Introduction La leptospirose est une zoonose particulièrement fréquente dans les départements et régions d’Outre-mer (DROM), où son incidence est 20 à 50 fois supérieure à celle observée en France hexagonale. Malgré ce constat, les études prospectives restent rares. Des incertitudes persistent quant à la prise en charge thérapeutique, la pertinence de certains tests diagnostiques, les facteurs pronostiques ou l’identification des populations à risque. Depuis l’inscription de la leptospirose comme maladie à déclaration obligatoire en août 2023, la nécessité d’un dispositif d’observation pérenne et harmonisé à l’ensemble des DROM s’est renforcée. Méthodologie LEPTO-FROG (LEPTOspirosis FRench Overseas Group registry) a pour ambition d’être le premier recueil multicentrique et prospectif consacré à la leptospirose dans les DROM. Ce registre s’appuie sur un réseau déjà structuré, associant cliniciens (infectiologues, réanimateurs, urgentistes) et microbiologistes. Les données épidémiologiques, clinico-biologiques, diagnostiques et thérapeutiques des patients pris en charge à l’hôpital pour une leptospirose confirmée ou probable seront recueillies via un e-CRF standardisé, complémentaire au formulaire de déclaration obligatoire. Chaque DROM dispose d’un binôme d’infectiologues référent qui assure : le lien avec les laboratoires, la vérification de l’exhaustivité du recueil et l’accompagnement des équipes. Résultats attendus La capacité d’inclusion attendue de ce registre est de 300 à 400 cas par an. Il permettra ainsi de documenter de manière harmonisée les critères d’hospitalisation et les modalités de prise en charge des cas de leptospirose dans ces DROM. Il fournira des données indispensables pour évaluer les performances des tests diagnostiques (PCR sanguine, PCR urinaire, sérologie), identifier des facteurs pronostiques et caractériser l’épidémiologie microbienne (sérogroupes, génovars) ainsi que son impact sur les phénotypes cliniques. Il contribuera également à identifier des facteurs d’exposition communs ultramarins et spécifiques à chaque territoire, utile pour guider les mesures de prévention. A terme, une interface en lien avec la médecine de ville pourrait être envisagée afin de gagner en exhaustivité et représentativité. Discussion/Conclusion La mise en place du registre LEPTO-FROG représente une opportunité majeure d’harmoniser les pratiques et d’améliorer la prise en charge de la leptospirose dans les DROM. Les données produites permettront de réévaluer les stratégies diagnostiques en vie réelle, d’optimiser les parcours de soins et de développer des actions de prévention ciblées adaptés aux réalités locales. Ce registre s’inscrit donc pleinement dans les priorités de santé publique visant à améliorer la surveillance et la prise en charge d’une maladie fréquente et potentiellement grave.
In their article entitled “Morocco, a New Era of Robotic Surgery”, published in the Société Internationale d’Urologie Journal, El Anzaoui et al [...]
BACKGROUND:The diagnostic accuracy of prostate cancer has been improved by the use of multiparametric magnetic resonance imaging (MRI). However, the role of the Prostate Imaging-Reporting and Data System (PI-RADS) score in combination with MRI in predicting issues after local prostate cancer treatment remains unclear. The aim of this study was to evaluate the PI-RADS score as a predictive factor for biochemical recurrence or progression (BCR) of prostate cancer. METHODS:This retrospective monocentric study included 304 men who underwent targeted prostate biopsies plus standard biopsies after MRI between 2017 and 2020. All the included patients had a PI-RADS score of at least 3. Survival probabilities were estimated by the Kaplan-Meier method. The hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between individual characteristics and BCR or progression were estimated using the Cox proportional hazards regression model for univariate and multivariate analyses. All tests were two-sided, and P<0.05 was considered to indicate statistical significance. All analyses were performed using StatView software version 5.0 and MedCalc software version 17.5. RESULTS:In total, 283 patients were included in our study. The median age at biopsy was 67.8 years, and the median follow-up was 4.9 years. The median time to BCR or progression after active surveillance (AS) was 4.7 years. A total of 22.3% of the patients experienced biochemical recurrence. No risk factors for biochemical recurrence according to the MRI PI-RADS score were significantly identified by univariate or multivariate analyses. Biochemical-free survival was 87% for the PI-RADS 5 group, 90% for the PI-RADS 4 and 80% for the PI-RADS 3 group at 3 years. There were no significant differences among these three groups in terms of BCR-free survival (P=0.4). CONCLUSION:In the present study, MRI lesion description with PI-RADS or the usual risk group did not seem to be sufficient to predict biochemical recurrence after local prostate cancer treatment, especially in our particular population. Future studies could pair the PI-RADS with histologic data of the prostatic index lesion to predict recurrence. LEVEL OF EVIDENCE: 4:
Introduction The lung cancer continues to be the primary cause of cancer-related deaths, despite significant advancements in treatment through the introduction of immunological checkpoint inhibitors (ICI). These inhibitors, initially used as monotherapy, are now employed in combined therapies, resulting in improved survival rates. The ICI function by restoring T-cell activity to target tumor cells, but may lead to undesirable immune-related adverse events (irAE), necessitating careful management. Methods The IMPATHI study, a prospective observational study conducted at the Begin Military Hospital, evaluated patient adherence to ePRO-based telemonitoring using the Cureety platform. The study included patients with advanced thoracic cancer receiving immunotherapy. Minors and those who did not consent to digital surveillance were excluded. Patients filled out ePRO questionnaires, and their health status was classified into four levels. The primary objective was compliance evaluation, with secondary objectives including tolerance profile and impact on survival. Results The study recruited 22 patients, with a median age of 66years. Adenocarcinoma was the most common diagnosis, and 91% of patients had metastatic disease. Patient adherence to the telemonitoring platform was 83.3%, with 64% of responses indicating stable conditions. Common adverse events included asthenia, dyspnea, and joint/muscle pain. The 24-month progression-free survival rate was 79%, and the overall survival rate was 71.1%. Conclusion The IMPATHI study demonstrates the potential of telemonitoring in the management of lung cancer patients receiving ICI therapy, with high compliance and promising survival outcomes. Telemonitoring offers significant benefits in early detection of adverse events and personalized care to patients. Future efforts should focus on expanding access to telemonitoring for all patients.
