Risultati della ricerca per “Position paper della French Headache Society sul trattamento dell'emicrania” – Pagina 5

Objectives
This study aims to characterise the diversity of post-COVID-19 physical and mental health outcomes, known as the post-COVID-19 condition (PCC), and the determining factors 3–6 months after acute SARS-CoV-2 infection.

Design
This is a prospective cohort study.

Setting
This study took place at the European Hospital of Marseille, France.

Participants
Participants include patients with acute COVID-19 treated as inpatients or outpatients.

Interventions
Interventions include face-to-face assessment of physical and mental health symptoms.

Main outcome measures
Main outcome measures include symptom scores and scales, as well as paraclinical elements (thoracic CT scan, pulmonary functional tests). Multiple component analysis was used to identify clinical phenotypic clusters of PCC patients, as well as their initial comorbidity groups. A multinomial regression model was used to evaluate the association between the initial comorbidities and disease severity with PCC phenotype.

Results
A total of 210 patients agreed to participate, of which 157 (75%) reported at least one symptom at the 3–6 months visit; mostly asthenia, dyspnoea, psychiatric disorders such as anxiety, depression, post-traumatic stress disorder and cognitive disorders. Four PCC clusters were recognised: (1) paucisymptomatic PCC (n=82, 39%); (2) physical sequelae PCC (n=39, 18.6%), (3) pre-existing pulmonary comorbidities PCC (n=29, 13.8%); and (4) functional somatic and/or mental symptoms PCC (n=60, 28.6%). In addition to their PCC symptoms, the patients in these clusters differed in terms of their demographic characteristics (sex), comorbidities and severity of COVID-19.

Conclusions
The four identified PCC clusters corresponded to distinct and coherent clinical and paraclinical entities, making it possible to consider adapted and personalised prognosis and therapeutic interventions.

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Febbraio 2025

Guidelines Development Group for the British Society of Gastroenterology guidelines for the diagnosis and management of cholangiocarcinoma

GUT (Recent Issues)

We have recently published in Gut the British Society of Gastroenterology (BSG) guidelines for the diagnosis and management of cholangiocarcinoma.1 In the guidelines we recommended cisplatin plus gemcitabine (CisGem) chemotherapy as first-line systemic treatment in patients with advanced biliary tract cancer (BTC), and that immunotherapy may be added to CisGem chemotherapy if approved and available (Recommendation 39). A few weeks after the guidelines were published, the UK’s National Institute for Health and Care Excellence approved and recommended the use of durvalumab plus gemcitabine and cisplatin as an option for treating locally advanced, unresectable or metastatic BTC in adults,2 and we believe this triple combination should be first line. This was also approved by the Scottish Medicines Consortium in November 2023 and thus represents a new standard of care for cholangiocarcinoma treatment, but this is not specifically mentioned in the latest published BSG guidelines. Furthermore, at…

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Febbraio 2025

Biological embodiment of educational attainment and future risk of breast cancer: findings from a French prospective cohort

BMJ (recent)

Background
Women with higher educational attainment have a higher risk of developing breast cancer (BC). Despite the acknowledged impact of reproductive and lifestyle factors, some excess risks remain unexplained. Many studies support the hypothesis that education has a distinctive effect on physiological processes associated with health, independently of known risk factors.

Objectives
In this study, we aimed to determine whether the biological embodiment of education could be part of the observed social inequalities in BC risk. We focused on biomarkers from several physiological systems examined individually, and jointly through a biological health score (BHS).

Design
Prospective cohort study.

Setting
This study, based on a subsample of the French E3N cohort, included women with biological data from four nested case–control studies.

Participants
The study included 3048 postmenopausal women (17% BC).

Main outcome measures
We first evaluated the association between educational attainment and each biomarker, separately (N=11) and by combining them into a BHS, indicative of an augmented biological health hazard when elevated. Finally, we explored the relationships between the socially patterned biomarkers and BHS, and risk of incident BC.

Results
Women with higher educational attainment exhibited a lower BHS in comparison to those with lower educational attainment (βhigh education=–0.21 (95% CI –0.42; 0.01), model 2). Specific biomarkers associated with the cardiovascular (systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides (TG), high-density lipoprotein (HDL)), inflammatory (C reactive protein (CRP)) and hormonal systems (sex hormone-binding globulin (SHBG) and oestradiol) were found socially distributed (OR CRP-high=0.70 (95% CI 0.54; 0.91), OR TG-high=0.79 (95% CI 0.61; 1.04), OR DBP-high=0.69 (95% CI 0.53; 0.90), OR SBP-high=0.57 (95% CI 0.44; 0.74), OR HDL-high=0.79 (95% CI 0.60; 1.03), (OR SHBG-high=0.67 (95% CI 0.52; 0.88), OR oestradiol-high=1.34 (95% CI 1.00; 1.79); model 1). Associations persisted after adjustment for cofounders and a large set of potential mediators for two of the investigated cardiovascular markers (OR DBP-high=0.75 (95% CI 0.57; 1.00), OR SBP-high=0.61 (95% CI 0.46; 0.81); model 2). No associations were found between the socially stratified biomarkers and BHS with risk of BC.

Conclusion
Educational attainment has a direct impact on biological processes suggesting that the biological embodiment of the social environment could be a potential pathway that mediates the association between educational attainment and health. Further studies are needed to specifically investigate the relationships between socially stratified biomarkers and BC risk.

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Febbraio 2025