C. Gaudy-Marqueste

Impact of STROBE Statement Publication on Quality of Observational Study Reporting: Interrupted Time Series versus Before-After Analysis

Background In uncontrolled before-after studies, CONSORT was shown to improve the reporting of randomised trials. Before-after studies ignore underlying secular trends and may overestimate the impact of interventions. Our aim was to assess the impact of the 2007 STROBE statement publication on the quality of observational study reporting, using both uncontrolled before-after analyses and interrupted time series. Methods For this quasi-experimental study, original articles reporting cohort, case-control, and cross-sectional studies published between 2004 and 2010 in the four dermatological journals having the highest 5-year impact factors (≥4) were selected. We compared the proportions of STROBE items (STROBE score) adequately reported in each article during three periods, two pre STROBE period (2004–2005 and 2006–2007) and one post STROBE period (2008–2010). Segmented regression analysis of interrupted time series was also performed. Results Of the 456 included articles, 187 (41%) reported cohort studies, 166 (36.4%) cross-sectional studies, and 103 (22.6%) case-control studies. The median STROBE score was 57% (range, 18%–98%). Before-after analysis evidenced significant STROBE score increases between the two pre-STROBE periods and between the earliest pre-STROBE period and the post-STROBE period (median score2004–05 48% versus median score2008–10 58%, p<0.001) but not between the immediate pre-STROBE period and the post-STROBE period (median score2006–07 58% versus median score2008–10 58%, p = 0.42). In the pre STROBE period, the six-monthly mean STROBE score increased significantly, by 1.19% per six-month period (absolute increase 95%CI, 0.26% to 2.11%, p = 0.016). By segmented analysis, no significant changes in STROBE score trends occurred (−0.40%; 95%CI, −2.20 to 1.41; p = 0.64) in the post STROBE statement publication. Interpretation The quality of reports increased over time but was not affected by STROBE. Our findings raise concerns about the relevance of uncontrolled before-after analysis for estimating the impact of guidelines.

Initial metastatic kinetics is the best prognostic indicator in stage IV metastatic melanoma.

AIM In metastatic melanoma (MM) there is an agreement that a fast or slow progression should influence the choice between drugs with immediate impact (BRAF-inh) or delayed (ipilimumab) activity. MM kinetics thus appears crucial for medical decision, although only estimated through surrogate markers (tumour load or lactate dehydrogenase (LDH)). Our objective was to show that 1-MM kinetics can be measured and 2- is a real prognostic factor. METHOD Among all stage IV MM, we retrospectively select those with long follow-up who had two comparable total body computed tomography (CT) scans within the first 3 months, and did not receive meantime any treatment with a likely impact on MM kinetics. Kinetics index (KI) was calculated from changes in total metastatic volume (ΔTMV/ΔT). RESULTS In 126 patients, KI of progression ranges from 0 to 24,839 mm3/day. Overall survival (OS) was significantly much lower in the higher terciles of KI than in the lower ones (median OS of 459, 388 and 183 days, for KI of 0-99, 100-999 and > or =1000 mm3/day, respectively). In the multivariate analysis, KI was more predictive of OS than LDH or tumour load. CONCLUSION Delaying major treatments in stage IV MM for a few weeks permits a measure of KI, which is the best prognostic indicator in MM. The huge range of KI probably reflects major differences in aggressiveness that any therapeutic decision should take into account. KI could be used to assess prospectively how much the efficacy of each new MM drugs is influenced by MM initial kinetics.

Cognitive training with photographs as a new concept in an education campaign for self-detection of melanoma: a pilot study in the community

Background  Cognitive education using only photographs has been shown to be more effective than the ABCD algorithm to improve melanoma recognition in the general population.

Prise en charge des condylomes anogénitaux profus de l’enfant par laser CO2

Resume Introduction La prise en charge des condylomes anogenitaux de l’enfant peut s’averer delicate, surtout en cas de lesions profuses, et pose le probleme de l’identification du mode de transmission. Malades et methodes Les dossiers de tous les enfants adresses a la plate-forme Laser du CHU de la Conception a Marseille entre 1995 et 2005 pour le traitement de condylomes anogenitaux profus ont ete etudies de facon retrospective. L’objectif principal etait d’evaluer l’efficacite et la tolerance du traitement par laser CO 2 des condylomes anogenitaux. L’objectif secondaire etait d’etudier le mode de contamination. Resultats Dix-sept enfants âges de 2 a 11 ans ont ete pris en charge. Tous ont ete examines de facon standardisee, de meme que leur fratrie et parents, avec recherche de signes d’infection a papillomavirus humain et d’elements en faveur de sevices sexuels. Le traitement par laser etait pratique par le meme operateur sous anesthesie generale. Pour tous, la cicatrisation a ete rapide sans complication ni sequelle fonctionnelle. Deux enfants ont ete perdus de vue. Dix enfants (66,7 p. 100 des enfants traites) n’ont presente aucune recidive apres une seule seance de laser CO 2 . Une contamination verticale a ete retenue chez six enfants, une contamination horizontale chez sept enfants. Pour quatre enfants, le mode de contamination est reste inconnu. Aucun cas d’abus sexuel n’a ete avere. Conclusion Le caractere indolore du traitement par laser CO 2 , la rapidite de la cicatrisation, le faible taux de complication et de recidive, et le risque cicatriciel minime en font une technique de choix pour la prise en charge des condylomes anogenitaux profus de l’enfant. La contamination verticale est la plus frequente et les sevices sexuels qui doivent toujours etre recherches restent rares.

Les anti-H1 en pratique dermatologique

INTRODUCTION: Histamine is an inflammation mediator that is fundamental for the development of some allergic reactions and is also implied in several common dermatological affections. Anti-H1s are molecules capable of couteracting the effect of histamine on its specific receptors. There are two types: first generation anti-H1 and second generation anti-H1. OBJECTIVE: To assess the efficacy of anti-H1 in the treatment of skin diseases. PATIENTS AND METHODS: A reference search was made using the Pubmed data bank. Critical analysis was made of the articles selected based on their evidence. RESULTS AND CONCLUSION: Demonstration of the efficacy of anti-H1 was only confirmed in a few dermatitis. Urticaria is the indication of choice. The symptomatic use of anti-H1 may be justified within the context of other dermatitis. The second rather than the first generation molecules should be preferred because of the lesser side effects and improved pharmacokinetic profile.

Granulomes induits par des injections de leuproréline acétate (Enantone

BACKGROUND Gonadorelin analogues (LHRH) are used for the endocrine treatment of prostatic cancer, central early puberty and various gynaecological conditions. Cutaneous adverse events seldom occur. We report a case of injection-site granulomas induced by leuprorelin acetate (Enantone®). CASE REPORT A 76-year-old man presented with several subcutaneous nodules on his left arm. The nodules were hard but painless. He had received subcutaneous injections of Enantone® for prostatic cancer. Histological examination of a skin biopsy specimen demonstrated granulomatous inflammation with a necrotic centre; screening for an infectious aetiology was negative. Serial sections showed giant cells containing translucent round microspheres in the subcutaneous tissue. Limitation to the leuprorelin acetate injection sites in the arm and detection at histological analysis of microspheres probably bound to an injected product militated in favour of granulomas caused by injections of Enantone®. DISCUSSION Injection-site granulomas caused by Enantone® are rare. Their formation may depend on the mode of administration: the more superficial the injection, the higher the risk of developing granulomas. The formation of these lesions is probably a foreign body reaction to the excipient.

Predictors of long‐term drug survival for infliximab in psoriasis

Limited information is available regarding factors associated with long‐term drug survival of infliximab for psoriasis in real life.

Effets secondaires cutanés de l’association télaprévir/peg-interféron/ribavirine pour le traitement de l’hépatite C chronique : étude prospective d’une cohorte multicentrique

BACKGROUND Telaprevir, sale of which was suspended, has been approved in combination with pegylated interferon and ribavirin (triple therapy) in the treatment of chronic hepatitis C virus (HCV). Skin eruptions and isolated cases of severe cutaneous adverse reactions (SCAR) have been reported. AIMS Our aim was to assess the incidence of skin eruption and the clinical characteristics of mucocutaneous adverse events (AE), and to identify potential risk factors for telaprevir-associated skin eruption. PATIENTS AND METHODS A prospective observational multicenter follow-up cohort study with monthly controls by a dermatologist and additional examinations in case of any undercurrent AE. RESULTS Among the 48 enrolled patients, the incidence of skin eruption was 58.4%, consisting mainly of maculopapular and eczematous lesions and only one case of SCAR. Telaprevir was discontinued in 6% of patients due to severe rash, whereas peginterferon and ribavirin were continued. The median time to onset of rash following telaprevir initiation was 25 days (range: 3-79 days). The rash was preceded by skin dryness and associated with pruritus in 100% and 90% of patients, respectively. Of those presenting with skin eruption, 37.5% also complained of conjunctival or oral lesions, or of anorectal symptoms. Neither a past history of dermatological conditions nor sociodemographic or viral status was predictive factor for skin rash. CONCLUSIONS Telaprevir-related dermatitis has a high incidence but is mostly of mild intensity. In most cases, tri-therapy was continued under close dermatological follow-up allowing rapid detection of rare instances of severe drug eruptions. Ribavirin and Interferon were thus continued even in the event of diffuse eruptions, enabling confirmation of the causative role of telaprevir in these eruptions.

Immune checkpoints inhibitors for solid tumours after allogeneic haematopoietic stem-cell transplantation: About four clinical cases

Immunotherapy, and particularly immune checkpoint inhibitors (ICI), represents one of the best advances in oncology in the last decade. Drugs which block the immune checkpoints (mainly PD-1/PD-L1 and CTLA-4) pathway have shown durable objective responses for advanced various solid malignancies including melanoma [1e3] and nonesmall cell lung carcinoma [4e6]. CTLA-4 is a negative regulator of Tcell activation [7], which can be inactivated by ipilimumab, a recombinant human monoclonal antibody that avoids CTLA-4 binding to its ligand. Nivolumab and pembrolizumab are human monoclonal antibodies that block the interaction between programmed cell death protein 1 receptor (PD-1) and its ligands (PD-L1 and PD-L2) leading to a decrease in PD-1emediated inhibition of the immune response [8]. CTLA-4 and PD-1 pathways are also involved in limiting excessive T-cell activation and prevention of auto-immunity [9]. Allogeneic haematopoietic stem-cell transplantation