (70% of all dispensed opioids), followed by strong opioid, hydromorphone (11%), morphine (10%), and oxycodone (5%). The prevalence of codeine use decreased by 47% from 4.3% in 2005 to 2.3% in 2015, accompanied by an increased use of strong opioid, morphine (0.029 to 1.41%), hydromorphone (0.115 to 1.08%) and oxycodone (0.022 to 0.44%), from 1998 to 2015. The average durations of opioid exposure were significantly longer among pregnancies exposed to strong opioid as compared to weak opioid regardless of the cumulative duration or duration of action (P Conclusions Given the differences in the safety profile between strong opioids and the major weak opioid codeine, the increased use of strong opioids during pregnancy with longer treatment duration raises public health concerns.
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- 2021
24. Agreement between a regional pharmacovigilance centre and an adjudication committee regarding adverse drug reactions on a cohort of hospitalised children
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Nicolas Pages, Anissa Bounabi, Inesse Boussaha, Marietou Ndiaye, Aurélie Portefaix, Gaelle Simeon, Claire Guy, Jean Stagnara, Nathalie Paret, Thierry Vial, Pirayeh Eftekhari, Daniel Floret, Vincent Gajdos, Jean-Paul Langhendries, Nathalie Bleyzac, Corinne Alberti, Evelyne Jacqz-Aigrain, Kim An Nguyen, and Behrouz Kassai
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Cohort Studies ,Pharmacovigilance ,Drug-Related Side Effects and Adverse Reactions ,Adverse Drug Reaction Reporting Systems ,Humans ,Pharmacology (medical) ,Child ,Child, Hospitalized - Abstract
The EREMI project was set up to collect data on adverse drug reactions (ADRs) occurring due to off-label and/or unlicensed drugs prescribed to hospitalised children in France. These events were evaluated by a regional pharmacovigilance centre (RPC) and an adjudication committee (AC). The aim of this study was to assess the agreement between these two different entities on their evaluation of ADRs.The RPC first validated the ADRs and assessed their causality using the Naranjo scale. The AC assessed then ADRs using all available information, including the RPC evaluation. The agreement on severity and nature of ADRs, role of treatment (suspect or concomitant) and drug causality was calculated using Cohen's nonparametric kappa coefficient (k).Three hundred and eighty-six events were reported in 219 children. The RPC excluded 65 events and validated 321 ADRs. Agreement was very good on nature of ADRs (k=0.85) and role of treatment (k=0.81), moderate on severity of ADRs (k=0.60) and very poor on drug causality (k=0.05).Agreement between the RPC and the AC was not constant throughout this evaluation. They troubled to agree on severe ADRs and on drug causality.
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- 2021
25. Replacing liquid with solid dosage forms in pediatric practice: Feasibility and economic impact from a hospital-based study
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Rama Arab, Behrouz Kassai, Roubi Kilo, Catherine Cornu, Elisabete Gomes, and Tristan Dagonneau
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Pharmaceutical Preparations ,Administration, Oral ,Feasibility Studies ,Humans ,Pharmacology (medical) ,Child ,Hospitals ,Acetaminophen - Abstract
To identify the 10 drugs most frequently administered to children in liquid dosage forms which are eligible for replacement with suitable authorized solid dosage forms and to assess the expected economic impact of this substitution.The health record data from 312,152 oral drug administrations were analyzed. Ten drugs were selected according to their frequency of administration in liquid dosage forms, the availability of solid form alternatives, and the suitability of these alternatives for the children receiving the corresponding liquid forms. Potential hospital cost savings of the suggested substitutions were calculated.The 10 drugs identified as most frequently administered and for which suitable solid forms were available were: paracetamol, cyamemazine, valproic acid, clonazepam, furosemide, prazepam, hydroxyzine, alfacalcidol, amitriptyline, and levetiracetam. Thirty-four point six of the administrations of these drugs in liquid dosage forms could be delivered using suitable solid dosage forms without additional cost.Opportunities exist for substituting liquid dosage forms with market-available solid dosage forms suitable in size and dosage for the pediatric population.
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- 2021
26. Polyclonal expansion of TCR Vb 21.3 + CD4 + and CD8 + T cells is a hallmark of multisystem inflammatory syndrome in children
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Olivier Dauwalder, David Klatzmann, Marie Duperril, Marion Moreews, Christine Lombard, Behrouz Kassai, Fanny Bajolle, Jean-Laurent Casanova, Anne-Laure Mathieu, Guillaume Monneret, Magali Perret, Rémi Pescarmona, Aurélie Portefaix, Jacqueline Marvel, Laurent Abel, Christophe Malcus, Tiphaine Louazon, Anne Moulin-Zinsch, Mehdi Mezidi, Lisa Giovannini-Chami, Omran Allatif, Hugues Patural, Thierry Walzer, Emilie Chopin, Francois Vandenesh, Encarnita Mariotti-Ferrandiz, Fabienne Venet, Céline Dupieux, Valérie Launay, Paul Bastard, Sophie Trouillet-Assant, Jean-Christophe Richard, Olivier Thaunat, Shen-Ying Zhang, Marine Villard, Samira Khaldi-Plassart, Kahina Saker, Alexandre Belot, Sophia Djebali, Marlène Dreux, Alicia Bellomo, Isabelle Rouvet, Robin Pouyau, Etienne Javouhey, Margaux Guerder, Sonia Teyssedre, Valérie Dubois, Kenz Le Gouge, Hugues Flodrops, Jean-Marie De Guillebon, Centre International de Recherche en Infectiologie - UMR (CIRI), Institut National de la Santé et de la Recherche Médicale (INSERM)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), Equipe de Statistique Appliquée (UMRS 1158) (ESA), Ecole Superieure de Physique et de Chimie Industrielles de la Ville de Paris (ESPCI Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Neurophysiologie Respiratoire Expérimentale et Clinique, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Hospices Civils de Lyon (HCL), Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l’enfant / National Referee Centre for Rheumatic and AutoImmune and Systemic Diseases in Children [Lyon] (RAISE), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hôpital Edouard Herriot [CHU - HCL], Physiopathologie de l'immunodépression associée aux réponses inflammatoires systémiques - EA 7426 (PI3), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Centre National de Reference des Staphylocoques, Université de Lyon, Centre hospitalier de Valence, Hôpital Louis Pradel [CHU - HCL], Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), INSERM U1059, SAINBIOSE - Santé, Ingénierie, Biologie, Saint-Etienne (SAINBIOSE-ENSMSE), Centre Ingénierie et Santé (CIS-ENSMSE), École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpitaux Pédiatriques de Nice Lenval (CHU-Lenval), Centre Hospitalier Universitaire de Nice (CHU Nice), Université Côte d'Azur (UCA), CIC CHU Lyon (inserm), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de La Réunion (CHU La Réunion), CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Imagine - Institut des maladies génétiques (IHU) (Imagine - U1163), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Rockefeller University [New York], Etablissement français du sang - Auvergne-Rhône-Alpes (EFS), Hôpital de la Croix-Rousse [CHU - HCL], Howard Hughes Medical Institute [Boston] (HHMI), Howard Hughes Medical Institute (HHMI)-Harvard Medical School [Boston] (HMS), Departement Hospitalo- Universitaire - Inflammation, Immunopathologie, Biothérapie [Paris] (DHU - I2B), 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)-Université Pierre et Marie Curie - Paris 6 (UPMC), Centre International de Recherche en Infectiologie (CIRI), École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Immunologie - Immunopathologie - Immunothérapie [CHU Pitié Salpêtrière] (I3), CHU Charles Foix [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)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Physiopathologie de l'immunodépression associée aux réponses inflammatoires systémiques / Pathophysiology of Injury-induced Immunosuppression (PI3), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Santé Ingénierie Biologie Saint-Etienne (SAINBIOSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Modeling & analysis for medical imaging and Diagnosis (MYRIAD), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), ANR-16-RHUS-0001,iMAP,iMAP(2016), Référent HAL, CIRI, École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université Pierre et Marie Curie - Paris 6 (UPMC)-CHU Pitié-Salpêtrière [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
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0301 basic medicine ,T cell ,[SDV]Life Sciences [q-bio] ,Immunology ,T-cell receptor ,Toxic shock syndrome ,General Medicine ,Human leukocyte antigen ,Biology ,medicine.disease ,3. Good health ,[SDV] Life Sciences [q-bio] ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,medicine.anatomical_structure ,Antigen ,medicine ,Cytotoxic T cell ,030212 general & internal medicine ,Cytokine storm ,CD8 - Abstract
International audience; Multisystem inflammatory syndrome in children (MIS-C) is a delayed and severe complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that strikes previously healthy children. As MIS-C combines clinical features of Kawasaki disease (KD) and toxic shock syndrome (TSS), we aimed to compare the immunological profile of pediatric patients with these different conditions. We analyzed blood cytokine expression and the T cell repertoire and phenotype in 36 MIS-C cases, which were compared with 16 KD, 58 TSS, and 42 coronavirus disease 2019 (COVID-19) cases. We observed an increase of serum inflammatory cytokines (IL-6, IL-10, IL-18, TNF-α, IFN-γ, sCD25, MCP1, and IL-1RA) in MIS-C, TSS, and KD, contrasting with low expression of HLA-DR in monocytes. We detected a specific expansion of activated T cells expressing the Vβ21.3 T cell receptor β chain variable region in both CD4 and CD8 subsets in 75% of patients with MIS-C and not in any patient with TSS, KD, or acute COVID-19; this correlated with the cytokine storm detected. The T cell repertoire returned to baseline within weeks after MIS-C resolution. Vβ21.3 + T cells from patients with MIS-C expressed high levels of HLA-DR, CD38, and CX3CR1 but had weak responses to SARS-CoV-2 peptides in vitro. Consistently, the T cell expansion was not associated with specific classical HLA alleles. Thus, our data suggested that MIS-C is characterized by a polyclonal Vβ21.3 T cell expansion not directed against SARS-CoV-2 antigenic peptides, which is not seen in KD, TSS, and acute COVID-19.
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- 2021
27. Safety of biological agents in paediatric rheumatic diseases: A real-life multicenter retrospective study using the JIRcohorte database
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Véronique Hentgen, Daniela Kaiser, Elvira Cannizzaro, Michael Hofer, Anne Maes, Salma Malik, Gerald Berthet, Carine Wouters, Behrouz Kassai, Anuela Kondi, Andreas Woerner, Agnès Duquesne, Aurélie Chausset, Isabelle Koné-Paut, Natalia Cabrera, Samuel Roethlisberger, Cyril Jeanneret, Florence Aeschlimann, Jean-Christophe Lega, Alexandre Belot, Laetitia Higel, University of Zurich, and Cabrera, Natalia
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Male ,Internationality ,Databases, Factual ,2745 Rheumatology ,Kaplan-Meier Estimate ,Etanercept ,Arthritis, Rheumatoid ,Cohort Studies ,paediatric rheumatology ,Biological Factors ,chemistry.chemical_compound ,Range of Motion, Articular ,Child ,Pain Measurement ,Incidence (epidemiology) ,Prognosis ,Treatment Outcome ,Antirheumatic Agents ,Child, Preschool ,Cohort ,Female ,JIRcohorte ,medicine.drug ,Cohort study ,medicine.medical_specialty ,Adolescent ,610 Medicine & health ,Antibodies, Monoclonal, Humanized ,Risk Assessment ,Abatacept ,Biological agents ,Tocilizumab ,Rheumatology ,Internal medicine ,medicine ,Humans ,Adverse effect ,Proportional Hazards Models ,Retrospective Studies ,business.industry ,Retrospective cohort study ,Arthritis, Juvenile ,Infliximab ,adverse events ,Canakinumab ,chemistry ,10036 Medical Clinic ,serious adverse events ,Multivariate Analysis ,juvenile idiopathic arthritis ,business - Abstract
OBJECTIVE: To analyse and report the incidence of side effects of biological agents in paediatric patients with inflammatory diseases using of real-life follow-up cohort. METHODS: In this international, observational, retrospective, multicentre study of children treated by biological agents and followed in the Juvenile Inflammatory Rheumatism (JIR) cohort (JIRcohorte) network, a Kaplan-Meier method was used to estimate the occurrence of adverse events. A Cox model was constructed to identify independent predictors of adverse events. RESULTS: Overall 813 patients totalling 3439 patients-year (PY) of biological agents were included. The main diagnosis was juvenile idiopathic arthritis (84%). A total of 222 patients (27.3%) had 419 adverse events, representing an incidence rate of 12.2 per 100 PY 95% CI [11.0; 13.4]. The overall incidence rate of serious adverse events was 3.9 per 100 PY 95% CI [3.2; 4.6]. Tocilizumab and infliximab were significantly associated with adverse events and canakinumab with serious adverse events. Univariate and multivariable analysis of adverse events and serious adverse events indicated that patients under biological agents with concomitant immunosuppressive drugs (excluding methotrexate) suffered from more of these events. CONCLUSION: This study suggests an overall an acceptable safety of biologic agents in children with inflammatory rheumatic diseases treated with biological agents. However, the concomitant prescription of immunosuppressive drugs with biological agents represents a substantial risk of adverse events. ispartof: JOINT BONE SPINE vol:86 issue:3 pages:343-350 ispartof: location:France status: published
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- 2019
28. Risperidone medication errors in children: an analysis of French poison centres data
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Antoine Villa, Nathalie Paret, Behrouz Kassai, Patrick Nisse, A.-M. Patat, Thierry Vial, Romain Torrents, and David Boels
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Male ,medicine.medical_specialty ,Poison Control Centers ,Sleepiness ,Injury control ,Accident prevention ,Poison control ,Toxicology ,Risk Assessment ,Suicide prevention ,Occupational safety and health ,03 medical and health sciences ,0302 clinical medicine ,Basal Ganglia Diseases ,Injury prevention ,medicine ,Humans ,Medication Errors ,030212 general & internal medicine ,Child ,Retrospective Studies ,Risperidone ,Dose-Response Relationship, Drug ,business.industry ,Age Factors ,Infant ,Human factors and ergonomics ,030208 emergency & critical care medicine ,General Medicine ,Prognosis ,Child, Preschool ,Emergency medicine ,Female ,France ,business ,Antipsychotic Agents ,medicine.drug - Abstract
To describe clinical consequences of risperidone medication errors in children of less than 13 years and to estimate a clinically relevant toxic dose.All cases of risperidone medication errors managed by French Poison Centres from 2001 to 2012 were analyzed. Inclusion criteria were a delay of at least 2 hours between ingestion and request to the FPC in asymptomatic children, an ingested dose above two-fold the maximal daily dose for children above 5 years or any symptomatic patient at the time of first contact.One hundred and sixty cases met our criteria. Median age was 8 years (range 0.9-12) and 28.1% were aged 5 years or less. Causes of the error were an incorrect dose in treated children (84.2%) or a dose given to a wrong child (15.8%). The median ingested dose was 0.1 mg/kg or 3.3-fold the maximum recommended dose. Overall, 59 children had no symptoms, 95 experienced minor symptoms and six moderate symptoms. Somnolence/sedation was the most common (73.3%). Of the 17 children who developed extrapyramidal disorders, all had minor or moderate symptoms and only five required a symptomatic treatment.Risperidone medication errors in children cause minimal effects. Somnolence and mild to moderate extrapyramidal reactions were the main features of toxicity, and significant cardiac or other neurological features were not observed. No case with severe toxicity was noted. At home surveillance can be proposed for children exposed to a dose ≤0.15 mg/kg.
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- 2018
29. Polyclonal expansion of TCR Vbeta 21.3
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Marion, Moreews, Kenz, Le Gouge, Samira, Khaldi-Plassart, Rémi, Pescarmona, Anne-Laure, Mathieu, Christophe, Malcus, Sophia, Djebali, Alicia, Bellomo, Olivier, Dauwalder, Magali, Perret, Marine, Villard, Emilie, Chopin, Isabelle, Rouvet, Francois, Vandenesh, Céline, Dupieux, Robin, Pouyau, Sonia, Teyssedre, Margaux, Guerder, Tiphaine, Louazon, Anne, Moulin-Zinsch, Marie, Duperril, Hugues, Patural, Lisa, Giovannini-Chami, Aurélie, Portefaix, Behrouz, Kassai, Fabienne, Venet, Guillaume, Monneret, Christine, Lombard, Hugues, Flodrops, Jean-Marie, De Guillebon, Fanny, Bajolle, Valérie, Launay, Paul, Bastard, Shen-Ying, Zhang, Valérie, Dubois, Olivier, Thaunat, Jean-Christophe, Richard, Mehdi, Mezidi, Omran, Allatif, Kahina, Saker, Marlène, Dreux, Laurent, Abel, Jean-Laurent, Casanova, Jacqueline, Marvel, Sophie, Trouillet-Assant, David, Klatzmann, Thierry, Walzer, Encarnita, Mariotti-Ferrandiz, Etienne, Javouhey, and Alexandre, Belot
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Adult ,CD4-Positive T-Lymphocytes ,SARS-CoV-2 ,Child, Preschool ,Receptors, Antigen, T-Cell, alpha-beta ,COVID-19 ,Cytokines ,Humans ,HLA-DR Antigens ,CD8-Positive T-Lymphocytes ,Child ,Lymphocyte Activation ,Systemic Inflammatory Response Syndrome - Abstract
Multiple Inflammatory Syndrome in Children (MIS-C) is a delayed and severe complication of SARS-CoV-2 infection that strikes previously healthy children. As MIS-C combines clinical features of Kawasaki disease and Toxic Shock Syndrome (TSS), we aimed to compare the immunological profile of pediatric patients with these different conditions. We analyzed blood cytokine expression, and the T cell repertoire and phenotype in 36 MIS-C cases, which were compared to 16 KD, 58 TSS, and 42 COVID-19 cases. We observed an increase of serum inflammatory cytokines (IL-6, IL-10, IL-18, TNF-α, IFNγ, CD25s, MCP1, IL-1RA) in MIS-C, TSS and KD, contrasting with low expression of HLA-DR in monocytes. We detected a specific expansion of activated T cells expressing the Vβ21.3 T cell receptor β chain variable region in both CD4 and CD8 subsets in 75% of MIS-C patients and not in any patient with TSS, KD, or acute COVID-19; this correlated with the cytokine storm detected. The T cell repertoire returned to baseline within weeks after MIS-C resolution. Vβ21.3+ T cells from MIS-C patients expressed high levels of HLA-DR, CD38 and CX3CR1 but had weak responses to SARS-CoV-2 peptides in vitro
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- 2021
30. Superantigenic TCR Vbeta 21.3 signature in Multisystem Inflammatory Syndrome in Children
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Encarnita Mariotti-Ferrandiz, Marlène Dreux, Kenz Le Gouge, Aurélie Portefaix, Anne-Moulin-Zinsch, Alexandre Belot, Emilie Chopin, Marie Duperril, Marion Moreews, Hugues Patural, Thierry Walzer, Jean-Christophe Richard, Anne-Laure Mathieu, Robin Pouyau, Etienne Javouhey, Olivier Thaunat, Valérie Dubois, Hugues Flodrops, Behrouz Kassai, Marine Villard, Alicia Bellomo, Laurent Abel, Fabienne Venet, Samira Khaldi-Plassart, Sophia Djebali, David Klatzmann, Jacqueline Marvel, Sonia Teyssedre, Céline Dupieux, Tiphaine Louazon, Lisa Giovannini-Chami, Sophie Trouillet-Assant, Christine Lombard, Francois Vandenesh, Mehdi Mezidi, Shen-Ying Zhang, Guillaume Monneret, Jean-Laurent Casanova, Magali Perret, Rémi Pescarmona, Margaux Guerder, Paul Bastard, Christophe Malcus, and Isabelle Rouvet
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business.industry ,medicine.medical_treatment ,T cell ,Toxic shock syndrome ,medicine.disease ,Cytokine release syndrome ,Cytokine ,medicine.anatomical_structure ,Immune system ,Immunology ,medicine ,Cytotoxic T cell ,Interferon gamma ,business ,CD8 ,medicine.drug - Abstract
ObjectivesMultiple Inflammatory Syndrome in Children (MIS-C) is the most severe pediatric form of COVID-19 and occurs in previously healthy children. MIS-C combines features of Kawasaki disease and Toxic Shock Syndrome (TSS).MethodsChildren with suspected MIS-C were included within the first week of diagnosis and a large scale immunoassay was performed to determein the immunologic signature of these patients.ResultsWe characterized the immunological profile of 27 MIS-C cases in comparison with 4 KD and 4 TSS cases. Similarly to TSS, an increase of serum inflammatory cytokines (IL-6, TNF-a, CD25s) was observed in MIS-C contrasting with low expression of HLA-DR monocytes, a feature often associated with immune paralysis. Expansions of T cells expressing the Vβ21.3 T cell receptor β chain variable region were detected in both CD4 and CD8 subsets in almost 50% of patients and Vβ21.3-positive T cells expressed high level of HLA-DR highlighting their specific activation. TCR sequencing uncovered the polyclonal nature of the Vβ 21.3+ population. SARS-CoV2 antigene-specific production of interferon gamma in T cells was not increased in MIS-C T cells compared to COVID-19 patients suggesting the antigen-specific immune response in MIS-C patients is not pivotal to the manifestation.ConclusionsOur findings argue in favor of a strong activation of the immune system related to a superantigenic immune response in MIS-C with a specific polyclonal Vβ21.3 T cell expansion.Key messagesWhat is already known about this subject ?MIS-C occurs 3-5 weeks after acute SARS-CoV2 infection and overlap features of Toxic Shock syndrome and Kawasaki disease.MIS-C appears different in term of cytokine and autoantibodies generation from KD with subtle signs of T cells activationWhat does this study add?This study demonstrates that Vβ21.3+ CD4 and CD8 T cells are highly increased in about 50% of MIS-C and distinctive of the Vβ2+ expansion observed in toxic shock syndrome in This reflects a specific T cell activation and cytokine release syndrome similar to toxic shock syndromeHow mich this impact on clinical practice or future developments?Vβ21.3+ signature can be available on a short term basis by flowcytometry and represents a signature of the MIS-C.As for TSS, immunomodulating therapies may revert the superantigenic activation and resolve this life threatening pediatric condition.
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- 2021
31. Protocol of controlled odorant stimulation for reducing apnoeic episodes in premature newborns: a randomised open-label Latin-square study with independent evaluation of the main endpoint (PREMODEUR)
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Olivier Claris, Marc Thevenet, Delphine Maucort-Boulch, Jean Iwaz, Huu Kim Nguyen, Sonia Galletti, Patricia Duchamp-Viret, Patricia Franco, Franck Plaisant, Aurore Guyon, Elise Cornaton, Hélène Gauthier-Moulinier, Laurent Remontet, Behrouz Kassai, Andrei Cividjian, Centre de recherche en neurosciences de Lyon - Lyon Neuroscience Research Center (CRNL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Femme Mère Enfant [CHU - HCL] (HFME), Hospices Civils de Lyon (HCL), Université de Lyon, Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Hôpital de la Croix-Rousse [CHU - HCL], Viret, Patricia, Centre de recherche en neurosciences de Lyon (CRNL), and Université de Lyon-Université de Lyon-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
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Tachycardia ,Olfactory system ,medicine.medical_specialty ,Pediatrics ,Apnea ,Infant, Premature, Diseases ,Irritability ,neonatology ,Sleep medicine ,[SDV.MHEP.PED] Life Sciences [q-bio]/Human health and pathology/Pediatrics ,Intensive Care Units, Neonatal ,Intensive care ,neonatal intensive & critical care ,medicine ,Humans ,[SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] ,Neonatology ,Risk factor ,Child ,Randomized Controlled Trials as Topic ,[SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics ,business.industry ,paediatric intensive & critical care ,sleep medicine ,Infant, Newborn ,Infant ,Paediatrics ,General Medicine ,Doxapram ,Odorants ,Medicine ,[SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] ,neurophysiology ,medicine.symptom ,business ,Infant, Premature ,medicine.drug - Abstract
Introduction Apnoea affects 85% of premature infants under 34 weeks of age and would be an important risk factor for subsequent neuropsychological disorders. Currently, premature children with life-threatening apnoeas receive stimulants such as methylxanthines (mainly, caffeine) or doxapram (an analeptic unlicensed in children under 15). However, these products have undesirable effects (hyperarousal, irritability, sleep disorders, tachycardia) and are not always effective because apnoea does persist in some premature newborns. Previous studies have indicated that odorant stimulation, a non-invasive intervention, may stimulate the respiratory rhythm. The objective of the present protocol is to reduce the occurrence of apnoeic episodes in premature newborns by controlled odorant stimulation added to current pharmacological treatments. Methods and analysis The project is a randomised open-label Latin-square trial with independent evaluation of the main endpoint. It will include 60 preterm neonates from two university hospital neonatal intensive care units over 2 years (2021–2023). Each newborn will receive no (S0), sham (S1) or real olfactory stimulation (S2) in random order. During S2, three distinct odorants (mint, grapefruit and vanilla) will be delivered successively, in puffs, over 24 hours. Mint and grapefruit odours stimulate the main and the trigeminal olfactory pathways, whereas vanilla odour stimulates only the main olfactory pathway. A statistical analysis will compare the incidence of apnoeic episodes during S1 versus S2 using a mixed effects Poisson model. Ethics and dissemination Ethical approval was obtained from the Comité de Protection des Personnes Île-de-France XI (# 2017-AO13-50-53). The results will be disseminated through various scientific meetings, specialised peer-reviewed journals and, whenever possible, posted on appropriate public websites. Trial registration number NCT02851979; Pre-results.
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- 2021
32. Available medications used as potential therapeutics for COVID-19: What are the known safety profiles in pregnancy
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Behrouz Kassai, Odile Sheehy, Caroline Quach, Evelyne Vinet, Sasha Bernatsky, Jin Ping Zhao, and Anick Bérard
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RNA viruses ,Viral Diseases ,Epidemiology ,Physiology ,Maternal Health ,Blood Pressure ,030204 cardiovascular system & hematology ,Pathology and Laboratory Medicine ,Vascular Medicine ,Cohort Studies ,0302 clinical medicine ,Medical Conditions ,Immunodeficiency Viruses ,Pregnancy ,Risk Factors ,Medicine and Health Sciences ,Birth Weight ,030212 general & internal medicine ,education.field_of_study ,Multidisciplinary ,Obstetrics ,Pregnancy Outcome ,Quebec ,Obstetrics and Gynecology ,Hematology ,Infectious Diseases ,Physiological Parameters ,Premature birth ,Medical Microbiology ,Viral Pathogens ,Cohort ,Infant, Small for Gestational Age ,Viruses ,Hypertension ,Medicine ,Premature Birth ,Female ,medicine.symptom ,Pathogens ,Live birth ,Live Birth ,Cohort study ,Research Article ,Adult ,medicine.medical_specialty ,Science ,Population ,Immunology ,Antiviral Agents ,Microbiology ,03 medical and health sciences ,Hypertensive Disorders in Pregnancy ,Retroviruses ,medicine ,Humans ,education ,Microbial Pathogens ,business.industry ,SARS-CoV-2 ,Lentivirus ,Body Weight ,Drug Repositioning ,Infant, Newborn ,Organisms ,Biology and Life Sciences ,HIV ,Covid 19 ,Infant, Low Birth Weight ,medicine.disease ,COVID-19 Drug Treatment ,Low birth weight ,Medical Risk Factors ,Small for gestational age ,Women's Health ,business - Abstract
Background Medications already available to treat other conditions are presently being studied in clinical trials as potential treatments for COVID-19. Given that pregnant women are excluded from these trials, we aimed to investigate their safety when used during pregnancy within a unique population source. Methods Using the population-based Quebec Pregnancy Cohort, we identified women who delivered a singleton liveborn (1998–2015). Taking potential confounders into account including indications for use, the risk of prematurity, low birth weight (LBW), small for gestational age (SGA), and major congenital malformation (MCM) associated with COVID-19 repurposed drug use during pregnancy were quantified using generalized estimation equations. Results Of the 231,075 eligible pregnancies, 107 were exposed to dexamethasone (0.05%), 31 to interferons (0.01%), 1,398 to heparins (0.60%), 24 to angiotensin-receptor blockers (ARB) (0.01%), 182 to chloroquine (0.08%), 103 to hydroxychloroquine (0.05%), 6,206 to azithromycin (2.70%), 230 to oseltamivir (0.10%), and 114 to HIV medications (0.05%). Adjusting for potential confounders, we observed an increased risk of prematurity related to dexamethasone (aOR 1.92, 95%CI 1.11–3.33; 15 exposed cases), anti-thrombotics (aOR 1.58, 95%CI 1.31–1.91; 177 exposed cases), and HIV medications (aOR 2.04, 95%CI 1.01–4.11; 20 exposed cases) use. An increased risk for LBW associated with anti-thrombotics (aOR 1.72, 95%CI 1.41–2.11; 152 exposed cases), and HIV medications (aOR 2.48, 95%CI 1.25–4.90; 21 exposed cases) use were also found. Gestational exposure to anti-thrombotics (aOR 1.20, 95%CI 1.00–1.44; 176 exposed cases), and HIV medications (aOR 2.61, 95%CI 1.51–4.51; 30 exposed cases) were associated with SGA. First-trimester dexamethasone (aOR 1.66, 95%CI 1.02–2.69; 20 exposed cases) and azithromycin (aOR 1.10, 95%CI 1.02–1.19; 747 exposed cases) exposures were associated with MCM. Conclusions Many available medications considered as treatments for COVID-19 are associated with adverse pregnancy outcomes. Caution is warranted when considering these medications during the gestational period.
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- 2020
33. Relationship between adverse drug reactions and unlicensed/off-label drug use in hospitalized children (EREMI): A study protocol
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Nathalie Paret, Yanis Mimouni, Behrouz Kassai, Elham Jaberi, Nadine Bossard, Inesse Boussaha, Laurent Roche, Corinne Alberti, K.A. Nguyen, Laurent Remontet, Laure Guittard, Evelyne Jacqz-Aigrain, and Thierry Vial
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Drug ,Drug-Related Side Effects and Adverse Reactions ,media_common.quotation_subject ,Off-label use ,030226 pharmacology & pharmacy ,03 medical and health sciences ,Pharmacovigilance ,0302 clinical medicine ,Medicine ,Adverse Drug Reaction Reporting Systems ,Humans ,Multicenter Studies as Topic ,Pharmacology (medical) ,Prospective Studies ,Medical prescription ,Adverse effect ,Prospective cohort study ,Child ,media_common ,Drug Labeling ,business.industry ,Medical record ,Off-Label Use ,medicine.disease ,Observational Studies as Topic ,Pharmaceutical Preparations ,Observational study ,Medical emergency ,business ,Child, Hospitalized - Abstract
Summary Introduction To date, few studies have shown a significant association between off-label drug use and adverse drug reactions (ADRs). The main aims of this study is to evaluate the relationship between adverse drug reactions and unlicensed or off-label drugs in hospitalized children and to provide more information on prescribing practice, the amplitude, consequences of unlicensed or off-label drug use in pediatric inpatients. Methods In this multicenter prospective study started from 2013, we use the French summaries of product characteristics in Theriaque (a prescription products guide) as a primary reference source for determining pediatric drug labeling. The detection of ADRs is carried out spontaneously by health professionals and actively by research groups using a trigger tool and patients’ electronic health records. The causality between suspected ADRs and medication is evaluated using the Naranjo and the French methods of imputability independently by pharmacovigilance center. All suspected ADRs are submitted for a second evaluation by an independent pharmacovigilance experts. Strength and limitations of this study For our best knowledge, EREMI is the first large multicenter prospective and objective study in France with an active ADRs monitoring and independent ADRs validation. This study identifies the risk factors that could be used to adjust preventive actions in children's care, guides future research in the field and increases the awareness of physicians in off-label drug use and in detecting and declaring ADRs. As data are obtained through extraction of information from hospital database and medical records, there is likely to be some under-reporting of items or missing data. In this study the field specialists detect all adverse events, experts in pharmacovigilance centers assess them and finally only the ADRs assessed by the independent committee are confirmed. Although we recruit a high number of patients, this observational study is subject to different confounders.
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- 2020
34. Efficacy and safety of topiramate in binge eating disorder: a systematic review and meta-analysis
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Sylvain Iceta, Guillaume Grenet, Benjamin Rolland, Lucie Jurek, Behrouz Kassai, Michel Cucherat, Mikail Nourredine, Marine Auffret, Centre Hospitalier le Vinatier [Bron], Hospices Civils de Lyon (HCL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Comportement et noyaux gris centraux = Behavior and Basal Ganglia [Rennes], Université de Rennes (UR)-Université européenne de Bretagne - European University of Brittany (UEB)-CHU Pontchaillou [Rennes]-Institut des Neurosciences Cliniques de Rennes = Institute of Clinical Neurosciences of Rennes (INCR), Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Université Laval [Québec] (ULaval), Centre de recherche en neurosciences de Lyon - Lyon Neuroscience Research Center (CRNL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), CHU Pontchaillou [Rennes]-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Université européenne de Bretagne - European University of Brittany (UEB)-Institut des Neurosciences Cliniques de Rennes (INCR), Centre de recherche en neurosciences de Lyon (CRNL), Université de Lyon-Université de Lyon-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Rennes (UR)-Université européenne de Bretagne - European University of Brittany (UEB)-CHU Pontchaillou [Rennes]-Institut des Neurosciences Cliniques de Rennes (INCR), and CarMeN, laboratoire
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Topiramate ,medicine.medical_specialty ,[SDV]Life Sciences [q-bio] ,02 engineering and technology ,Placebo ,law.invention ,03 medical and health sciences ,020210 optoelectronics & photonics ,0302 clinical medicine ,Randomized controlled trial ,binge eating ,systematic review ,Binge-eating disorder ,law ,Internal medicine ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,Humans ,Hypoglycemic Agents ,Bulimia ,Clinical Trials as Topic ,Binge eating ,business.industry ,disorder ,medicine.disease ,Confidence interval ,3. Good health ,[SDV] Life Sciences [q-bio] ,meta-analysis ,Psychiatry and Mental health ,Anti-Anxiety Agents ,Relative risk ,Meta-analysis ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
BackgroundTo assess the efficacy and safety of topiramate in treating binge eating disorder (BED), using a systematic review and meta-analysis of the available randomized clinical trials (RCTs).MethodsThe RCTs assessing topiramate vs placebo with or without adjunctive psychotherapy in BED were reviewed using a systematic search in the PubMed, Web of Science, PsycINFO, Cochrane Database of Systematic Review, and ClinicalTrials.gov search Websites, from inception to November 2019. Main outcomes were the changes in binge frequency, quality of life, and weight, respectively. Effect estimates were pooled using random-effect models and presented as risk ratios (RRs) or mean differences (MDs) and their 95% confidence interval (95% CI). Data extraction was performed by two independent reviewers.ResultsThree studies were eligible for inclusion, involving 528 BED patients. Topiramate was found to be significantly more efficacious than placebo in reducing: (a) the number of binge episodes per week (MD = −1.31; 95% CI = −2.58 to −0.03; I2 = 94%); (b) the number of binge days per week (MD = −0.98; 95% CI = −1.80 to −0.16; I2 = 94%); and (c) weight (MD = −4.91 kg; 95% CI = −6.42 to −3.41; I2 = 10%). However, participants in the topiramate groups withdrew significantly more frequently for safety reasons, relative to placebo participants (RR = 1.90; 95% CI = 1.13-3.18, I2 = 0%).ConclusionsPreliminary findings support a possible efficacy of topiramate for the treatment of BED, even if safety concerns could limit the practical use of this treatment in BED subjects.
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- 2020
35. Adherence to cysteamine in nephropathic cystinosis: A unique electronic monitoring experience for a better understanding. A prospective cohort study: CrYSTobs
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Christine Vianey-Saban, Pierre Cochat, Fabien Subtil, Ségolène Gaillard, Eurielle Bodénan, Denis Morin, Cécile Acquaviva-Bourdain, Patrice Nony, Aurélia Bertholet-Thomas, Cécile Rouges, Georges Deschênes, Justine Bacchetta, Valérie Laudy, Setareh Zarrabian, Sandrine Lemoine, Behrouz Kassai, Bruno Ranchin, Laurent Roche, Catherine Mercier, CarMeN, laboratoire, Centre d'Investigation Clinique [Bron] (CIC1407), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupement Hospitalier Est [Bron], Hospices Civils de Lyon (HCL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Hôpital Edouard Herriot [CHU - HCL], Hôpital Robert Debré, CHU Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre de référence des maladies rénales rares Néphrogones [CHU-HCL, Lyon], Hôpital Femme Mère Enfant [CHU - HCL] (HFME), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), CIC Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Saint Eloi (CHRU Montpellier), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique 1426 (CIC 1426), Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-CHU Saint-Eloi-Institut National de la Santé et de la Recherche Médicale (INSERM)
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Nephrology ,Adult ,Male ,medicine.medical_specialty ,Adolescent ,[SDV]Life Sciences [q-bio] ,Cysteamine ,Cystinosis ,030232 urology & nephrology ,Renal function ,Age at diagnosis ,030204 cardiovascular system & hematology ,Nephropathic cystinosis ,03 medical and health sciences ,chemistry.chemical_compound ,Young Adult ,0302 clinical medicine ,Nephropathic Cystinosis ,Internal medicine ,medicine ,Humans ,In patient ,Prospective Studies ,Prospective cohort study ,Child ,business.industry ,Disease progression ,Fanconi Syndrome ,3. Good health ,[SDV] Life Sciences [q-bio] ,chemistry ,Adherence ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Medication event monitoring system ,Female ,Electronics ,business - Abstract
International audience; INTRODUCTION: In nephropathic cystinosis (NC), adherence to cysteamine remains challenging; poor adherence is worsening the disease progression with a decline of kidney function and increase of extrarenal morbidities. Our objective was to describe adherence to cysteamine in NC patients, using electronic monitoring systems. METHODS: Patients with confirmed NC, aged \textgreater 4 years and receiving oral cysteamine (short acting or delayed release formulation as standard of care) from 3 French reference centers, were included. Adherence to treatment was primarily assessed as the percentage of days with a good adherence score, adherence score rating from 0 (poor) to 2 (good). A descriptive analysis was performed after 1-year follow-up. RESULTS: Seventeen patients (10 girls, median age: 13.9 (5.4-33.0) years) were included. Median age at diagnosis was 17.0 (3.0-76.9) months and age at start of cysteamine was 21.0 (15.5-116.3) months. Median daily dose of cysteamine was 1.05 (0.55-1.63) g/m(2)/day. Over the year, the median percentage of days with a good adherence score was 80 (1-99)% decreasing to 68 (1-99)% in patients \textgreater 11 years old. The median of average number of hours covered by treatment in a day was 22.5 (6.1-23.9) versus 14.9 (9.2-20.5) hours for delayed release versus short acting cysteamine. CONCLUSION: Our data are the first describing a rather good adherence to cysteamine, decreasing in adolescents and adults. We described a potential interest of the delayed release formulation. Our data highlight the need for a multidisciplinary approach including therapeutic education and individualized approaches in NC patients transitioning to adulthood. Graphical abstract.
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- 2020
36. Effect of Non-Steroidal Anti-Inflammatory Drugs on Sport Performance Indices in Healthy People: a Meta-Analysis of Randomized Controlled Trials
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Natane Reynaud, Clémence Grange, Pierre Sallet, Patrice Nony, Behrouz Kassai-Koupai, Catherine Cornu, Justine Munier, Sonia Ounissi, and Amanda Regalin
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Anti-inflammatory agents ,medicine.medical_specialty ,Sports medicine ,biology ,business.industry ,Athletes ,Physical Therapy, Sports Therapy and Rehabilitation ,Evidence-based medicine ,Cochrane Library ,biology.organism_classification ,Placebo ,Doping in sport ,Non-steroidal ,law.invention ,Athletic performance ,Randomized controlled trial ,law ,Meta-analysis ,Intervention (counseling) ,Internal medicine ,Medicine ,Orthopedics and Sports Medicine ,Systematic Review ,Healthy volunteers ,business - Abstract
Background Non-steroidal anti-inflammatory drugs (NSAIDs) are medications that are frequently used by athletes. There may also be some abuse of these substances, although it is unclear whether NSAIDs in fact enhance performance. We performed a systematic review and meta-analysis to evaluate the effect of NSAIDs on sport performance indices. Methods We selected randomized trials from the PubMed and Cochrane Library databases investigating the effects of NSAIDs on sport performance. Volunteers could be healthy adult men and women. Any NSAID, administered by any route, taken prior to any type of exercise, and for any duration could be used. The control intervention could be a placebo, an active substance, or no intervention. We included double-blind, single-blind, and open-label studies. The primary outcome was the maximum performance in exercises as defined in each study. The secondary outcomes were the time until self-reported exhaustion and the self-reported pain. Results Among 1631 records, we retained thirteen parallel-group and ten crossover studies, totaling 366 and 148 subjects, respectively. They were disparate regarding treatments, dose and duration, and the type of exercise. There was neither significant difference in the maximum performance between NSAIDs and control groups nor in the time until exhaustion nor in self-perceived pain. Conclusions The existence of an ergogenic effect of NSAIDs on sport performance indices was unable to be concluded, since the level of evidence of the studies is low, the doses tested, and the exercises performed are very heterogeneous and far from those observed in real-life practices. More studies are required.
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- 2020
37. Contribution of rare and predicted pathogenic gene variants to childhood-onset lupus: a large, genetic panel analysis of British and French cohorts
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Alexandre Belot, Gillian I Rice, Sulliman Ommar Omarjee, Quentin Rouchon, Eve M D Smith, Marion Moreews, Maud Tusseau, Cécile Frachette, Raphael Bournhonesque, Nicole Thielens, Christine Gaboriaud, Isabelle Rouvet, Emilie Chopin, Akihiro Hoshino, Sylvain Latour, Bruno Ranchin, Rolando Cimaz, Paula Romagnani, Christophe Malcus, Nicole Fabien, Marie-Nathalie Sarda, Behrouz Kassai, Jean-Christophe Lega, Stéphane Decramer, Pauline Abou-Jaoude, Ian N Bruce, Thomas Simonet, Claire Bardel, Pierre Antoine Rollat-Farnier, Sebastien Viel, Héloise Reumaux, James O'Sullivan, Thierry Walzer, Anne-Laure Mathieu, Gaelle Marenne, Thomas Ludwig, Emmanuelle Genin, Jamie Ellingford, Brigitte Bader-Meunier, Tracy A Briggs, Michael W Beresford, Yanick J Crow, Dominique Campion, Jean-Francois Dartigues, Jean-François Deleuze, Jean-Charles Lambert, Richard Redon, Emma Allain-Launay, Kenza Bouayed, Stephane Burtey, Aurélia Carbasse, Véronique Despert, Olivier Fain, Michel Fischbach, Hugues Flodrops, Caroline Galeotti, Eric Hachulla, Yves Hatchuel, Jean-Francois Kleinmann, Isabelle Kone-Paut, Aurélia Lanteri, Irène Lemelle, Hélène Maillard, François Maurier, Ulrich Meinzer, Isabelle Melki, Sandrine Morell-Dubois, Anne Pagnier, Maryam Piram, Charlotte Samaille, Jean Sibilia, Olivia Weill, Eslam Al-Abadi, Kate Armon, Kathryn Bailey, Michael Beresford, Mary Brennan, Coziana Ciurtin, Janet Gardner-Medwin, Kirsty Haslam, Daniel Hawley, Alice Leahy, Valentina Leone, Devesh Mewar, Rob Moots, Clarissa Pilkington, Athimalaipet Ramanan, Satyapal Rangaraj, Annie Ratcliffe, Philip Riley, Ethan Sen, Arani Sridhar, Nick Wilkinson, Fiona Wood, Imagine - Institut des maladies génétiques (IHU) (Imagine - U1163), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Réponse immunitaire innée dans les maladies infectieuses et auto-immunes – Innate immunity in infectious and autoimmune diseases, Centre International de Recherche en Infectiologie - UMR (CIRI), Institut National de la Santé et de la Recherche Médicale (INSERM)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), Academic Unit of Medical Genetic, University of Manchester [Manchester], Reproduction et développement des plantes (RDP), École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Institut de biologie structurale (IBS - UMR 5075), Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche Interdisciplinaire de Grenoble (IRIG), Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Grenoble Alpes (UGA), Hospices Civils de Lyon (HCL), Laboratoire de Biologie Moléculaire de la Cellule (LBMC), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Developpement Normal et Pathologique du Système Immunitaire, Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de néphrologie, rhumatologie et dermatologie pédiatriques [Hôpital Femme Mère Enfant, HCL], Hospices Civils de Lyon (HCL)-Hôpital Mère Enfant, Rheumatology Unit, Department of Paediatrics, Anna Meyer Children's Hospital and University of Florence, Hospices Civils de Lyon, Laboratoire d'Immunologie, Groupement Hospitalier Edouard Herriot, 5 Place d'Arsonval, F-69437, Lyon Cedex 03, France, parent, Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Evaluation et modélisation des effets thérapeutiques, Département biostatistiques et modélisation pour la santé et l'environnement [LBBE], Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Institut de médecine moléculaire de Rangueil (I2MR), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-IFR150-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Pédiatrique [Jeanne de Flandre], Hôpital Jeanne de Flandre [Lille], Genetic Medicine, University of Manchester [Manchester]-Faculty of Human and Medical Sciences, Spanish National Cancer Research Centre, Génétique, génomique fonctionnelle et biotechnologies (UMR 1078) (GGB), Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO)-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Service d'immuno-hématologie pédiatrique [CHU Necker], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Imagine - Institut des maladies génétiques (IMAGINE - U1163), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de neurologie [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Université de Bordeaux (UB), Centre National de Génotypage (CNG), Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Epidémiologie des maladies chroniques : impact des interactions gène environnement sur la santé des populations, Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé, unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Centre hospitalier universitaire de Nantes (CHU Nantes), Centre de néphrologie et transplantation rénale [Hôpital de la Conception - APHM], Hôpital de la Conception [CHU - APHM] (LA CONCEPTION)-Assistance Publique - Hôpitaux de Marseille (APHM), Service Pédiatrique [Rennes], CHU Pontchaillou [Rennes], Service de Médecine Interne [CHU Saint-Antoine], CHU Saint-Antoine [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), service pédiatrique de dialyse et de transplantation rénales, CHU Strasbourg-Hôpital de Hautepierre [Strasbourg], Service de médecine interne [Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), 'Personal Protection Against Vectors' working group (PPAV), PPAV working group, CHU Strasbourg, Hôpital Bicêtre, Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, Service de Pédiatrie [Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de médecine interne, Hôpital Sainte-Blandine-Centre hospitalier régional Metz-Thionville (CHR Metz-Thionville), Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases [Paris], Centre de référence des rhumatismes inflammatoires et maladies autoimmunes systémiques rares de l'enfant [Paris] (RAISE), AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Pédiatrie Générale et Rhumatologie Pédiatrique, Service de rhumatologie [Strasbourg], Service de Pédiatrie - Néphrologie, Médecine interne, Hypertension, CHU Toulouse [Toulouse]-Hôpital des Enfants, CHU Toulouse [Toulouse], University of Edinburgh, Analyse et Traitement Informatique de la Langue Française (ATILF), Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), Centre International de Recherche en Infectiologie (CIRI), École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Università degli Studi di Firenze = University of Florence (UniFI), Université de Toulouse (UT)-Université de Toulouse (UT)- Institut Fédératif de Recherche Bio-médicale Institution (IFR150)-Institut National de la Santé et de la Recherche Médicale (INSERM), EFS-Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), Unité de recherche de l'institut du thorax (ITX-lab), Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)
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Proband ,[SDV]Life Sciences [q-bio] ,Immunology ,Population ,Genome-wide association study ,Biology ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Rheumatology ,immune system diseases ,Genotype ,medicine ,Immunology and Allergy ,1000 Genomes Project ,education ,skin and connective tissue diseases ,ComputingMilieux_MISCELLANEOUS ,030304 developmental biology ,Genetic association ,030203 arthritis & rheumatology ,Genetics ,0303 health sciences ,education.field_of_study ,Systemic lupus erythematosus ,[SDV.BBM.BS]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Structural Biology [q-bio.BM] ,medicine.disease ,3. Good health ,Mendelian inheritance ,symbols - Abstract
Summary Background Systemic lupus erythematosus (SLE) is a rare immunological disorder and genetic factors are considered important in its causation. Monogenic lupus has been associated with around 30 genotypes in humans and 60 in mice, while genome-wide association studies have identified more than 90 risk loci. We aimed to analyse the contribution of rare and predicted pathogenic gene variants in a population of unselected cases of childhood-onset SLE. Methods For this genetic panel analysis we designed a next-generation sequencing panel comprising 147 genes, including all known lupus-causing genes in humans, and potentially lupus-causing genes identified through GWAS and animal models. We screened 117 probands fulfilling American College of Rheumatology (ACR) criteria for SLE, ascertained through British and French cohorts of childhood-onset SLE, and compared these data with those of 791 ethnically matched controls from the 1000 Genomes Project and 574 controls from the FREX Consortium. Findings After filtering, mendelian genotypes were confirmed in eight probands, involving variants in C1QA, C1QC, C2, DNASE1L3, and IKZF1. Seven additional patients carried heterozygous variants in complement or type I interferon-associated autosomal recessive genes, with decreased concentrations of the encoded proteins C3 and C9 recorded in two patients. Rare variants that were predicted to be damaging were significantly enriched in the childhood-onset SLE cohort compared with controls; 25% of SLE probands versus 5% of controls were identified to harbour at least one rare, predicted damaging variant (p=2·98 × 10−11). Inborn errors of immunity were estimated to account for 7% of cases of childhood-onset SLE, with defects in innate immunity representing the main monogenic contribution. Interpretation An accumulation of rare variants that are predicted to be damaging in SLE-associated genes might contribute to disease expression and clinical heterogeneity. Funding European Research Council.
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- 2020
38. A population pharmacokinetic model for escitalopram and its major metabolite in depressive patients during the perinatal period: Prediction of infant drug exposure through breast milk
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Alice Panchaud, Behrouz Kassai-Koupai, Manuella Epiney, Jean-François Tolsa, Chin B. Eap, Monia Guidi, C. Fischer, Olivier Claris, Chantal Csajka, Sophie Rothenburger, Mathilde Morisod Harari, Jean-Michel Hascoet, Pascal Gaucherand, Yvan Vial, Cristina Borradori Tolsa, Sylvie Rouiller, Etienne Weisskopf, Etienne Beaufils, Myriam Bickle Graz, Kim An Nguyen, Université de Genève (UNIGE), Université de Lausanne (UNIL), Lausanne University Hospital, Department of Obstetrics and Gynaecology (MHH), Hannover Medical School [Hannover] (MHH), Service de Néonatalogie [Lyon], Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Ensemble Hospitalier de la Côte (EHC), Hôpital Femme Mère Enfant [CHU - HCL] (HFME), Hospices Civils de Lyon (HCL), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hôpitaux Universitaires de Genève (HUG), Department of Obstetrics and Gynecology [Colombus], Ohio State University [Columbus] (OSU), Développement, Adaptation et Handicap. Régulations cardio-respiratoires et de la motricité (DevAH), Université de Lorraine (UL), and Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)
- Subjects
medicine.medical_specialty ,breastfeeding ,escitalopram ,Population ,Breastfeeding ,Citalopram ,Breast milk ,030226 pharmacology & pharmacy ,03 medical and health sciences ,0302 clinical medicine ,population pharmacokinetics ,Pregnancy ,Internal medicine ,medicine ,Escitalopram ,Animals ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Prospective Studies ,education ,Serotonin Uptake Inhibitors/pharmacokinetics ,Pharmacology ,education.field_of_study ,[SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics ,ddc:615 ,ddc:618 ,Milk, Human ,business.industry ,Infant exposure ,Infant ,Human/metabolism ,Original Articles ,3. Good health ,NONMEM ,Breast Feeding ,Milk ,Pharmaceutical Preparations ,exposure ,Citalopram/pharmacokinetics ,[SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology ,Population study ,Female ,business ,[SDV.AEN]Life Sciences [q-bio]/Food and Nutrition ,Selective Serotonin Reuptake Inhibitors ,medicine.drug - Abstract
International audience; Background and objectives: Escitalopram (SCIT) is frequently prescribed to breastfeeding women. Available information on SCIT excretion into breast milk is based on heterogeneous and incomplete data. A population pharmacokinetic model that aimed to better characterize maternal and infant exposure to SCIT and its metabolite was developed.Methods: The study population was composed of women treated by SCIT or racemic citalopram and enrolled in the multicenter prospective cohort study SSRI‐Breast Milk study (ClinicalTrial.gov NCT01796132). A joint structural model was first built for SCIT and S‐desmethylcitalopram (SDCIT) in plasma using NONMEM and the milk‐to‐plasma ratio (MPR) was estimated by adding the drug breast milk concentrations. The effect of different influential covariates was tested and the average drug exposure with variability through breastfeeding was predicted under various conditions by simulation.Results: The study enrolled 33 patients treated with SCIT or racemic citalopram who provided 80 blood and 104 milk samples. Mean MPR for both parent drug and metabolite was 1.9. Increased milk fat content was significantly associated with an increased drug transfer into breast milk (+28% for SCIT and +18% for SDCIT when fat amount doubles from 3.1 to 6.2 g/100 mL). Simulations suggested that an exclusively breastfed infant would ingest daily through breast milk 3.3% of the weight‐adjusted maternal SCIT dose on average.Conclusion: The moderate between‐subject variability in milk concentration of SCIT and the limited exposure to escitalopram through breast milk observed provide reassurance for treated mothers of breastfed healthy infants
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- 2020
39. Collaboration between academics, small pharmaceutical company and patient organizations in the development of a new formulation of cysteamine in nephropathic cystinosis: A successful story
- Author
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Cécile Acquaviva-Bourdain, Catherine Cornu, Fabien Subtil, Patrice Nony, Catherine Mercier, Christine Vianey-Saban, Denis Morin, Georges Deschênes, Aurélia Bertholet-Thomas, Ségolène Gaillard, Behrouz Kassai, Pierre Cochat, Laurent Roche, EPICIME-CIC 1407 de Lyon, Inserm, Service de Pharmacologie Clinique, Hospices Civils de Lyon, 69677 Bron, France, parent, Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Hôpital Robert Debré Paris, Hôpital Robert Debré, Structural Impact Laboratory (SIMLab), Centre for Research-based Innovation (CRI), Norwegian University of Science and Technology [Trondheim] (NTNU), Norwegian University of Science and Technology (NTNU)-Norwegian University of Science and Technology (NTNU), Institut de biologie et chimie des protéines [Lyon] (IBCP), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Service Maladies Héréditaires du Métabolisme et Dépistage Néonatal [CHU Lyon] (Centre de Biologie et Pathologie Est), Hospices Civils de Lyon (HCL)-Groupement Hospitalier Est, Biostatistiques santé, Département biostatistiques et modélisation pour la santé et l'environnement [LBBE], Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon, Hospices Civils de Lyon (HCL), Service de néphrologie, rhumatologie et dermatologie pédiatriques [Hôpital Femme Mère Enfant, HCL], Hospices Civils de Lyon (HCL)-Hôpital Mère Enfant, Centre de référence des maladies rénales rares Néphrogones [CHU-HCL, Lyon], Hôpital Femme Mère Enfant [CHU - HCL] (HFME), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Motricité, interactions, performance EA 4334 / Movement - Interactions - Performance (MIP), Le Mans Université (UM)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Université de Nantes - UFR des Sciences et Techniques des Activités Physiques et Sportives (UFR STAPS), Université de Nantes (UN)-Université de Nantes (UN), EPICIME-CIC 1407 de Lyon, Inserm, Service de Pharmacologie Clinique, CHU-Lyon, Institut de Génomique Fonctionnelle (IGF), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), and CCSD, Accord Elsevier
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[SDV]Life Sciences [q-bio] ,Population ,Disease ,030226 pharmacology & pharmacy ,Patient advocacy ,Nephropathic cystinosis ,Clinical research ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Multidisciplinary approach ,Nephropathic Cystinosis ,Medicine ,Pharmacology (medical) ,education ,[SDV.IB] Life Sciences [q-bio]/Bioengineering ,education.field_of_study ,business.industry ,3. Good health ,Rare diseases ,Clinical trial ,[SDV] Life Sciences [q-bio] ,[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,business ,Rare disease - Abstract
International audience; Rare diseases usually concern small and disseminated population. Implementing clinical research with the right design, outcomes measures and the recruitment of patients are challenges. Collaborations, training and multidisciplinary approach are often required. In this article, we provide an overview of a successful collaboration in nephropathic cystinosis (NC), focusing on what was the key of success, the interactions between academics, the pharmaceutical company and patients organizations. NC is considered as a very rare disease. In 2010, a new formulation of cysteamine, the only available treatment to improve renal outcome of the disease, was proposed by a small American company. Studies were implemented in France under the coordination of an expert of the disease and the clinical investigation center of Lyon. The collaboration resulted in a good recruitment and retention of the patients in the study and most of all in the availability of the new formulation in France. Patients could have facilitated the research by being involved in the early stages of the studies. Involving patients and public early in the process is particularly important in rare diseases as the patient is a great source of knowledge and has his own expectations. Priorities of research, design, conduct and reporting of clinical trials can be defined in collaboration with adults but also with young patients or public, the first concerned in rare diseases. This concept is still to be developed and improved especially with paediatric patients.
- Published
- 2020
40. Reference values for the external genitalia of full-term and pre-term female neonates
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Sarah Castets, Kim-An Nguyen, Franck Plaisant, Malika Baya Prudon, Ingrid Plotton, Behrouz Kassai, Sylvain Roche, Rene Ecochard, Olivier Claris, Marc Nicolino, Carine Villanueva, and Claire-Lise Gay
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medicine.medical_specialty ,Percentile ,Birth weight ,Anal Canal ,030209 endocrinology & metabolism ,Gestational Age ,Clitoromegaly ,Clitoris ,03 medical and health sciences ,0302 clinical medicine ,Reference Values ,medicine ,Birth Weight ,Humans ,Neonatology ,Prospective Studies ,Prospective cohort study ,Full Term ,030219 obstetrics & reproductive medicine ,Adrenal Hyperplasia, Congenital ,business.industry ,Obstetrics ,Infant, Newborn ,Obstetrics and Gynecology ,Gestational age ,General Medicine ,Reference values ,Pediatrics, Perinatology and Child Health ,Female ,France ,medicine.symptom ,business - Abstract
Background and objectivesIdentifying virilisation of the genitalia in female newborns early during the neonatal period is important to diagnose pathologies. However, there is no clear threshold for clitoromegaly or for the anogenital ratio. The objective of this study was to define reference values for the external genitalia of full-term and pre-term female neonates.DesignThis was a prospective study of all females born in the study centre between May 2014 and July 2016. Clitoral length and anogenital ratio were measured in 619 newborns with a gestational age of 24+2 to 41+3 weeks during their first 3 days of life. Associations between the values at day 3 and gestational age, birth weight and other newborn characteristics were examined by linear regression.ResultsThe mean clitoral length at day 3 of life was 3.69±1.53 mm (n=551; 95th percentile, 6.5 mm; maximum, 8 mm), and the mean anogenital ratio was 0.42±0.09 (95th percentile, 0.58). There was no significant variation with gestational age or birth weight, and no significant difference between the results at day 0 and day 3.ConclusionThese results suggest that clitoromegaly can be defined as a clitoral length >6.5 mm. Values ≥8 mm should prompt further investigations. An anogenital ratio >0.6 should be considered a sign of virilisation. Since clitoral size does not vary with gestational age or birth weight, clitoromegaly should not be attributed to prematurity.
- Published
- 2019
41. The interplay between bone and vessels in pediatric CKD: lessons from a single-center study
- Author
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Melody Vierge, Anke Doyon, Justine Bacchetta, Evgenia Preka, Tiphanie Ginhoux, Behrouz Kassai, and Bruno Ranchin
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Male ,medicine.medical_specialty ,Adolescent ,030232 urology & nephrology ,Diastole ,Urology ,Renal function ,Parathyroid hormone ,Blood Pressure ,Pulse Wave Analysis ,030204 cardiovascular system & hematology ,Carotid Intima-Media Thickness ,03 medical and health sciences ,0302 clinical medicine ,Bone Density ,Renal Dialysis ,medicine ,Vitamin D and neurology ,Humans ,Prospective Studies ,Renal Insufficiency, Chronic ,Quantitative computed tomography ,Child ,Vascular Calcification ,Pulse wave velocity ,Chronic Kidney Disease-Mineral and Bone Disorder ,medicine.diagnostic_test ,business.industry ,medicine.disease ,Calcium, Dietary ,Blood pressure ,Nephrology ,Cancellous Bone ,Pediatrics, Perinatology and Child Health ,Calcium ,Female ,Tomography, X-Ray Computed ,business ,Glomerular Filtration Rate ,Kidney disease - Abstract
Mineral and bone disorders associated to chronic kidney disease (CKD-MBD) are a daily challenge for pediatric nephrologists, with a significant risk of long-term bone and vascular comorbidities. This single-center study is a prospective transversal evaluation of pediatric CKD patients of our center, part of the European 4C study. In addition to clinical and biochemical data, vascular and bone evaluation was performed: 24-h blood pressure assessment, carotid intima-media thickness (cIMT), pulse wave velocity (PWV), and high-resolution peripheral quantitative computed tomography (HR-pQCT) at the ultra-distal tibia. Results are presented as median (range). At a median age of 12.9 years (10.2–17.9), SDS height of − 1.0 (− 3.3–1.2) and estimated glomerular filtration rate (eGFR) of 33 mL/min/1.73m2 (11–72), 32 patients (8 girls) were evaluated. Median calcium, phosphate, parathyroid hormone (PTH), and 25 OHD3 levels were 2.44 mmol/L (2.24–2.78), 1.43 mmol/L (1.0–2.7), 80 pg/mL (9–359), and 70 nmol/L (32–116), respectively. Bivariate Spearman and backward multivariable analyses showed that calcium and bone trabecular thickness (Tb.Th), were positively associated with diastolic and mean arterial blood pressure (both for the 24 h, day and night assessment), whereas PTH and vitamin D did not predict blood pressure. We show that the greater the serum levels of calcium, the greater the (diastolic and mean) blood pressure; moreover, the greater the Tb. Th, the greater the (diastolic and mean) blood pressure. The role of calcium supplements to explain such findings in early pediatric CKD can be discussed.
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- 2018
42. Involving children and young people in clinical research through the forum of a European Young Persons’ Advisory Group: needs and challenges
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Ségolène Gaillard, Begonya Nafria Escalera, Behrouz Kassai, Nathalie Touil, Pamela Dicks, Joana Claverol-Torres, Sandrine Mardirossian, Jenny Preston, and Salma Malik
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Pharmacology ,Prioritization ,Research design ,Medical education ,Clinical Studies as Topic ,Decision Making ,Research skills ,Europe ,03 medical and health sciences ,0302 clinical medicine ,Clinical research ,Research Design ,030225 pediatrics ,Humans ,Pharmacology (medical) ,Research questions ,030212 general & internal medicine ,Psychology ,Young person - Abstract
Children and young people are seen as fundamental to the design and delivery of clinical research as active and reflective participants. In Europe, involvement of children and young people in clinical research is promoted extensively in order to engage young people in research as partners and to give them a voice to raise their own issues or opinions and for their involvement in planning and decision making in addition to learning research skills. Children and young people can be trained in clinical research through participation in young person advisory groups (YPAGs). Members of YPAGs assist other children and young people to learn about clinical research and share their experience and point of view with researchers, thereby possibly influencing all phases of research including the development and prioritization of research questions, design and methods, recruitment plans, and strategies for results dissemination. In the long term, the expansion of YPAGs in Europe will serve as a driving force for refining pediatric clinical research. It will help in a better definition of research projects according to the patients' needs. Furthermore, direct engagement of children and young people in research will be favorable to both researchers and young people.
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- 2018
43. Research priority setting in childhood chronic disease: a systematic review
- Author
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Melissa Wake, Sophie Hill, Harrison Lindsay Odgers, Suzy Haddad, Anne McKenzie, Behrouz Kassai, Sally Crowe, Patrina H Y Caldwell, Pamela Lopez-Vargas, Allison Tong, Adam Jaffe, Ross Pinkerton, Andrew Davidson, Peter Richmond, Jonathan C. Craig, and Jennifer J Couper
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medicine.medical_specialty ,Palliative care ,Health Personnel ,CINAHL ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Stakeholder Participation ,030225 pediatrics ,Outcome Assessment, Health Care ,Health care ,medicine ,Humans ,030212 general & internal medicine ,Child ,business.industry ,Focus group ,Caregivers ,Family medicine ,Chronic Disease ,Pediatrics, Perinatology and Child Health ,Quality of Life ,Outcomes research ,business ,Psychosocial ,Qualitative research - Abstract
ObjectiveTo evaluate research priority setting approaches in childhood chronic diseases and to describe the priorities of stakeholders including patients, caregivers/families and health professionals.DesignWe conducted a systematic review of MEDLINE, Embase, PsycINFO and CINAHL from inception to 16 October 2016. Studies that elicited stakeholder priorities for paediatric chronic disease research were eligible for inclusion. Data on the prioritisation process were extracted using an appraisal checklist. Generated priorities were collated into common topic areas.ResultsWe identified 83 studies (n=15 722). Twenty (24%) studies involved parents/caregivers and four (5%) children. The top three health areas were cancer (11%), neurology (8%) and endocrine/metabolism (8%). Priority topic areas were treatment (78%), disease trajectory (48%), quality of life/psychosocial impact (48%), disease onset/prevention (43%), knowledge/self-management (33%), prevalence (30%), diagnostic methods (28%), access to healthcare (25%) and transition to adulthood (12%). The methods included workshops, Delphi techniques, surveys and focus groups/interviews. Specific methods for collecting and prioritising research topics were described in only 60% of studies. Most reviewed studies were conducted in high-income nations.ConclusionsResearch priority setting activities in paediatric chronic disease cover many discipline areas and have elicited a broad range of topics. However, child/caregiver involvement is uncommon, and the methods often lack clarity. A systematic and explicit process that involves patients and families in partnership may help to inform a more patient and family-relevant research agenda in paediatric chronic disease.
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- 2018
44. Use of available clinical evidence to extrapolate drug effects from adults to children
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Faustine Glais, Catherine Cornu, Behrouz Kassai-Koupai, Guillaume Grenet, A. Lajoinie, and Perrine Janiaud
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Adult ,medicine.medical_specialty ,Context (language use) ,Placebo ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,030225 pediatrics ,Intervention (counseling) ,Drug Discovery ,Humans ,Medicine ,Pharmacology (medical) ,030212 general & internal medicine ,Child ,Intensive care medicine ,Clinical Trials as Topic ,business.industry ,Age Factors ,Clinical trial ,Treatment Outcome ,Clinical research ,Drug development ,Relative risk ,business - Abstract
Summary The extrapolation of the benefit risk ratio from adults to children is performed during drug development and often implicitly used by many paediatricians when prescribing off-label drugs in children. This is due to the specific constraints of paediatric clinical research leading to a lack of safety and efficacy data in children. Extrapolation frameworks for drug development have been proposed by several regulatory agencies. Using a meta-epidemiological approach, we explored the similarities and differences of the benefit, the benefit risk ratio and the perceived placebo effect between adults and children from meta-analyses including randomized double-blinded placebo-controlled trials evaluating a drug intervention in an indication in adults and children with separate data for both populations. We also explored the use of the effect model using adult data to predict the treatment effect in children and to calibrate future paediatric clinical trials. Our research highlights the importance of using all available evidence and quantitative methods before extrapolating the benefit risk ratio from adults to children and carrying out new studies in the context of the existing evidence. More generally, this should be applied to any research to avoid a waste of time and resources invested.
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- 2018
45. Reducing waste in pediatric clinical research
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Kim-An Nguyen, Behrouz Kassai, Catherine Cornu, Guillaume Grenet, and Faustine Glais
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Biomedical Research ,Process management ,media_common.quotation_subject ,Pediatric research ,03 medical and health sciences ,0302 clinical medicine ,Clinical research ,Research Design ,030225 pediatrics ,Government Regulation ,Humans ,Pharmacology (medical) ,Quality (business) ,Research quality ,030212 general & internal medicine ,Business ,Child ,media_common - Abstract
Summary The importance of reducing waste and increasing value when conducting research has been emphasized by a series of articles published in the Lancet in 2014. A survey indicates that, one year later, these articles have not influenced how research is conducted. In this review, we explore four stages described by Moher et al. in research production that lead to waste. We show that all four stages including, questions relevant to users, appropriate design conduct and analysis, accessible full research, unbiased and usable reports, efficient research regulation and management of biomedical research are also producing an important waste in pediatric research. We conclude that methods to improve research quality and limit waste need to be implemented in pediatric research and recognized by authorities as a priority.
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- 2018
46. Justification de la prescription hors-AMM d’antibiotiques chez l’enfant hospitalisé
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Behrouz Kassai, Rémy Boussageon, Christelle Berthod, Matthias Jacquet-Lagrèze, Léopold Adelaide, and Audrey Lajoinie
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03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Pharmacology (medical) ,030212 general & internal medicine - Abstract
Resume Les prescriptions hors- ou sans autorisation de mise sur le marche (AMM) sont communes en services de pediatrie, particulierement pour les antibiotiques. Il n’a pas ete evalue si ces strategies de prescriptions hors ou sans AMM etaient justifiees par des essais randomises comparatifs de bonne qualite. Objectif Le but de cette etude etait de comparer le niveau de preuve d’efficacite des prescriptions d’antibiotiques hors/sans AMM avec celles qui respectaient l’AMM dans un hopital pediatrique. Notre hypothese etait que les prescriptions d’antibiotiques hors/sans AMM avaient un moins bon niveau de preuve d’efficacite que celles avec AMM. Methode Cette etude observationnelle evaluait les prescriptions d’antibiotiques a l’hopital femme-mere-enfant des hospices civils de Lyon. Chaque prescription a ete classee selon le type d’autorisation de mise sur le marche (avec, hors ou sans AMM) et selon son niveau de preuve disponible dans la litterature (preuves d’efficacite, preuves insuffisantes ou absence de preuve). Elles ont egalement ete classees selon qu’il existait ou non des essais randomises comparatifs, quelle que soit la qualite des essais. Les donnees ont ete collectees a partir des dossiers medicaux informatises des patients. Resultats Cent huit prescriptions ont ete identifiees, correspondant a 72 mono, bi ou triantibiotherapies, administrees a 62 patients. Aucune prescription n’etait sans AMM, 34 % (n = 37) etaient horsAMM et 66 % (n = 71) respectaient l’AMM. Trente-deux prescriptions atypiques n’ont pas ete analysees. Sur les 76 prescriptions, faisant l’objet d’une revue de la litterature, 36 etaient justifiees par des essais randomises : les prescriptions avec AMM (32/51) etaient significativement plus souvent justifiees par des essais randomises que les prescriptions horsAMM (4/25). Cependant, aucune prescription, avec ou horsAMM, ne remplissait les criteres de « preuve d’efficacite » avec deux essais randomises concluant de bonne qualite. Discussion Sur la base de cet echantillon de petite taille, nous avons montre qu’il n’existait pas d’essais randomises de bonne qualite justifiant les prescriptions d’antibiotiques dans les services de pediatrie, quel que soit leur statut vis-a-vis de l’AMM. Les prescriptions avec AMM sont mieux justifiees par des essais randomises que celles hors/sans AMM. Les prescriptions etaient en accord avec les recommandations actuelles si des recommandations existaient. Il manque des essais randomises en infectiologie pediatrique pour etablir des recommandations basees sur des preuves de bonne qualite.
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- 2017
47. A sudden death risk score specifically for hypertension
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M. Fall, Muaamar Al-Gobari, Yanis Mimouni, Lutgarde Thijs, H. Le, François Gueyffier, Lars H Lindholm, Ivanny Marchant, Marc Cerou, Fabien Subtil, and Behrouz Kassai
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Adult ,Male ,medicine.medical_specialty ,Physiology ,Myocardial Infarction ,Alternative medicine ,MEDLINE ,030204 cardiovascular system & hematology ,Sudden death ,law.invention ,Death, Sudden ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Risk Factors ,law ,Internal Medicine ,medicine ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Aged ,Proportional Hazards Models ,Randomized Controlled Trials as Topic ,Framingham Risk Score ,Cardiovascular History ,business.industry ,Proportional hazards model ,Middle Aged ,medicine.disease ,Hypertension ,Emergency medicine ,Female ,Medical emergency ,Cardiology and Cardiovascular Medicine ,business - Abstract
To construct a sudden death risk score specifically for hypertension (HYSUD) patients with or without cardiovascular history.Data were collected from six randomized controlled trials of antihypertensive treatments with 8044 women and 17 604 men differing in age ranges and blood pressure eligibility criteria. In total, 345 sudden deaths (1.35%) occurred during a mean follow-up of 5.16 years. Risk factors of sudden death were examined using a multivariable Cox proportional hazards model adjusted on trials. The model was transformed to an integer system, with points added for each factor according to its association with sudden death risk.Antihypertensive treatment was not associated with a reduction of the sudden death risk and had no interaction with other factors, allowing model development on both treatment and placebo groups. A risk score of sudden death in 5 years was built with seven significant risk factors: age, sex, SBP, serum total cholesterol, cigarette smoking, diabetes, and history of myocardial infarction. In terms of discrimination performance, HYSUD model was adequate with areas under the receiver operating characteristic curve of 77.74% (confidence interval 95%, 74.13-81.35) for the derivation set, of 77.46% (74.09-80.83) for the validation set, and of 79.17% (75.94-82.40) for the whole population.Our work provides a simple risk-scoring system for sudden death prediction in hypertension, using individual data from six randomized controlled trials of antihypertensive treatments. HYSUD score could help assessing a hypertensive individual's risk of sudden death and optimizing preventive therapeutic strategies for these patients.
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- 2017
48. Comparaison de la gravité des intoxications à la chloroquine et de l’hydroxychloroquine. Une étude rétrospective
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Jean-Christophe Lega, Guillaume Grenet, Thierry Vial, Behrouz Kassai, Maylis Borocco, Xavier Jarrige, Bernard Allaouchiche, Sabine Mainbourg, and Nathalie Paret
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Health, Toxicology and Mutagenesis ,Toxicology - Abstract
Objectifs La chloroquine (CQ) et l’hydroxychloroquine (HCQ) ont ete proposees comme traitement de la COVID-19, avec une certaine iatrogenie. En effet, les intoxications aigues avec ces traitements sont connues pour leur gravite. Les doses toxiques de la CQ sont bien etablies, contrairement a celles de l’HCQ. Notre objectif etait de comparer la gravite des intoxications a l’HCQ par rapport a celles a la CQ. Methode Il s’agit d’une etude retrospective menee sur les cas d’intoxication aigue (prise unique) ou subaigue (plusieurs prises pendant moins de 7 jours) a la CQ et a l’HCQ, survenus entre 1999 et 2019 inclus, dans la region Auvergne-Rhone-Alpes (AuRA), present dans la base de donnees du centre antipoison de Lyon. Les criteres d’exclusion concernaient les intoxications chroniques, ou avec une dose supposee ingeree (DSI) inferieure aux posologies maximales recommandees. La gravite des cas (score PSS de 0–aucune–a 3–severe–) a ete verifiee a la lumiere du dossier clinique, par une meme personne, repondeur du centre antipoison, en ouvert du traitement. Les caracteristiques des cas inclus ont ete decrites pour chacun des deux groupes (CQ vs HCQ) : effectif, âge, sexe, circonstances de l’intoxication, DSI (en g/jour). Les scores de gravite entre les deux groupes (CQ vs HCQ) ont ete compares par regression logistique. Notre critere de jugement principal etait la gravite, ajustee sur la DSI/jr (une prise unique equivalent a 1 jour, la DSI totale sur plusieurs jours etaient divisee par le nombre de jour pour les intoxications subaigues). Les statistiques ont ete realisees avec le logiciel Stata. Une p value nominale a 5 % etait consideree significative sans correction pour test multiple. Resultats Parmi les 71 cas extraits, 50 ont ete exclus (6 intoxications chroniques, 12 aides a la prescription, 31 doses therapeutiques, 1 sans information). Vingt et un cas ont ete inclus : 15 (71 %) avec l’HCQ et 6 (29 %) avec la CQ. La proportion d’homme etait de 27 % et de 33 %, l’âge median de 40 ans (intervalles interquartiles (IQR) 25-59 ans) et de 27 ans (IQR, 21-34 ans) et la DSI mediane etait de 2,0 g/j (IQR 2,4-4,4) et de 3,6 g/j (IQR 0,8-6,0), respectivement pour HCQ et CQ. Dans les groupes HCQ et CQ, les circonstances d’intoxication etaient respectivement une conduite suicidaire (80 % vs 83 %), une erreur therapeutique (20 % vs 0 %), un mesusage (0 % vs 17 %), avec une intoxication aigue (93 % vs 83 %) ou subaigue (7 % vs 17 %) ; de gravite nulle PPS0 (27 % vs 0 %), faible PSS1 (20 % vs 0 %), moderee PSS2 (33 % vs 67 %) ou severe PSS3 (20 % vs 33 %). Les symptomes caracterisant la gravite severe des cas inclus etaient les suivant : troubles de la repolarisation, hypokaliemie, hypoglycemie, etat de choc, Glasgow score 0,05) sur la difference de gravite entre les deux molecules, ajustee sur la DSI/jour. Conclusion Notre etude pilote presentaient plusieurs limites (effectif limite, caractere retrospectif). Nos resultats etaient non concluants sur la difference de gravite entre les cas d’intoxication a l’HCQ ou a la CQ. Neanmoins, la CQ n’etait impliquee que dans des cas de gravite moderee ou severe. Atteindre un echantillon plus important de patients permettrait une plus grande puissance pour montrer une difference significative entre une gravite moderee pour l’HCQ versus severe pour la CQ. Il serait necessaire d’etendre cette etude a l’echantillon national des 8 CAP francais.
- Published
- 2021
49. Attention and Executive Disorders in Neurofibromatosis 1: Comparison Between NF1 With ADHD Symptomatology (NF1 + ADHD) and ADHD Per Se
- Author
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Laurence Lion-François, Catherine Mercier, George A. Michael, Behrouz Kassai, Vincent Desportes, Virginie Coutinho, Daniel Gérard, Emeline Peyric, Vania Herbillon, Tiphanie Ginhoux, Isabelle Kemlin, Hôpital Femme Mère Enfant [CHU - HCL] (HFME), Hospices Civils de Lyon (HCL), Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], EPICIME-CIC 1407 de Lyon, Inserm, Service de Pharmacologie Clinique, hospices civils de Lyon, CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Evaluation et modélisation des effets thérapeutiques, Département biostatistiques et modélisation pour la santé et l'environnement [LBBE], Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Centre d'Investigation Clinique [Bron] (CIC1407), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupement Hospitalier Est [Bron], Centre de recherche en neurosciences de Lyon - Lyon Neuroscience Research Center (CRNL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Laboratoire d'Etude des Mécanismes Cognitifs (EMC), and Université Lumière - Lyon 2 (UL2)
- Subjects
congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Neurofibromatosis 1 ,neuropsychology ,MESH: Attention Deficit Disorder with Hyperactivity ,Neuropsychological Tests ,neurofibromatosis type 1 ,behavioral disciplines and activities ,03 medical and health sciences ,0302 clinical medicine ,MESH: Child ,mental disorders ,Developmental and Educational Psychology ,medicine ,Humans ,ADHD ,0501 psychology and cognitive sciences ,Attention deficits ,Neurofibromatosis ,Child ,Psychiatry ,MESH: Neurofibromatosis 1 ,neoplasms ,MESH: Humans ,05 social sciences ,Neuropsychology ,MESH: Neuropsychological Tests ,executive functions ,medicine.disease ,Executive functions ,attention ,nervous system diseases ,Clinical Psychology ,Attention Deficit Disorder with Hyperactivity ,[SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] ,Psychology ,030217 neurology & neurosurgery ,050104 developmental & child psychology - Abstract
International audience; Objective: To compare children with Neurofibromatosis type 1 and associated ADHD symptomatology (NF1 + ADHD) with children having received a diagnosis of ADHD without NF1. The idea was that performance differences in tasks of attention between these two groups would be attributable not to the ADHD symptomatology, but to NF1 alone. Method: One group of children with NF1 + ADHD (N = 32), one group of children with ADHD (N = 31), and one group of healthy controls (N = 40) participated in a set of computerized tasks assessing intensive, selective, and executive aspects of attention. Results: Differences were found between the two groups of patients in respect of several aspects of attention. Children with NF1 + ADHD did not always perform worse than children with ADHD. Several double dissociations can be established between the two groups of patients. Conclusion: ADHD symptomatology in NF1 does not contribute to all attention deficits, and ADHD cannot account for all attention impairments in NF1.
- Published
- 2017
50. Palivizumab prophylaxis in infants with cystic fibrosis does not delay first isolation of Pseudomonas aeruginosa or Staphylococcus aureus
- Author
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Stéphane Sanchez, Behrouz Kassai-Koupai, Marie-Laure Dalphin, Philippe Reix, Laurianne Coutier, Clélia Buchs, Catherine Mainguy, and M. Perceval
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Male ,Palivizumab ,Staphylococcus aureus ,medicine.medical_specialty ,Pediatrics ,Cystic Fibrosis ,Respiratory Syncytial Virus Infections ,medicine.disease_cause ,Staphylococcal infections ,Antiviral Agents ,Injections, Intramuscular ,Cystic fibrosis ,Drug Administration Schedule ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Internal medicine ,medicine ,Humans ,Pseudomonas Infections ,Respiratory system ,Retrospective Studies ,Pseudomonas aeruginosa ,business.industry ,Age Factors ,Case-control study ,Infant ,Retrospective cohort study ,Staphylococcal Infections ,medicine.disease ,Treatment Outcome ,030228 respiratory system ,Case-Control Studies ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,business ,Follow-Up Studies ,medicine.drug - Abstract
Respiratory syncytial virus (RSV) infections may worsen cystic fibrosis (CF) lung disease and favor Pseudomonas aeruginosa (Pa) or Staphylococcus aureus (Sa) acquisition, which is of particular importance in the youngest patients. We aimed to determine the effectiveness of PVZ on microbiological outcomes in young children with CF. We conducted a retrospective case-control study to compare these outcomes in children who systematically received PVZ (PVZ+; n = 40) or not (PVZ-; n = 140). One case was matched with at least three same-gender controls born the same year and month. Median (range) age at first Pa isolation was not statistically different between PVZ- (12.3 [3.8-32.6] months) and PVZ+ (10.4 [1.2-33.0] months; p = 0.953) patients. A similar trend was found for Sa (PVZ+: 6.4 [2.0-59.0] months; PVZ-: 3.8 [0.1-74.1] months; p = 0.191). The proportion of Pa isolations by 3 years of age did not differ between groups (PVZ+ 40% vs. PVZ- 41.4%), but this proportion was higher for Sa in the PVZ+ group (97%) than in the PVZ- group (85%; p = 0.001). Healthcare consumption and growth outcomes did not significantly differ between groups.Systematic PVZ use did not delay key pathogen acquisition in young children with CF. What is known: • Palivizumab is the only available monoclonal antibody against respiratory syncytial virus infection. • Whether or not it is useful in infants with cystic fibrosis remains controversial. What is new: • Palivizumab does not delay key pathogens (Pseudomonas aeruginosa, Staphylococcus aureus) first isolation in young children with cystic fibrosis. • Palivizumab does not reduce healthcare consumption or improve growth during the first 3 years of life of young children with cystic fibrosis.
- Published
- 2017
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