Centre Hospitalier de Bigorre

Fostamatinib is available in France since October 2021 for the treatment of adult chronic immune thrombocytopenia (ITP). French health authorities requested a 3-year, prospective, multicenter registry to provide real-world evidence about the effectiveness and safety of fostamatinib. Patients' characteristics, treatment response (ongoing exposure to fostamatinib and a platelet count ≥ 30 × 109/L with no rescue in the previous 4 weeks) after 3, 6, 12, and 24 months (M); bleeding; fostamatinib discontinuation; adverse drug reactions (ADRs) and other events of interest have been analyzed. In total, 164 patients were included (median age: 59 years; 55.5% women; 84.1% had previous bleeding; 30 had secondary ITP; 89.0% had chronic ITP). The median ITP duration was 7.2 years and the median number of previous ITP treatments was 6. The response rate was 44.0% (70/159) at M3, 41.9% (62/148) at M6, 32.4% (44/136) at M12 and 20.0% (21/105) at M24. Concomitant treatment (mostlyTPO-RA) was used in > 60.0% of responders at each endpoint. The cumulative discontinuation rate at each endpointwas, respectively, 27.0%, 44.6%, 55.9%, and 76.2%. Seventy-one (43.3%) patients experienced at least one bleeding duringfostamatinib exposure; none was fatal. One hundred adverse drug reactions (8 serious) were observed in 61 (36.7%)patients, including diarrhea in 28 (17.1%) patients, arterial hypertension in 17 (10.4%). Seven thrombosis (4.3%) and40 infections (12 serious) were reported in 25 patients (15.2%), mostly in patients with known risk factors. In conclusion,fostamatinib in combination with TPO-RA should be considered in difficult-to-treat ITP patients. No new safety signal was observed.

Non-typhoidal salmonella (NTS) is one of the main germs responsible for intestinal infections worldwide, and can present life-threatening extra-digestive complications such as endarteritis. A septic deep vein thrombosis (DVT) is characterised by intraluminal thrombus and venous wall inflammation and suppuration and has been rarely reported in the setting of NTS infection. We present the case of an immunosuppressed 83-year-old man who developed NTS sepsis, complicated by an infected and ruptured left internal iliac artery aneurysm and contiguous femoro-iliac septic DVT. Septic DVT ranks among the serious extra-intestinal complications of NTS infections and may be contiguous with an endarteritis site.

Every year in France, 40% of people aged ≥80 years are hospitalized, with an average length of hospital stay of 25 days and a readmission rate of 14% to 30% within the month following discharge. This situation is putting pressure on the health care system, encouraging the reinforcement of home care to reduce avoidable hospitalization. The EPOCA remote patient monitoring (RPM) system is a medical and social telehealth solution specialized in RPM, teleconsultation, tele-expertise, and care coordination in emergency medicine and geriatrics. The platform provides long-term medical support at home (MSAH) with 24-7 telemonitoring of older adults with polypathology. We hypothesized that receiving long-term MSAH via the EPOCA RPM system would be associated with a reduction in the rates and durations of hospitalizations or emergency department (ED) visits in older adults with polypathology. We aimed to compare the hospitalization and ED visit rates, as well as the cumulative hospital stay duration, before and after enrollment in the EPOCA RPM system for older adults with polypathology. This retrospective observational study included older adults (aged ≥70 years) with polypathology (>2 affected systems) followed throughout 2 different types of long-term MSAH between February 2022 and October 2023. We compared the number of hospital admissions, including ED visits; the cumulative duration of hospital stays during the follow-up; and the average length of hospital stays during the period corresponding to the MSAH program (Y) compared to the year before entering the program (Y - 1). Subgroup analyses were conducted according to the severity of the participants' disability. A total of 120 participants were included in the MSAH program, with a mean age of 86.8 (SD 7.9) years. Hospitalization and ED visit rates decreased (-48%) between the Y - 1 and Y periods, as did the total duration of hospital stays (-63%). A significant reduction in number of hospitalizations (median decreased from 1.0 to 0.0 per patient per year; P<.001) and ED visits (median decreased from 1.0 to 0.0 per patient per year; P<.001) was observed between the Y - 1 and Y periods. This corresponded to a significant median reduction of 14 days spent at the hospital per patient per year (P<.001). The decrease in hospitalization and ED visit rates and numbers was greater in participants with severe disabilities than in those with no or moderate disabilities. Among older adults with polypathology, the EPOCA RPM system is associated with reduction in number of hospitalizations, ED visits, and duration of hospital stays. Facing the challenge of population aging, home telemonitoring embedded in the health care system offers potential benefits.

IntroductionThe insertion of a peripheral venous line is of paramount importance in the stabilisation of critically ill patients. It is a preferred method of venous access over more invasive techniques due to its immediacy and fewer complications. Difficulties of catheterisation can result in delays to treatment, increased complication risks and pain, and a waste of valuable time and healthcare resources. Our hypothesis is that infrared vein illumination could improve the success rate of peripheral venous catheterisation in critically ill patients at risk of difficult catheterisation.Methods and analysisThis is a prospective, multicentre, randomised, open-label controlled trial. It will be conducted in France and will involve critically ill patients at risk of difficult peripheral catheterisation. Patients will be randomly assigned to usual care or infrared vein illumination. The primary outcome is the rate of successful peripheral venous catheterisation at first puncture. Secondary outcomes include time to placement, overall rate of successful peripheral venous catheterisation, number of punctures, quality (calibre of the catheter), replacement rate, need for central line and local complications (dysfunction, diffusion, haematoma and lymphangitis).Ethics and disseminationThe study has been granted ethical approval (CPP Ile de France 1). Following the provision of informed consent, patients will be included in the study. The results will be submitted for publication in peer-reviewed journals.Trial registration numberNCT03932214.

PurposeAcute kidney disease (AKD) is a significant health care burden worldwide. However, little is known about this complication after major surgery.MethodsWe conducted an international prospective, observational, multi-center study among patients undergoing major surgery. The primary study endpoint was the incidence of AKD (defined as new onset of estimated glomerular filtration rate (eCFR) < 60 ml/min/1.73 m2 present on day 7 or later) among survivors. Secondary endpoints included the relationship between early postoperative acute kidney injury (AKI) (within 72 h after major surgery) and subsequent AKD, the identification of risk factors for AKD, and the rate of chronic kidney disease (CKD) progression in patients with pre-existing CKD.ResultsWe studied 9510 patients without pre-existing CKD. Of these, 940 (9.9%) developed AKD after 7 days of whom 34.1% experiencing an episode of early postoperative-AKI. Rates of AKD after 7 days significantly increased with the severity (19.1% Kidney Disease Improving Global Outcomes [KDIGO] 1, 24.5% KDIGO2, 34.3% KDIGO3; P < 0.001) and duration (15.5% transient vs 38.3% persistent AKI; P < 0.001) of early postoperative-AKI. Independent risk factors for AKD included early postoperative-AKI, exposure to perioperative nephrotoxic agents, and postoperative pneumonia. Early postoperative-AKI carried an independent odds ratio for AKD of 2.64 (95% confidence interval [CI] 2.21–3.15). Of 663 patients with pre-existing CKD, 42 (6.3%) had worsening CKD at day 90. In patients with CKD and an episode of early AKI, CKD progression occurred in 11.6%.ConclusionOne in ten major surgery patients developed AKD beyond 7 days after surgery, in most cases without an episode of early postoperative-AKI. However, early postoperative-AKI severity and duration were associated with an increased rate of AKD and early postoperative-AKI was strongly associated with AKD independent of all other potential risk factors.

BackgroundSwallowed topical corticosteroids (tC) are common therapy for patients with eosinophilic esophagitis (EoE). Widely heterogeneous results have occurred due to their active ingredients, formulations and doses.ObjectiveTo assess the effectiveness of topical corticosteroid therapy for EoE in real‐world practice.MethodsCross‐sectional study analysis of the multicentre EoE CONNECT registry. Clinical remission was defined as a decrease of ≥50% in dysphagia symptom scores; histological remission was defined as a peak eosinophil count below 15 per high‐power field. The effectiveness in achieving clinico‐histological remission (CHR) was compared for the main tC formulations.ResultsOverall, data on 1456 prescriptions of tC in monotherapy used in 866 individual patients were assessed. Of those, 904 prescriptions with data on formulation were employed for the induction of remission; 234 reduced a previously effective dose for maintenance. Fluticasone propionate formulations dominated the first‐line treatment, while budesonide was more common in later therapies. A swallowed nasal drop suspension was the most common formulation of fluticasone propionate. Doses ≥0.8 mg/day provided a 65% CHR rate and were superior to lower doses. Oral viscous solution prepared by a pharmacist was the most common prescription of budesonide; 4 mg/day provided no benefit over 2 mg/day (CHR rated being 72% and 80%, respectively). A multivariate analysis revealed budesonide orodispersible tablets as the most effective therapy (OR 18.9, p < 0.001); use of higher doses (OR 4.3, p = 0.03) and lower symptom scores (OR 0.9, p = 0.01) were also determinants of effectiveness.ConclusionReduced symptom severity, use of high doses, and use of budesonide orodispersible tablets particularly were all independent predictors of tC effectiveness.