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George D, Allena R, Bourzac C, Pallu S, Portier H, Rémond Y. How mechanobiological modelling of cellular activities can predict bone density evolution? Comput Methods Biomech Biomed Engin 2020. [DOI: 10.1080/10255842.2020.1812843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- D. George
- University of Strasbourg, CNRS, ICUBE, Strasbourg, France
| | - R. Allena
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, Paris, France
| | - C. Bourzac
- University of Paris, CNRS, INSERM, B3OA, Paris, France
| | - S. Pallu
- University of Paris, CNRS, INSERM, B3OA, Paris, France
- University of Orléans, COST, Orléans, France
| | - H. Portier
- University of Paris, CNRS, INSERM, B3OA, Paris, France
- University of Orléans, COST, Orléans, France
| | - Y. Rémond
- University of Strasbourg, CNRS, ICUBE, Strasbourg, France
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Abstract
12 female judoists using oral contraceptives (OCU) containing 0.03 mg ethinylestradiol and 3 mg drospirenone for 20 ± 12 months (mean ± SD) were compared with a control group of 14 judoist noncontraceptive users (NCU) in order to evaluate resting (T1) and postexercise (T2) lipid peroxidation (LPO) and antioxidant parameters. Data were collected 20 min before and 10 min after a morning session of judo training and included determination of lag phase (Lp) before free radical-induced oxidation, glutathione peroxidase (GPx), α-tocopherol, retinol, and oxidative stress markers related to LPO. Significantly higher resting oxidative stress (+125.8 and +165.2% for malondialdehyde and lipid peroxides, respectively) and lower values of Lp and GPx (-23.4 and -12.1%, respectively) were observed in the OCU compared with NCU. The judo training session induced an increase in plasma LPO whatever the treatment. We noted significant increases in Lp (+14.7%; p<0.05 vs. preexercise) and GPx (22.1%; p<0.05 vs. preexercise) only in the NCU group. We suggest that a judo training session favourably altered some antioxidants in NCU but not in OCU. As excessive oxidative stress is linked to the development of several chronic diseases, the use of agents to reduce antioxidants may be reasonable in OCU.
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Chavanet P, Atale A, Mahy S, Neuwirth C, Varon E, Dabernat H, Portier H. [Nasopharyngeal carriage, antibiotic susceptibility and serotyping of Streptococcus pneumoniae and Haemophilus influenzae in children attending day care centers]. Med Mal Infect 2011; 41:307-17. [PMID: 21429682 DOI: 10.1016/j.medmal.2011.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 12/27/2010] [Accepted: 02/07/2011] [Indexed: 11/28/2022]
Abstract
UNLABELLED The aim of this study was to investigate the nasal carriage of Streptococcus pneumoniae (SP) and Haemophilus influenzae (HI) in children. METHODS Nasal samples were swabbed from children 3 months to 3 years of age, between December 2006 and April 2007, in 10 day-care centers in Dijon. RESULTS Three hundred and eighty-five children, 22.7 ± 8.4 months, were included. All were vaccinated against H1 and 92% had received at least one dose of PCV7 vaccine. HI colonization (55%) was associated with young age and concomitant pneumococcal carriage (52.4% vs. 39%). Amoxicillin/clavulanate and cefotaxime resistance rates were 17% and 0.5%. Pneumococcal carriage (48%) was increased in case of prior hospitalization. The rate of PDSP, 50%, was increased in case of recent infection (91% vs. 81%), previous antibiotherapy (64% vs. 41%), and decreased if PCV7 was completed (40.2% vs. 61,8%). There was no resistance to amoxicillin. The erythromycin resistance rate was 50.5%. 15% of the strains were vaccinal serotypes. Thirty-six and 41% of the strains were related and non-related to vaccine serotypes. Twenty-four and 11.6% of the strains were serotypes 19A and 6A respectively. CONCLUSION Over the last 10 years the global antibiotic resistance in children decreased for SP (22.9%) but nasal colonization remained stable due to the increase of some serotypes, such as 19A, most often resistant to antibiotics. The vaccine effectiveness against HI is optimal since no HIb serotypes were detected; resistance to betalactam is currently due equally to enzymatic mechanism and alteration of protein binding penicillin.
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Affiliation(s)
- P Chavanet
- Département d'infectiologie, CHU de Dijon, BP 77908, 21000 Dijon, France.
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Préau M, Leport C, Salmon-Ceron D, Carrieri P, Portier H, Chene G, Spire B, Choutet P, Raffi F, Morin M. Health-related quality of life and patient–provider relationships in HIV-infected patients during the first three years after starting PI-containing antiretroviral treatment. AIDS Care 2010; 16:649-61. [PMID: 15223534 DOI: 10.1080/09540120410001716441] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The aim of this study was to investigate factors associated with better health-related quality of life (HRQL) during the first three years after starting PI-containing antiretroviral treatment. Clinical, social and behavioural data from the APROCO cohort enabled us to analyze simultaneously the association between HRQL and patients' relationships with their health care providers. A self-administered questionnaire collected information about HRQL (MOS-SF36) and relationships with medical staff (trust and satisfaction with information). Two aggregate scores, the physical (PCS) and mental (MCS) component summaries (adjusted for baseline HRQL), were used as dependent variables in the linear regressions to identify factors associated with HRQL. We had complete longitudinal data for 360 of the 611 patients followed through M36. Factors independently associated with a high MCS were (male) gender, no more than one change in treatment, (few) self-reported symptoms and trust in the physician. Factors independently associated with high PCS levels were employment, no children, (few) self-reported symptoms and satisfaction with the information and explanations provided by the medical staff. These results underline the need to improve patient-provider relationships to optimize long-term HRQL. Socio-behavioural interventions should focus on this goal.
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Affiliation(s)
- M Préau
- INSERM U379/ORS,Marseille and University Aix-Marseille, Aix en Provence, France.
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Duong M, Dubois C, Buisson M, Eicher JC, Grappin M, Chavanet P, Portier H. Non-Hodgkin's lymphoma of the heart in patients infected with human immunodeficiency virus. Clin Cardiol 2009; 20:497-502. [PMID: 9134285 PMCID: PMC6655975 DOI: 10.1002/clc.4960200519] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A case of HIV-associated cardiac non-Hodgkin's lymphoma (NHL) is described, and the epidemiologic and clinicopathologic features of 21 cases previously reported in the literature are analyzed. All patients were homosexual males, and the cardiac NHL was the first acquired immune deficiency syndrome-defining condition in the majority. Patients were referred with nonspecific clinical findings including dyspnea and tachycardia, but rapid progression of cardiac dysfunction was frequent after symptoms appeared. Echocardiography constitutes the most useful noninvasive procedure in the diagnosis of cardiac NHL. Most of the patients had disseminated diseased at initial presentation; pathologically, the lymphomas were of B lymphocyte origin and of high-grade subtypes. Prognosis of HIV-associated cardiac NHL is generally poor, although clinical remission has been observed with combination chemotherapy. Cardiac lymphomas in HIV-associated patients are typically high-grade and often disseminate early. Although the prognosis is poor, patients in whom dissemination has not occurred could have longer survival under systemic chemotherapy.
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Affiliation(s)
- M Duong
- Department of Infectious Diseases, Hôpital du Bocage, Dijon, France
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Arlettaz A, Le Panse B, Portier H, Lecoq AM, Thomasson R, De Ceaurriz J, Collomp K. Salbutamol intake and substrate oxidation during submaximal exercise. Eur J Appl Physiol 2008; 105:207-13. [PMID: 18925413 DOI: 10.1007/s00421-008-0891-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2008] [Indexed: 11/24/2022]
Abstract
In order to test the hypothesis that salbutamol would change substrate oxidation during submaximal exercise, eight recreationally trained men twice performed 1 h at 60% VO(2) peak after ingestion of placebo or 4 mg of salbutamol. Gas exchange was monitored and blood samples were collected during exercise for GH, ACTH, insulin, and blood glucose and lactate determination. With salbutamol versus placebo, there was no significant difference in total energy expenditure and substrate oxidation, but the substrate oxidation balance was significantly modified after 40 min of exercise. ACTH was significantly decreased with salbutamol during the last 10 min of exercise, whereas no difference was found between the two treatments in the other hormonal and metabolic parameters. The theory that the ergogenic effect of salbutamol results from a change in substrate oxidation has little support during relatively short term endurance exercise, but it is conceivable that longer exercise duration can generate positive findings.
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Affiliation(s)
- A Arlettaz
- Laboratoire Activité Motrice et Adaptation Psychophysiologique, UFR STAPS, Université d'Orléans, 2, Allée du Château, BP6237, 45062 Orléans Cedex 2, France
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Portier H, Chatard JC, Filaire E, Jaunet-Devienne MF, Robert A, Guezennec CY. Effects of branched-chain amino acids supplementation on physiological and psychological performance during an offshore sailing race. Eur J Appl Physiol 2008; 104:787-94. [PMID: 18704484 DOI: 10.1007/s00421-008-0832-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2008] [Indexed: 12/01/2022]
Abstract
The aim of the present study was to investigate the effect of protein diets, rich in branched chain amino acids (BCAA) on perceived exertion, mental and physical performance during an offshore sailing race that lasted 32 h. Twelve sailors were randomly allocated into one of two groups [Control (CON) and BCAA: n = 6/group]. The BCAA group consumed a standard diet of 11.2 MJ day(-1) (58% carbohydrate, 30% fat, 12% Protein) along with a high-protein supplement of 1.7 MJ day(-1) (40% carbohydrate, 35% protein, 25% fat) and 1.7 MJ day(-1) composed of 50% valine, 35% leucine, and 15% isoleucine. CON was given a standard diet of 14.5 MJ day(-1) (58% carbohydrate, 30% fat and 12% protein). During the race, heart rate was monitored. Subjects self-evaluated their feeling of fatigue every 3 h, and 12 samples of saliva from each subject were collected to perform cortisol assays. Before and after the race a vertical jump and a handgrip test were performed, and mental performance was evaluated with a standardized battery of tests. A significant increase in the feeling of fatigue was noted on the second day (D2) of race in both groups; the increase was higher in CON (P < 0.05). For both groups, salivary cortisol concentration followed a nycthemeral rhythm, with an alteration during the race as evidenced by high midnight cortisol levels between D1 and D2, and significantly decreased cortisol levels observed on D2 (P < 0.05). There was no change in physical performance at the end of the race in both groups. As a significant decrease (P < 0.05) in short-term memory performance was observed only in the CON group. These data indicate that an offshore sailing race enhances the feeling of fatigue, and decreases short-term memory performance. These detrimental consequences are reduced by a high-protein diet with BCAA.
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Affiliation(s)
- H Portier
- AMAPP EA 4248, Université d'Orléans, 2 allée du château, Orléans, France.
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Collomp K, Arlettaz A, Portier H, Lecoq AM, Le Panse B, Rieth N, De Ceaurriz J. Short-term glucocorticoid intake combined with intense training on performance and hormonal responses. Br J Sports Med 2007; 42:983-8. [PMID: 18048433 DOI: 10.1136/bjsm.2007.043083] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the effects of short-term prednisolone ingestion combined with intense training on exercise performance, hormonal (adrenocorticotrophic hormone (ACTH), prolactin, luteinising hormone (LH), growth hormone (GH), thyroid-stimulating hormone (TSH), dehydroepiandrosterone (DHEA), testosterone, insulin) and metabolic parameters (blood glucose, lactate, bicarbonate, pH). METHODS Eight male recreational athletes completed four cycling trials at 70-75% peak O(2) consumption until exhaustion just before (1) and after (2) either oral placebo or prednisolone (60 mg/day for 1 week) treatment coupled with standardised physical training (2 hours/day), according to a double-blind and randomised protocol. Blood samples were collected at rest, during exercise and passive recovery for the hormonal and metabolic determinations. RESULTS Time of cycling was not significantly changed after placebo but significantly increased (p<0.05) after prednisolone administration (50.4 (6.2) min for placebo 1, 64.0 (9.1) min for placebo 2, 56.1 (9.1) min for prednisolone 1 and 107.0 (20.7) min for prednisolone 2). There was no significant difference in any measured parameters after the week of training with placebo but a decrease in ACTH, DHEA, PRL, GH, TSH and testosterone was seen with prednisolone treatment during the experiment (p<0.05). No significant change in basal, exercise or recovery LH, insulin, lactate, pH or bicarbonate was found between the two treatment, but blood glucose was significantly higher under prednisolone (p<0.05) at all time points. CONCLUSION Short-term glucocorticoid administration induced a marked improvement in endurance performance. Further studies are needed to determine whether these results obtained in recreational male athletes maintaining a rigorous training schedule are gender-dependent and applicable to elite athletes.
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Affiliation(s)
- K Collomp
- Laboratoire Activité Physique, Santé et Performance, UFR STAPS, Université d'Orléans, Orleans, France.
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Duong M, Dumas JP, Buisson M, Martha B, Piroth L, Grappin M, Waldner A, Chavanet P, Portier H. Limitation of exercise capacity in nucleoside-treated HIV-infected patients with hyperlactataemia. HIV Med 2007; 8:105-11. [PMID: 17352767 DOI: 10.1111/j.1468-1293.2007.00439.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Inhibition of DNA polymerase gamma by nucleoside reverse transcriptase inhibitors (NRTIs) can cause mitochondrial dysfunction and cellular toxicity. Hyperlactataemia, which is a consequence of a shift in the metabolism of pyruvate, is an indicator of nucleoside-related mitochondrial toxicity. METHODS We evaluated exercise and oxidative capacities as well as circulatory and ventilatory responses to exercise in 24 HIV-infected patients on NRTIs presenting hyperlactataemia [mean (+/-standard deviation) fasted lactate=3.5+/-1.1 mmol/L]; 27 NRTI-treated patients with normal baseline lactate concentrations were used as controls (mean fasted lactate=1.6+/-0.3 mmol/L). RESULTS In the patients with hyperlactataemia, the average peak work capacity (1.7+/-0.6 W/kg) and peak oxygen consumption (VO(2)) (21+/-4 mL/kg/min) were significantly lower (P<0.01) than in control subjects (work, 2.1+/-0.4 W/kg; VO(2), 25+/-4 mL/kg/min). The capacity to increase oxygen extraction during exercise was significantly diminished in the hyperlactataemia group, as shown by a low peak systemic arteriovenous oxygen difference (a-vO(2)) difference compared with controls (11+/-3 vs 14+/-3 mL/dL; P=0.008), and as indicated by a linear correlation between VO(2) and systemic a-vO(2) difference (r(2)=0.76). During exercise, the increases in cardiac output relative to VO(2) (mean Delta cardiac output (Q)/DeltaVO(2)=8+/-3.6) and ventilation (mean Delta ventilation (VE)/DeltaVO(2)=48.6+/-13.2) were significantly higher in hyperlactataemia patients compared with controls (mean cardiac output Delta(Q)/DeltaVO(2)=6+/-2; mean DeltaVE/DeltaVO(2)=42+/-12.7; P=0.03). CONCLUSIONS The degree of exercise limitation in patients with nucleoside-related mitochondrial toxicity correlates directly with the severity of impaired muscle oxidative phosphorylation, as indicated by the capacity for muscle oxygen extraction. Exaggerated circulatory and ventilatory responses to exercise are direct consequences of the level of impaired muscle oxidative phosphorylation.
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Affiliation(s)
- M Duong
- Service des Maladies Infectieuses, Hôpital Universitaire du Bocage, Dijon, France.
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Arlettaz A, Portier H, Lecoq AM, Labsy Z, de Ceaurriz J, Collomp K. Effects of acute prednisolone intake on substrate utilization during submaximal exercise. Int J Sports Med 2007; 29:21-6. [PMID: 17614029 DOI: 10.1055/s-2007-964994] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We examined the hypothesis that acute therapeutic glucocorticoid intake could change the contribution of fat and carbohydrate (CHO) in energy production during exercise. Nine healthy recreationally-trained male subjects twice performed submaximal exercise (60 min at 60 % VO2max) after ingestion of placebo (Pla) or 20 mg of prednisolone (Pred), according to a double blind and randomized protocol. Respiratory exchange was monitored during exercise and blood samples were collected at rest, every 10 min during exercise and after 5, 10, and 20 min of passive recovery. Pred intake significantly increased total energy expenditure during exercise, but CHO oxidation was lower and fat oxidation higher after Pred vs. Pla. ACTH and IL-6 concentrations were significantly decreased with Pred during exercise, whereas no variations were found in GH, insulin, blood glucose, and lactate between the 2 treatments. In conclusion, it appears that acute prednisolone systemic administration does reduce total carbohydrate oxidation during submaximal exercise. Further studies are necessary to clarify the mechanisms involved and to determine whether this modification in the substrate oxidation balance under glucocorticoid administration in recreationally-trained male subjects could result in a competitive advantage in elite athletes.
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Affiliation(s)
- A Arlettaz
- LAPSEP, UFR STAPS Orléans, Orléans Cedex 2, France.
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Arlettaz A, Collomp K, Portier H, Lecoq AM, Rieth N, Le Panse B, De Ceaurriz J. Effects of acute prednisolone administration on exercise endurance and metabolism. Br J Sports Med 2007; 42:250-4; discussion 254. [PMID: 17609220 DOI: 10.1136/bjsm.2007.039040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine whether acute glucocorticoid (GC) intake alters performance and selected hormonal and metabolic variables during submaximal exercise. METHODS In total, 14 recreational male athletes completed two cycling trials at 70-75% maximum O(2) uptake starting 3 h after an ingestion of either a lactose placebo or oral GC (20 mg of prednisolone) and continuing until exhaustion, according to a double-blind randomised protocol. Blood samples were collected at rest, after 10, 20, 30 minutes, and at exhaustion and recovery for measurement of growth hormone (GH), adrenocorticotropic hormone (ACTH), dehydroepiandrosterone (DHEA), prolactin, insulin, blood glucose, lactate and interleukin (IL)-6 determination. RESULTS Cycling duration was not significantly changed after GC or placebo administration (55.9 (5.2) v 48.8 (2.9) minutes, respectively). A decrease in ACTH and DHEA (p<0.01) was observed with GC during all of the experiments and in IL-6 after exhaustion (p<0.05). No change in basal, exercise or recovery GH, prolactin, insulin or lactate was found between the two treatments but blood glucose was significantly higher with GC (p<0.05) at any time point. CONCLUSION From these data, acute systemic GC administration does seem to alter some metabolic markers but did not influence performance during submaximal exercise.
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Affiliation(s)
- A Arlettaz
- LAPSEP, Faculty of Sport Science, University of Orléans, Orléans, France
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Portier H, Arlettaz A, Lepanse B, Lecocq AM, Collomp K. Variabilité de la fréquence cardiaque chez des gymnastes rythmiques prépubères: effets d'un entraînement intensif. Sci Sports 2007. [DOI: 10.1016/j.scispo.2007.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Perot A, Kazaz ES, Morgny C, Portier H. [Vaccination status of Burgundy inhabitants: a survey in various institutions]. Med Mal Infect 2007; 37:215-21. [PMID: 17336021 DOI: 10.1016/j.medmal.2006.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2005] [Accepted: 10/06/2006] [Indexed: 10/23/2022]
Abstract
AIM The authors had for aim to determine the vaccination coverage in Burgundy. This study was based on data collection from institutions either in charge of vaccination or controlling the vaccination coverage of given target populations. METHOD The concerned institutions were asked to provide a representative sample of the population controlled between September 2000 and June 2001 and a longitudinal study was carried out on the data. The analysis of vaccination coverage was made by institution and included i) the rate of people carrying a document proving their vaccination, ii) the rate of minimal vaccination coverage, and iii) the rate of maximal vaccination coverage. RESULTS 4,159 people participated in the study. The analysis revealed that, on the first university medical follow-up, young people rarely carried a vaccination certificate. This rate increased in occupational medicine and in healthcare institutions. The minimum rates of vaccination coverage against tetanus strongly decreased for population of over 60 years of age (39.6%), and adults living in precariousness (44.3%). In occupational medicine, 34.2% of women ignored their vaccinal status against rubella, almost 10% said that they had not contracted the disease and were not vaccinated. CONCLUSION This survey confirmed the urgent need to improve the vaccination coverage against tetanus for people over 60 years of age, and vaccination against rubella for women of reproductive age. It also demonstrated the need to provide adults with an appropriate vaccination file allowing recording and saving their respective vaccination status.
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Affiliation(s)
- A Perot
- Echelon Local du Service Médical d'Auxerre, 1 et 3, rue du Moulin, 89000 Auxerre, France.
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Arlettaz A, Portier H, Lecoq AM, Rieth N, De Ceaurriz J, Collomp K. Administration de courte durée de prednisolone et sécrétion d'érythropoïétine. Sci Sports 2007. [DOI: 10.1016/j.scispo.2006.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
To study the effects of a therapeutical dose of corticosteroid alone or associated with beta-2 agonist on performance and substrate response during intense submaximal exercise, seven healthy moderately trained male volunteers participated in the double-blind randomized cross-over study. An intense endurance exercise test to exhaustion was performed after ingestion of placebo (Pla), 20 mg prednisolone (Pred), and 20 mg prednisolone plus 4 mg salbutamol (Pred-Sal). Blood samples were collected at rest, after 5, 10 min of exercise, at exhaustion, and after 5 (r5), 10 (r10), and 20 (r20) min of passive recovery for ACTH, growth hormone, insulin, blood glucose, and lactate measurements. There were no significant differences in exercise time to exhaustion between the three treatments (Pla: 21.5 +/- 2.9; Pred: 22.0 +/- 2.5; Pred-Sal: 24.2 +/- 2.8 min). ACTH was significantly lowered after Pred and Pred-Sal vs. Pla from the start of exercise to the end of the experiment (p < 0.05). Pred and Pred-Sal increased resting and recovery (r10 and r20) significantly but not exercise blood glucose values. There were no significant differences in growth hormone concentrations between the three treatments whereas insulin was significantly higher at rest, during exercise, and at r20 after Pred-Sal administration vs. Pred and Pla (p < 0.05). Pred and Pred-Sal showed no significant effect on blood lactate compared with Pla treatment. These preliminary results do not support the hypothesis that acute oral therapeutic corticosteroid intake alone or associated with beta-2 mimetic improves performance during intense submaximal exercise, but further studies are necessary with tests of longer duration.
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Affiliation(s)
- A Arlettaz
- Atosep Laboratory, Faculty of Sports Sciences, University of Orleans, Vendôme street BP 6237, 45062 Orléans, France
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Audia S, Martha B, Grappin M, Duong M, Buisson M, Couaillier JF, Lorcerie B, Chavanet P, Portier H, Piroth L. Les abcès pyogènes secondaires du psoas : à propos de six cas et revue de la littérature. Rev Med Interne 2006; 27:828-35. [PMID: 16959381 DOI: 10.1016/j.revmed.2006.07.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2006] [Accepted: 07/17/2006] [Indexed: 11/27/2022]
Abstract
PURPOSE Psoas abscess is a rare disease in developed countries. Its diagnosis is difficult and any delay could lead to a worsen prognosis. The aim of this study is to determine the best diagnostic and therapeutic practices. METHODS A retrospective study of psoas abscess that occurred during six months was performed. RESULTS Six cases of secondary psoas abscess are reported. They were associated with spondylodiscitis in three cases, arthritis and gynaecologic infection in the three remaining cases. Anatomic diagnosis was performed by tomodensitometry. Microbiologic diagnosis was obtained by blood culture or direct puncture of the abscess. Antibiotics were associated with percutaneous drainage in two cases, with simple puncture in one case, and with surgery in one case. A local improvement w observed in all cases. The oldest patients presented the worst complications which were not directly caused by the abscess. CONCLUSION Physicians must be aware of psoas abscess because of their increasing incidence. Despite the fact that digestive pathologies are the main cause of secondary psoas abscess, bone infections, particularly spine infections, should be taken into consideration. Tomodensitometry guided puncture or percutaneous drainage are of diagnostic and therapeutic interest. Infectious samples must be taken before starting antibiotics, which have to be efficient against Gram negative bacillus, anaerobes and Staphylococcus aureus. Surgery must be quickly performed when the primary infection localisation need it, in case of voluminous abscess or when antibiotics and drainage are inefficient.
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Affiliation(s)
- S Audia
- Service des maladies infectieuses et tropicales, hôpital d'enfants, CHU de Dijon, 10, boulevard du Maréchal-de-Lattre-de-Tassigny, 21079 Dijon cedex, France
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Portier H, Arlettaz A, Lepanse B, Lecocq AM, Labsy Z, Collomp K. Estimation de la dépense énergétique en gymnastique rythmique. Sci Sports 2006. [DOI: 10.1016/j.scispo.2006.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Le Panse B, Arlettaz A, Portier H, Lecoq AM, De Ceaurriz J, Collomp K. Effets d'une prise chronique de salbutamol au cours d'un exercice maximal. Sci Sports 2006. [DOI: 10.1016/j.scispo.2006.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
OBJECTIVE To test the hypothesis that chronic salbutamol intake improves performance during supramaximal exercise and to estimate the effects of this treatment on body composition, bone mass, and metabolic indices in healthy women. METHODS Fourteen female volunteers (seven sedentary and seven recreationally trained) performed a 30 second Wingate test with and without salbutamol ingestion (12 mg/day for four weeks) in a random, double blind, crossover design. Blood samples were collected at rest, at the end of the test, and during passive recovery for lactate measurement. Body composition and bone mass were determined by dual energy x ray absorptiometry. RESULTS Peak power appeared significantly earlier and was significantly (p<0.05) increased after salbutamol intake in all subjects. There was no difference in total work performed and fatigue indices with salbutamol compared with placebo. No significant alterations in lean or fat body mass and bone variables were observed with salbutamol treatment in either trained or untrained subjects during the trial. In contrast, blood lactate was significantly (p<0.05) increased during the recovery period after salbutamol ingestion compared with placebo. CONCLUSION As in men, chronic administration of therapeutic concentrations of salbutamol did not induce an anabolic effect in women but increased maximal anaerobic power. Further studies are necessary to clarify the mechanisms involved.
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Affiliation(s)
- B Le Panse
- Laboratoire Activité Physique, Santé et Performance (LAPSEP), University of Orléans, Orléans, France
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Martha B, Croisier D, Durand D, Hocquet D, Plesiat P, Piroth L, Portier H, Chavanet P. In-vivo impact of the MexXY efflux system on aminoglycoside efficacy in an experimental model of Pseudomonas aeruginosa pneumonia treated with tobramycin. Clin Microbiol Infect 2006; 12:426-32. [PMID: 16643518 DOI: 10.1111/j.1469-0691.2006.01371.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aminoglycosides are of major importance in treating Pseudomonas aeruginosa pneumonia (PAP). However, their efficacy may be compromised by low-level resistance caused by the inducible MexXY multidrug efflux pump. In the present study, the impact of the MexXY efflux pump was investigated in vivo in an experimental model of PAP in rabbits treated with intravenous tobramycin. Three strains were used to induce PAP in rabbits: PAO1 (wild-type strain; MIC 1 mg/L), mutant 11B (mexX::Tn501; no expression of MexXY; MIC 0.5 mg/L) and mutant MutGR1 (MexZ null; constitutive expression of MexXY; MIC 2 mg/L). Five hours after inoculation, treatment with tobramycin (10 mg/kg) was implemented (peak serum concentration 30 mg/L). The animals were killed humanely 48 h after inoculation, and the residual pulmonary bacterial concentration was determined. Selection of bacteria expressing MexXY was determined by plating lung homogenates on agar plates containing antibiotic. Mean bacterial counts (log(10) CFU/g) for treated vs. untreated rabbits were 6.26 and 8.13 (p < 0.0001), 6.00 and 8.38 (p < 0.001), and 7.25 and 8.79 (p 0.04) for PAO1, 11B and MutGR1, respectively, with an overall mortality rate of 0% vs. 8.9% (p < 0.01). MexXY-overexpressing bacteria were recovered from three (21%) treated rabbits. The C(max)/MIC ratio was the parameter that was best associated with tobramycin efficacy. The bacteria overexpressing MexXY, recovered from lung, occurred with a C(max)/MIC window of 19-26. It was concluded that the experimental PAP model highlights poor tobramycin bacteriological efficacy in vivo, contrasting with survival gain, and that the contribution of the MexXY system to this low level of tobramycin efficacy is modest. Finally, this model appears to be suitable for the investigation of new anti-pseudomonal therapeutic strategies.
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Affiliation(s)
- B Martha
- Division of Infectious Diseases, Hôpital du Bocage, University Hospital, 21000 Dijon, France
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Collomp K, Le Panse B, Portier H, Lecoq AM, Jaffre C, Beaupied H, Richard O, Benhamou L, Courteix D, De Ceaurriz J. Effects of Acute Salbutamol Intake During a Wingate Test. Int J Sports Med 2005; 26:513-7. [PMID: 16195982 DOI: 10.1055/s-2004-821223] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To investigate the impact of acute salbutamol intake on performance and selected hormonal and metabolic variables during supramaximal exercise, 13 recreational male athletes performed two 30-second Wingate tests after either placebo (PLA, lactose) or salbutamol (SAL, 4 mg) oral administration, according to a double-blind and randomized protocol. Blood samples collected at rest, end of the Wingate test, recovery (5, 10, 15 min) were tested for growth hormone (GH), insulin (INS), blood glucose (GLU), and lactate determination. We found the peak and mean power performed significantly increased after SAL vs. PLA (PPSAL: 896 +/- 46; PPPLA: 819 +/- 57 W; MPSAL: 585 +/- 27; MPPLA: 534 +/- 35 W, p < 0.05), whereas no change was observed in the fatigue index. Blood glucose and INS were significantly increased by SAL at rest, at the end of the Wingate test, and during the 5 first minutes of recovery (p < 0.05). Plasma GH was significantly decreased by SAL (p < 0.05) during the recovery whereas end-exercise and recovery blood lactate tended but were not significantly increased after SAL vs. PLA. From these data, acute salbutamol intake at therapeutical dosage did appear to improve peak power and mean power during a supramaximal exercise, but the mechanisms involved need further investigation.
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Affiliation(s)
- K Collomp
- LPM-IPROS, Faculté du Sport et de l'Education Physique, Orléans, France.
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Le Panse B, Collomp K, Portier H, Lecoq AM, Jaffre C, Beaupied H, Richard O, Benhamou L, De Ceaurriz J, Courteix D. Effects of Short-Term Salbutamol Ingestion During a Wingate Test. Int J Sports Med 2005; 26:518-23. [PMID: 16195983 DOI: 10.1055/s-2004-821224] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The effects of a chronic salbutamol intake (SAL, 12 mg/d during 3 weeks) on changes in body composition, metabolic indices and performance during a 30-second Wingate test were determined in 8 strength-trained male athletes (T) and 7 sedentary male (UT) subjects, according to a double-blind, randomized, cross-over protocol. Blood samples were collected both at rest, at the end of the test, and during passive recovery (5 min, 10 min, 15 min) for leptin (at rest), and blood lactate measurements. No significant changes in lean body mass, fat mass, and leptin were observed with SAL treatment in either group during the trial. Peak power was significantly increased (p < 0.05) after SAL intake in all subjects (T: 11.9 %; UT: 8.3 %) with a decrease in time to peak power with SAL compared to placebo (PLA) (p < 0.05). There was no change in total work performed and in fatigue indices with SAL compared to PLA. Blood lactate was significantly increased after SAL vs. PLA during the recovery (p < 0.05) in all subjects. The data demonstrate that the chronic administration of therapeutic levels of salbutamol increases maximal anaerobic power in man, irrespective of the subjects' training status. This study also rules out any implication of an anabolic effect in this improvement in performance during supramaximal exercise. Further studies are necessary to clarify the mechanisms involved.
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Affiliation(s)
- B Le Panse
- LPM-IPROS, Faculté des Sports, Orléans, France
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24
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Portier H, Brambilla C, Garre M, Paganin F, Poubeau P, Zuck P. Moxifloxacin monotherapy compared to amoxicillin-clavulanate plus roxithromycin for nonsevere community-acquired pneumonia in adults with risk factors. Eur J Clin Microbiol Infect Dis 2005; 24:367-76. [PMID: 15944847 DOI: 10.1007/s10096-005-1347-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The objective of this study was to assess the efficacy and safety of moxifloxacin versus amoxicillin-clavulanate plus roxithromycin (comparator) in adult community-acquired pneumonia (CAP) patients with risk factors. In this comparative, randomized, multicenter, open-label study, patients hospitalized for CAP received a 10-day oral treatment with either moxifloxacin (400 mg o.d.) or amoxicillin-clavulanate (1,000/125 mg t.i.d.) plus roxithromycin (150 mg b.i.d.). Clinical and bacteriological outcomes were assessed during test of cure and follow-up visits (5-7 days and 21-28 days after the end of treatment, respectively). Of 349 randomized patients, 346 were included in the intent-to-treat analysis and 289 in the per-protocol analysis. Their baseline characteristics were comparable. The most frequent risk factors for mortality were age >65 years (50.0%), alcoholism (23.1%), and comorbidities (50.6%); chronic obstructive pulmonary disease (COPD) (25.4%) and diabetes mellitus (13.6%) were the most common associated comorbidities. A causative pathogen was documented in 66 of 346 (19.1%) of the patients (including 21 with positive blood cultures). Respective per-protocol clinical success rates at test-of-cure (primary efficacy endpoint) for moxifloxacin and comparator were 131 of 151 (86.8%) and 120 of 138 (87.0%), with a 95% confidence interval (CI) of -8.0-7.6 for the difference. Bacteriological success rates (eradication) were 23 of 30 (76.7%) and 23 of 31 (74.2%); rates for patients with positive blood cultures were 10 of 14 and 4 of 6. Persistent clinical success rates at follow-up were 118 of 120 (98.3%) and 102 of 106 (96.2%), with a 95%CI of -2.2-6.4 for the difference. The intent-to-treat analysis confirmed these results. Adverse events associated with moxifloxacin and the comparator drug were reported for 42 of 171 (24.6%) and 50 of 175 (28.6%) of the patients, respectively, and comprised predominantly digestive disorders, which occurred in 9.4% and 21.1%. On the basis of these results, once-daily oral moxifloxacin alone is as effective as amoxicillin-clavulanate plus roxithromycin for the treatment of CAP in patients with risk factors.
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Affiliation(s)
- H Portier
- CHU de Dijon, Hôpital du Bocage, BP 1542, 21034 Dijon Cedex, France.
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Le Panse B, Arlettaz A, Portier H, Lecoq AM, Courteix D, De Ceaurriz J, Collomp K. Répercussions d'une prise chronique de salbutamol au cours d'un exercice supramaximal. Sci Sports 2005. [DOI: 10.1016/j.scispo.2005.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Portier H, Beytout J. [Preventive antibiotherapy for splenectomized and asplenic patients. Recent recommendations]. Med Mal Infect 2005; 34 Suppl 1:S67-8. [PMID: 15676253 DOI: 10.1016/s0399-077x(04)90022-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- H Portier
- Service des maladies infectieuses et tropicales, CHU de Dijon, France
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Petit JM, Duong M, Masson D, Buisson M, Duvillard L, Bour JB, Brindisi MC, Galland F, Guiguet M, Gambert P, Portier H, Vergès B. Serum adiponectin and metabolic parameters in HIV-1-infected patients after substitution of nevirapine for protease inhibitors. Eur J Clin Invest 2004; 34:569-75. [PMID: 15305892 DOI: 10.1111/j.1365-2362.2004.01379.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In the context of HIV infection and antiretroviral therapy, adiponectin concentrations have been shown to be related to lipodystrophy, metabolic alterations and HIV-protease inhibitor (PI) use. The replacement of PI by nevirapine has improved the lipid profile of patients under antiretroviral therapy. The aim of the present study was to examine whether adiponectin concentration or insulin sensitivity level correlate with the modifications of lipid parameters after the switch of PI by nevirapine. MATERIAL AND METHODS The evolution of metabolic parameters before and after 6 months of substitution of nevirapine for protease inhibitors was evaluated in a cohort of 55 HIV-1 infected patients. Adiponectin concentration, insulin sensitivity, lipid profile, cholesterol ester transfer protein (CETP) mass concentration and triglyceride enrichment of HDL were determined before and after the replacement of PI by nevirapine. Insulin sensitivity was evaluated by the HOMA model assessment. RESULTS Twenty-four weeks of treatment with nevirapine improved significantly the lipid profile with a significant reduction of apoB (from 0.98 to 0.92 g L(-1); P = 0.005) and triglyceride (from 2.02 to 1.66 mmol L(-1); P = 0.02). HDL cholesterol and apoA1 increased significantly (from 0.99 to 1.19 mmol L(-1); P = 0.001 and from 1.40 to 1.57 g L(-1); P < 0.001, respectively). The triglyceride enrichment of HDL significantly decreased after the replacement of PI by nevirapine (from 0.248 +/- 0.092 to 0.213 +/- 0.093; P = 0.003). At baseline, and after 24 weeks of nevirapine treatment, we observed significant correlations between adiponectin level and lipid parameters [(HDL-cholesterol (r = 0.66, P = 0.001 and r = 0.69, P = 0.001); triglycerides (r = -0.42, P = 0.002 and r = -0.57, P = 0.001), and triglyceride enrichment of HDL (r = -0.43, P = 0.005 and r = -0.53, P = 0.005)]. Twenty-four weeks of treatment with nevirapine did not significantly change adiponectin concentrations (from 984 to 1086 micro g L(-1), P = 0.22), CETP mass and insulin sensitivity. CONCLUSION This study shows that even though a strong correlation was found between adiponectin and some metabolic parameters at baseline and after 24 weeks of treatment by nevirapine, the improvement of lipid profile observed after the replacement of PI by nevirapine was not in relation to the change of plasma adiponectin concentration. The significant decrease of triglyceride enrichment of HDL after the replacement of PI by nevirapine probably leads to a decreased catabolism of HDL lipoprotein, and consequently explains the increase of plasma HDL concentration observed in this study.
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Affiliation(s)
- J M Petit
- Hôpital Universitaire du Bocage, Dijon, France.
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Affiliation(s)
- C Veyssier-Belot
- Maladies infectieuses, hôpital du Bocage, BP 1542, Dijon cedex, France
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Duong M, Buisson M, Peytavin G, Piroth L, Charles P, Grappin M, Chavanet P, Portier H. D-03 Caractéristiques virologiques et pharmacologiques des échecs thérapeutiques après switch des antiprotéases par la névirapine chez des patients infectés par le VIH avec une charge virale VIH indétectable. Med Mal Infect 2004. [DOI: 10.1016/s0399-077x(04)90161-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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30
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Duong M, Cottin Y, Froidure M, Petit JM, Piroth L, Zeller M, L'huillier I, Fargeot A, Mahrousseh M, Chavanet P, Wolf JE, Portier H. [Is there an increased risk for cardiovascular disease in HIV-infected patients on antiretroviral therapy?]. Ann Cardiol Angeiol (Paris) 2004; 52:302-7. [PMID: 14714344 DOI: 10.1016/s0003-3928(02)00190-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
There is a growing concern about an increased risk for cardiovascular disease in HIV infected patients receiving antiretroviral therapy (ART). This risk could be related to metabolic abnormalities associated with long-term use of antiretroviral drugs. In fact, well recognized cardiovascular risk factors such as hypertension, dyslipidaemia, diabetes mellitus and central fat deposition are increasingly seen in HIV patients on ART. These factors can also be associated with non reversible risk factors, such as male sex, age greater than 40 years and family history of premature coronary artery disease. In addition, cigarette smoking and sedentary lifestyle may predispose these patients to significant cardiovascular disease. A direct atherogenic effect of HIV infection itself or antiretroviral drugs is unlikely. Epidemiological studies have suggested an increased risk for coronary artery disease in HIV infected persons; nevertheless, only long term follow-up could confirm this statement. Despite these uncertainties, it seems reasonable to identify and manage cardiovascular risk factors in HIV infected patients.
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Affiliation(s)
- M Duong
- Service des maladies infectieuses, centre hospitalier régional universitaire (CHRU) du Bocage, 21034 Dijon, France
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31
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Portier H, Grappin M. [Struggle against infectious risk in splenectomized subjects. Certitude and questions]. Presse Med 2003; 32:S29-30. [PMID: 14631645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Affiliation(s)
- H Portier
- Service des maladies infectieuses Hôpital d'Enfants, Dijon (21)
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32
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Petit JM, Duong M, Duvillard L, Florentin E, Portier H, Lizard G, Brun JM, Gambert P, Verges B. LDL-receptors expression in HIV-infected patients: relations to antiretroviral therapy, hormonal status, and presence of lipodystrophy. Eur J Clin Invest 2002; 32:354-9. [PMID: 12027876 DOI: 10.1046/j.1365-2362.2002.00989.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Abnormalities in lipid levels and lipodystrophy (LD) have been commonly reported after commencement of highly active antiretroviral therapy (HAART). A major mechanism by which plasma low-density lipoprotein (LDL) cholesterol levels may be influenced is via the regulation of hepatic LDL receptor expression. The activity of LDL receptors is under hormonal control. Moreover, HIV infection and HAART are associated with important modifications of hormonal status. As the cause of these adverse reactions is unknown, the effects of HAART and lipodystrophy on LDL receptors were evaluated. MATERIALS AND METHODS Thirty-nine HIV treated patients (21 with a protease inhibitor (PI) containing regimen, 18 without PI use) and 22 control subjects were tested for insulin resistance (HOMA model assessment), lipid profile, serum concentration of dehydroepiandrosterone (DHEA) and LDL-R expression. LDL-R on mononuclear cells were quantified by flow cytrometry. RESULTS Among the 39 HIV infected patients, 14 patients had a lipodystrophy (LD). Patients with LD had significantly higher levels of triglyceride (TG) and insulin resistance compared to patients without LD. There was no significant difference in LDL-R count between patients with or without PI use. In contrast, LDL-R count was significantly lower in patients with LD compared with those without (8504 +/- 3901 vs. 13 200 +/- 4532, P = 0.001). There was no difference in LDL-R count between patients without LD and control subjects. Patients with LD had lower levels of DHEA compared to patients without LD. In HIV-infected patients, we found a significant correlation between LDL-R expression and TG (r = -0.32; P = 0.04) and LDL cholesterol (r = -0.33; P = 0.04). In contrast, we did not observe a correlation between DHEA level and LDL-R count or LDL cholesterol level. CONCLUSIONS HIV-lipodystrophy is associated with a lower expression of LDL-R. This decreased expression of LDL-R seems independent of DHEA or insulin secretion.
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Affiliation(s)
- J M Petit
- Hôpital Universitaire du Bocage, 21000 Dijon, France.
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Duong M, Cottin Y, Piroth L, Fargeot A, Lhuiller I, Bobillier M, Grappin M, Buisson M, Zeller M, Chavanet P, Wolf JE, Portier H. Exercise stress testing for detection of silent myocardial ischemia in human immunodeficiency virus-infected patients receiving antiretroviral therapy. Clin Infect Dis 2002; 34:523-8. [PMID: 11797181 DOI: 10.1086/338398] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2001] [Revised: 09/04/2001] [Indexed: 11/04/2022] Open
Abstract
The prevalence of silent myocardial ischemia (SMI) and the factors associated with SMI were evaluated in patients infected with human immunodeficiency virus (HIV) who had been receiving highly active antiretroviral therapy (HAART) for > or =12 months and did not have known coronary artery disease or cardiac symptoms. Patients prospectively underwent exercise stress testing. The prevalence of SMI was 11% (11 of 99 patients). Patients who had SMI were significantly older than were patients who did not (mean+/-SD, 51+/-8 years vs. 42+/-9 years; P=0.001) and were more likely to have trunk obesity (54% of patients vs. 17%; P=.004). A significant correlation was found between a positive exercise test result and obesity (correlation,.006), waist-to-hip ratio (.007), and glucose and cholesterol levels (.04; P=.03). In multivariate analysis, age, central fat accumulation, and cholesterol level were independent variables associated with the detection of SMI. Exercise testing might be recommended for patients with HIV who have central fat accumulation and hypercholesterolemia.
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Affiliation(s)
- M Duong
- Service des Maladies Infectieuses, Hôpital du Bocage, Dijon 21034, France.
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Piroth L, Grappin M, Petit JM, Buisson M, Duong M, Chavanet P, Portier H. Incidence of gynecomastia in men infected with HIV and treated with highly active antiretroviral therapy. Scand J Infect Dis 2002; 33:559-60. [PMID: 11515774 DOI: 10.1080/00365540110026476] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A longitudinal study found that the incidence of gynecomastia in HIV-infected male patients treated with highly active antiretroviral therapy was 0.8/100 patient-years, with a prevalence of 2.8% in those treated for > or = 2 y. Even though the physiopathology remains unclear, this study suggests that gynecomastia should be monitored in these patients.
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Affiliation(s)
- L Piroth
- Department of Infectious Diseases, University Hospital of Dijon, France
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36
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Desbiolles N, Piroth L, Lequeu C, Neuwirth C, Portier H, Chavanet P. Fractional maximal effect method for in vitro synergy between amoxicillin and ceftriaxone and between vancomycin and ceftriaxone against Enterococcus faecalis and penicillin-resistant Streptococcus pneumoniae. Antimicrob Agents Chemother 2001; 45:3328-33. [PMID: 11709304 PMCID: PMC90833 DOI: 10.1128/aac.45.12.3328-3333.2001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In the present study we assessed the use of a new in vitro testing method and graphical representation of the results to investigate the potential effectiveness of combinations of amoxicillin (AMZ) plus ceftriaxone (CRO) and of CRO plus vancomycin (VAN) against strains of Streptococcus pneumoniae highly resistant to penicillin and cephalosporins (PRP strains). We used the fractional maximal effect (FME) method of time-kill curves to calculate adequate concentrations of the drugs to be tested rather than relying on arbitrary choices. The concentrations obtained, each of which corresponded to a fraction of the maximal effect, were tested alone and in combination with the bacterial strains in a broth medium. Synergy was defined as a ratio of observed effect/theoretical effect, called FME, of greater than 1, additivity was defined as an FME equal to 1, and antagonism was defined as an observed effect lower than the best effect of one of the antibiotics used alone. The area between antagonism and additivity is the indifference zone. The well-known synergy between amoxicillin and gentamicin against a reference strain of Enterococcus faecalis was confirmed, with a best FME equal to 1.07. Two strains of PRP, strains PRP-1 and PRP-2, were studied. The MICs for PRP-1 and PRP-2 were as follows: penicillin, 4 and 16 microg/ml, respectively; AMZ, 2 and 8 microg/ml, respectively, CRO, 1 and 4 microg/ml, respectively; and VAN, 0.5 and 0.25 microg/ml, respectively. For PRP-1 the best FME for the combination AMZ-CRO was 1.22 with drug concentrations of 1.68 mg/liter for AMZ and 0.17 mg/liter for CRO; the best FME for the combination VAN-CRO was 1.75 with VAN at 0.57 mg/liter and CRO at 0.17 mg/liter. For PRP-2 the best FME obtained for the combination AMZ-CRO was 1.05 with drug concentrations of 11.28 mg/liter for AMZ and 0.64 mg/liter for CRO; the best FME obtained for the combination VAN-CRO was 1.35 with VAN at 0.25 mg/liter and CRO at 1.49 mg/liter. These results demonstrated the synergy of both combinations, AMZ-CRO and VAN-CRO, against PRP strains at drug concentrations achievable in humans. Consequently, either of the combinations can be proposed for use for the treatment of PRP infections.
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Affiliation(s)
- N Desbiolles
- Infectious Diseases Department and EA562, University Hospital, Dijon, France
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37
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Chavanet P, Piroth L, Grappin M, Buisson M, Gourdon F, Cabié A, Duong M, Brunel-Dalmas F, Peytavin G, Portier H. Randomized salvage therapy with saquinavir-ritonavir versus saquinavir-nelfinavir for highly protease inhibitor-experienced HIV-infected patients. HIV Clin Trials 2001; 2:408-12. [PMID: 11673815 DOI: 10.1310/afde-2byx-mdgl-n6mp] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE To compare saquinavir + ritonavir and saquinavir + nelfinavir with nucleoside recycling in patients with multiple failures of highly active antiretroviral therapy (HAART). METHOD This was a prospective, multicenter, randomized open trial. Inclusion criteria were the following: consent, age > 18, previous protease inhibitor (PI) exposure > 6 months, unchanged HAART > 3 months, and viral load > 3 log. The treatments compared were ritonavir 200 mg bid + saquinavir 600 mg bid (Rito-Saq), and nelfinavir 1,000 mg bid + saquinavir 600 mg bid (Nelf-Saq). Nucleoside analogues were recycled, and nonnucleoside inhibitors were not permitted. Trough levels of the three drugs were measured by high-performance liquid chromatography at the month 3 visit. After the study had been completed, genotyping analysis was done on the first serum at entry. RESULTS The study was interrupted due to the availability of new anti-HIV drugs. A random sample of 31 (16 Rito-Saq and 15 Nelf-Saq) patients was divided into two groups, which were comparable in terms of demographic data and previous history of HIV infection. Mean CD4 cell count and plasma viral load (pVL) were 316 +/- 169 and 3.89 +/- 0.87 for Rito-Saq and 448 +/- 238 and 3.85 +/- 0.32 for Nelf-Saq. Previous duration of PI exposure was 31 months for both groups. The mean number of protease gene mutations was 3.8 (range, 2-7) and 4.4 (range, 2-9), respectively. On intention-to-treat (ITT) analysis at month 6, pVL stabilization or decrease >/= 0.5 log was observed in 18 patients (58%): 10 for Rito-Saq and 8 for Nelf-Saq. In a multivariate logistic regression analysis, virological success at month 3 was inversely correlated to baseline viral load (R = 0.14; 95% CI 0.03-2.9; p =.01); and at month 6, virological success was inversely associated to the number of mutations in the protease gene (R = 2.2; 95% CI 0.73-6.53; p =.06). CONCLUSION Nelf-Saq and Rito-Saq combinations can be proposed in case of multiple HAART failures. The fact that the virological response was inversely correlated to baseline viral load makes the case for an early switch after a HAART failure.
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Affiliation(s)
- P Chavanet
- Infectious Disease Department, Centre Hospitalier Universitaire of Dijon, France.
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Weber P, Filipecki J, Bingen E, Fitoussi F, Goldfarb G, Chauvin JP, Reitz C, Portier H. Genetic and phenotypic characterization of macrolide resistance in group A streptococci isolated from adults with pharyngo-tonsillitis in France. J Antimicrob Chemother 2001; 48:291-4. [PMID: 11481304 DOI: 10.1093/jac/48.2.291] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Three hundred and three strains of group A streptococci (GAS) isolated from adults with pharyngitis were tested to evaluate their phenotype of resistance to macrolides-lincosamides and to search for macrolide resistance genes. MICs of clarithromycin were determined. The overall rate of resistance to both erythromycin and clarithromycin was 9.6%. Constitutive, inducible and M phenotypes of resistance were detected in 4.3, 2 and 3.3% of strains, respectively. All constitutive phenotypes harboured ermB genes, whereas inducible phenotypes had the ermTR gene and M phenotypes had the mefA gene. In France, the current resistance rate of GAS to erythromycin and clarithromycin remains low.
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Affiliation(s)
- P Weber
- Laboratoire de Biologie Médicale BIO VSM, 10 rue de la Gare, F-77360 Vaires-sur-Marne, France.
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Duong M, Piroth L, Peytavin G, Forte F, Kohli E, Grappin M, Buisson M, Chavanet P, Portier H. Value of patient self-report and plasma human immunodeficiency virus protease inhibitor level as markers of adherence to antiretroviral therapy: relationship to virologic response. Clin Infect Dis 2001; 33:386-92. [PMID: 11438909 DOI: 10.1086/321876] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2000] [Revised: 11/27/2000] [Indexed: 11/03/2022] Open
Abstract
Three methods of adherence to antiretroviral therapy were evaluated for 149 patients infected with human immunodeficiency virus (HIV): plasma level of protease inhibitors (PIs), patient self-report, and routine biological parameters associated with the use of some antiretroviral drugs. Adherence to therapy was estimated from a score calculated from answers to a self-administered questionnaire and on the basis of measurement of relevant plasma and blood levels. Of the 149 patients, 112 had a virologic response, and 122 had adequate trough PI levels. Plasma PI levels and virologic outcome were significantly correlated (P<.0001). The adherence score was significantly correlated with virologic response (P<.001). Macrocytosis was significantly associated with virologic response in the patients treated with zidovudine or stavudine (P=.006). PI level was the higher significant predictor of virologic response (P=.0003). Self-reported adherence (P=.01) and macrocytosis (P=.05) were also independently associated with antiretroviral efficacy.
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Affiliation(s)
- M Duong
- Division of Infectious Diseases, University Hospital, Dijon, 21034, France
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Portier H, Bourrillon A, Lucht F, Choutet P, Géhanno P, Meziane L, Bingen E. [Treatment of acute group A beta-hemolytic streptococcal tonsillitis in children with a 5-day course of josamycin]. Arch Pediatr 2001; 8:700-6. [PMID: 11484451 DOI: 10.1016/s0929-693x(00)00301-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
MATERIAL AND METHODS In this randomized open study, 325 children aged two to 15 years with acute tonsillitis and a positive test of GA beta H streptococcal antigen were treated with josamycin 50 mg.kg-1.day-1 b.i.d for 5 days, or penicillin 50,000 to 100,000 IU/day t.i.d for 10 days. Clinical assessments and throat cultures for GA beta HS isolation were performed at the inclusion visit (V1), at the end of treatment visit (V2: day 12 for all patients) and at the follow-up visit (V3: day 30). In case of positive GA beta HS culture, the bacterial DNA by RFLP was performed to differentiate between the persistence (presence of original strain at V2), relapse (eradication at V2 and acquisition of same strain at V3) and reinfection (eradication at V2 and acquisition of different strain at V3). RESULTS Two hundred and twenty-three patients were included in the bacteriological and clinical criteria per protocol analysis. At V2, eradication rates were comparable: 82% in josamycin and 80% in penicillin patients; clinical cure rates were 90% and 89%. At V3, relapse of GAS assessed only on clinically and bacteriologically cured patients at V2 occurred in 12% of josamycin patients and 12.8% of penicillin patients. Tolerance was good; 14% and 10% of josamycin and penicillin patients respectively experienced an adverse event. CONCLUSION In this non-inferiority study, the efficacy of a 5-day course of josamycin is comparable to reference treatment in GA beta HS tonsillitis in children.
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Affiliation(s)
- H Portier
- Service des maladies infectieuses et tropicales, centre hospitalier Bocage, 10, boulevard du Maréchal-de-Lattre-de-Tassigny, BP 1542, 21034 Dijon, France.
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Abstract
UNLABELLED Physical training with incomplete recovery times can produce significant fatigue. A study of cardiovascular responses showed that there is a sympathetic and a parasympathetic form of fatigue. PURPOSE The purpose of this experimentation was to measure the effects of intense endurance training on autonomic balance through a spectral analysis study of the heart rate (HR) and systolic blood pressure (SBP). METHODS Eight elite runners were tested twice: after a relative rest period (RRP) of 3 wk and after an 12-wk intense training period (ITP) for endurance. At the end of each phase, the subjects were tested by means of a VO2max test and a tilt-table test. RESULTS The resting heart rate (HR) variability was lower (P < 0.001) in the intensive training phase. Likewise, there were differences in the low-frequency (0.04-0.150 Hz; LF) and high-frequency (0.150-0.500 Hz; HF) components and the LF/HF ratio of the HR spectral analysis. The LF spectral power was significantly lower in the supine position (P < 0.05) during ITP. Upright tilting was accompanied by a 22.6% reduction in HF values during the rest period, whereas in ITP the HF spectral power rose by 31.2% (P < 0.01) during tilt, characterizing a greater parasympathetic system control. Sympathetic control represented by the LF/HF ratio regressed markedly (P < 0.01) in response to the tilt test in ITP. CONCLUSIONS The spectral analysis of SBP in the high frequencies shows that the changes in cardiac parameters are coupled with a decrease in sympathetic vasomotor control (-18%) and a reduction in diastolic pressure (-3.2%) in the response to the tilt test at the end of ITP. Spectral analysis could be a means of demonstrating impairment of autonomic balance for the purpose of detecting a state of fatigue that could result in overtraining.
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Affiliation(s)
- H Portier
- Department of Physiology, Institut de Medecine Aérospatiale du Service de Santé des Armées, Bretigny sur Orge, France.
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Duong M, Petit JM, Piroth L, Grappin M, Buisson M, Chavanet P, Hillon P, Portier H. Association between insulin resistance and hepatitis C virus chronic infection in HIV-hepatitis C virus-coinfected patients undergoing antiretroviral therapy. J Acquir Immune Defic Syndr 2001; 27:245-50. [PMID: 11464143 DOI: 10.1097/00126334-200107010-00005] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Insulin resistance (IR) in the context of highly active antiretroviral therapy (HAART) is becoming more common in HIV-infected patients. Patients with chronic hepatitis C virus (HCV) infection have an increased risk of IR and type 2 diabetes mellitus. A cross-sectional study was performed to investigate whether chronic HCV infection constitutes a risk factor for IR in HIV-HCV-coinfected patients undergoing HAART. Inclusion criteria were positive HCV viremia and a sustained increase of alanine aminotransferase of at least twice the normal value. A total of 29 HIV-HCV patients, 76 HIV patients, and 121 HCV controls were tested for IR and body mass index (BMI). IR was measured using the homeostasis model assessment. In HIV-HCV and HIV patients, fat redistribution and lipid profile were assessed. There was no significant difference in age, CD4 cell count, HIV viral load, or duration of HAART between the HIV-HCV and HIV groups. HIV-HCV patients and HCV controls had a significant increase in IR when compared with HIV patients (0.25 +/- 0.28 and 0.21 +/- 0.34 versus 0.04 +/- 0.37; p =.01 and p =.003, respectively). Lipoatrophy was observed more frequently in HIV-HCV patients in comparison with HIV patients (41% versus 14%; p =.003). In HIV-HCV patients, total cholesterol and triglyceride levels were significantly lower than in HIV patients. In multivariate analysis, IR, BMI, triglyceride levels, and peripheral fat wasting were the independent variables associated with HCV infection. Our findings suggest that chronic HCV infection is a significant factor associated with the development of metabolic abnormalities and with modifications in body composition in HIV patients receiving antiretroviral treatment.
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Affiliation(s)
- M Duong
- Division of Infectious Diseases, Department of Endocrinology, and Division of Hepatology, University Hospital, Dijon, France.
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Guézennec CY, Louisy F, Portier H, Laude D, Chapuis B, Plésant J. Effects of aerobatics flight on oxygen consumption and heart rate control: influence on autonomic cardiovascular regulation during recovery. Eur J Appl Physiol 2001; 84:562-8. [PMID: 11482552 DOI: 10.1007/s004210100381] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Oxygen consumption (VO2) and blood pressure regulation were measured on five pilots during and after normal training aerobatics flights of a mean duration of 35 min. The acceleration vector along the longitudinal axis of the body (Gz) ranged from + 6.5 Gz to -3.5 Gz. VO2 was continuously monitored by a miniature telemetric system (K2). Heart rate (fc), the abdominal muscle electromyogram (EMG) and Gz levels were recorded synchronously on a magnetic tape recorder. A tilt test was performed pre- and post-flight to evaluate fc and blood-pressure variability. The left forearm blood flow was measured by strain-gauge plethysmography. The mean VO2 during flight was 1.2 l x min(-1), with a peak VO2 of 2.1 l x min x fc ranged between 55 and 165 beats x min(-1) and showed a progressive increase under the effect of + Gz, with a sudden fall during -Gz. The abdominal muscle EMG indicated the occurrence of muscle contraction under Gz load. Maximal responses were observed during the Gz phase. Comparison between pre- and post-flight data showed lower post-flight systolic blood pressure with higher fc. Before flight, upright tilt induced a significant increase in low/ high frequency fc, as assessed using spectral analysis. This change was suppressed after flight. In summary, these data show that aerobatics flight leads to enhanced energy expenditure, mainly because of increased skeletal muscle work. The post-flight tilt test showed that aerobatic flight favors parasympathetic drive and, consequently, modifies blood pressure regulation during recovery. This action may decrease + Gz tolerance to a second aerobatics flight performed shortly after the first.
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Affiliation(s)
- C Y Guézennec
- Department of Physiology, Institut de Médecine Aérospatiale du Service de Santé des Armées, Brétigny sur Orge, France.
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Duong M, Piroth L, Grappin M, Forte F, Peytavin G, Buisson M, Chavanet P, Portier H. Evaluation of the Patient Medication Adherence Questionnaire as a tool for self-reported adherence assessment in HIV-infected patients on antiretroviral regimens. HIV Clin Trials 2001; 2:128-35. [PMID: 11590521 DOI: 10.1310/m3jr-g390-lxcm-f62g] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Adherence to antiretroviral medications is critically important for the success of therapy in patients treated for HIV infection. Patient self-report is a simple method to measure and explore adherence. Even though a variety of surveys have been developed to monitor self-reported adherence, there is no standardized instrument that may be used in routine clinical practice. The usefulness of the Patient Medication Adherence Questionnaire (PMAQ) was evaluated in HIV-infected patients on protease inhibitor (PI)-containing regimens. METHOD Data from 149 patients were collected. Study participants completed the PMAQ and provided blood samples to measure plasma HIV-1 RNA concentrations and trough plasma levels of PI. Patients were considered adherent if they had a virologic response and/or had an adequate trough plasma level of PI. RESULTS A close relationship was found between patient reports of adherence during the previous 4 days and objective measures such as HIV RNA level and plasma levels of PI. Motivation with regard to antiretroviral treatment, confidence in personal skills, and an optimistic attitude to life were identified as important determinants of adherence. On the other hand, sociodemographic background, social support, alcohol and illicit drug use, bothersome symptoms, and depression were not associated with a lower medication adherence. CONCLUSION Patients' psychological and behavioral factors are central in the acceptance and adherence to antiretroviral therapy. To improve the feasibility and the reproducibility of the PMAQ, we propose a revised form of the PMAQ, focusing on the variables identified as strong predictors of adherence.
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Affiliation(s)
- M Duong
- Division of Infectious Diseases, University Hospital, Dijon, France
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Portier H, Peyramond D, Boucot I, Grappin M, Boibieux A, Pribil C. Évaluation de l'applicabilité du consensus sur la prise en charge de l'angine chez l'adulte. Med Mal Infect 2001. [DOI: 10.1016/s0399-077x(01)00209-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Piroth L, Desbiolles N, Mateo-Ponce V, Martin L, Lequeu C, Charles PE, Portier H, Chavanet P. HMR 3647 human-like treatment of experimental pneumonia due to penicillin-resistant and erythromycin-resistant Streptococcus pneumoniae. J Antimicrob Chemother 2001; 47:33-42. [PMID: 11152429 DOI: 10.1093/jac/47.1.33] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
An experimental Streptococcus pneumoniae pneumonia model in rabbits was used to assess the efficacy of amoxycillin, erythromycin and a new ketolide, telithromycin (HMR 3647). The MICs of amoxycillin, erythromycin and HMR 3647 for the three clinical S. pneumoniae strains used were, respectively, (mg/L): 0.01, 16 and 0.02 (strain 195); 2, 0.25 and 0.02 (strain 16089); 8, >64 and 0.02 (strain 11724). Antibiotic therapy reproduced human serum pharmacokinetics (amoxycillin 1 g iv tds or erythromycin 500 mg qds or HMR 3647 800 mg bd). Forty-eight hours of therapy with HMR 3647 and amoxycillin resulted in significant bacterial clearance in the lungs and spleen of rabbits infected by S. pneumoniae strain 195 and strain 16089 (at least 3 log(10) cfu/g decrease, P < 0.001). Erythromycin was active against only the erythromycinsusceptible strain (3 log(10) cfu/g decrease at 48 h, P < 0.001). None of the antibiotics showed significant efficacy with strain 11724. All agents produced significant bacterial clearance when time above MBC was >33%, and microbiological failure when it was <25%, whereas MIC was not correlated with microbiological outcome with HMR 3647. Our findings suggest that pharmacodynamic data integrating MBC may be predictive of microbiological success or failure with greater accuracy than with MIC. HMR 3647 produced significant bacterial clearance in both penicillin- and erythromycin-resistant pneumonia, but was less effective against the highly erythromycin-resistant S. pneumoniae strain.
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Affiliation(s)
- L Piroth
- Service des Maladies Infectieuses et Tropicales, Hôpital du Bocage, BP 1542, 21034 Dijon cedex, France
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Portier H, Peyramond D, Boucot I, Grappin M, Boibieux A, Pribil C. Assessing applicability of guidelines on management of pharyngitis in adults in general practice. Med Mal Infect 2001. [DOI: 10.1016/s0399-077x(01)00210-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Portier H, Peyramond D, Boucot I, Pribil C, Grappin M, Chicoye A. Évaluation pharmaco-économique de l'usage des tests de diagnostic rapide dans l'angine de l'adulte. Med Mal Infect 2001. [DOI: 10.1016/s0399-077x(01)00260-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Piroth L, Callerot JY, Grappin M, Duong M, Buisson M, Portier H, Chavanet P. Therapeutic trials in HIV infection: which benefits for which patients? HIV Clin Trials 2001; 2:22-30. [PMID: 11590511 DOI: 10.1310/2v79-xx17-m0xt-eewl] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The purpose of our study was to make an assessment of the HIV patients' overall opinion of therapeutic trials, to analyze the motivations and the reasons linked to this perception, and to determine if their involvement in a therapeutic trial is a help or a hindrance to their treatment. METHOD All the inpatients and outpatients attending the Dijon University Hospital AIDS day care unit during the first 4 months of 1999 were given an anonymous questionnaire designed to record the patients' attitudes toward therapeutic trials, their motivations, and the perceived risks. The questionnaire was often completed in consultation with a psychoanalyst. RESULTS Two hundred and seven (207) patients were surveyed; 194 of them had a favorable opinion of therapeutic trials. The main motivations to take part in a therapeutic trial were altruistic. In contrast, individualistic considerations and relational motivations (such as to modify the relationship between the caregiver and the patient) were more closely associated with a negative perception. CONCLUSION Most of the patients will benefit or at least will not be harmed by being involved in a trial. However, the patients' attitudes toward the principle of therapeutic trials have to be determined before these patients are included in a given therapeutic trial. This is necessary to avoid the risk of subsequent medical care being altered because participation was either induced or compelled.
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Affiliation(s)
- L Piroth
- Service des Maladies Infectieuses et Tropicales, Hôpital d'Enfants, CHU Dijon, France
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Grappin M, Piroth L, Kohli E, Buisson M, Duong M, Chavanet P, Portier H. Incomplete genotypic resistance to nonnucleoside reverse transcriptase inhibitors in patients treated with nevirapine: a potential interest in clinical practice. J Acquir Immune Defic Syndr 2000; 25:464-5. [PMID: 11141247 DOI: 10.1097/00042560-200012150-00013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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