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Berger M, Daubin D, Charriot J, Klouche K, Le Moing V, Arnaud B, Morquin D, Jaussent A, Taourel P, Hayot M, Nagot N, Fesler P, Roubille C. Devenir des patients hospitalisés en soins critiques pour infection à SARS-COV2 : évaluation standardisée des séquelles à 6–9 mois. Rev Med Interne 2022. [PMCID: PMC9212689 DOI: 10.1016/j.revmed.2022.03.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Identifié en Chine en décembre 2019, le Severe Acute Respiratory SyndromeCoronavirus 2 (SARS-COV2) s’est rapidement propagé au niveau mondial. Si les études se sont initialement concentrées sur la prise en charge de la phase aiguë de la COrona VIrus Disease (COVID), l’objectif de ce travail est de s’intéresser aux conséquences à distance d’une hospitalisation pour COVID sévère. Patients et méthodes Nous avons réalisé une étude prospective, monocentrique, incluant des patients 6 à 9 mois après leur hospitalisation en soins critiques (soins intensifs ou réanimation) pour une infection confirmée à SARS-COV2. Les patients étaient évalués au cours d’une hospitalisation de jour en médecine interne. L’entretien débutait par un recueil des antécédents du patient, des évènements et des symptômes post-COVID. L’examinateur procédait ensuite à un examen clinique détaillé et un test de marche des 6 minutes (TM6). Les patients réalisaient de manière systématique des explorations fonctionnelles respiratoires (EFR), une tomodensitométrie (TDM) thoracique non injectée, une échographie cardiaque trans-thoracique (ETT), et un bilan biologique complet. Une batterie de tests était réalisée, explorant la qualité de vie et les séquelles psychologiques. Résultats Quatre-vingt-six patients, dont 71 (82,6 %) hommes, d’âge médian 65,8 ans (56,7;72,4), ont été évalués dans un délai moyen de 7 mois (min 3,4; max 14,9). L’hypertension artérielle (46,5 %), le diabète (34,9 %) et la dyslipidémie (39,5 %) étaient les antécédents médicaux les plus représentés. Douze (14,0 %) patients avaient une pathologie pulmonaire sous-jacente, principalement une broncho-pneumopathie chronique obstructive (BPCO). L’indice de comorbidités de Charlson médian était de 1 (0,0; 2,0). La durée médiane du séjour en soins critiques était de 10,0 (6,0;17,0) jours. Cinquante-quatre (62,8 %) patients ont eu une ventilation invasive et 67 (77,9 %) patients ont reçu un traitement par corticothérapie. Cinquante-sept (71,3 %) patients ont présenté une asthénie post-COVID, 39 (48,1 %) une faiblesse musculaire, 30 (36,6 %) des arthralgies. Quinze patients ont développé un déséquilibre du diabète et 9 un déséquilibre de la pression artérielle. Dix-sept (21,3 %) patients avaient une distance au TM6 < 80 % de la théorique. Quarante-six patients53,5 %) avaient un score de dyspnée Medical Reaserch Council (MRC) de 0 et 24 (27,9 %) avaient un score MRC de 1. Treize (15,5 %) patients avaient une auscultation anormale à type de crépitants secs des bases. Cinquante-deux (64,2 %) patients ont présenté un déficit de la diffusion du CO défini par une DLCO < 80 % et 16 (19,8 %) avaient une DLCO < 60 %. Le scanner thoracique montrait chez 35 (40,7 %) patients des lésions de verre dépoli et 18 (21,7 %) de la fibrose. Trente-deux patients (37,6 %) avaient un score PHQ-9 significatif pour une dépression, 20 (23,5 %) un score GAD-7 significatif pour un trouble anxieux et 8 (9,4 %) patients avaient un score PCL5 supérieur au seuil évoquant un état de stress post-traumatique. Le niveau de qualité de vie à distance de l’épisode aigu était satisfaisant avec une médiane de l’EQ-5D-3L à 0,89 (0,64;1,00). En analyse univariée, la fibrose sur le scanner de réévaluation et une DLCO < 60 % étaient associées à la durée du séjour en soins critiques et au niveau maximal de CRP pendant l’épisode aigu. En analyse multivariée, la fibrose et la DLCO étaient associées à la durée de séjour. En analyse uni et multivariée, le PHQ-9 et le GAD-7 étaient associés au sexe féminin. Discussion À ce jour, rares sont les études qui ont étudié de manière systématisée les séquelles somatiques et psychologiques à long terme de la COVID chez les patients qui ont été pris en charge en soins critiques. Conformément à la littérature, la diminution de la DLCO est l’anomalie la plus fréquemment retrouvée aux EFR, les plages de verre dépoli persistent sur le scanner et des lésions fibrotiques sont retrouvées chez plus d’un patient sur 5 [1], [2]. Ces anomalies contrastent avec une plainte respiratoire modérée et un examen clinique rassurant. Les symptômes généraux (asthénie, faiblesse musculaire et arthralgies) sont au cœur de la plainte fonctionnelle. Les déséquilibres de la tension artérielle et du diabète observés justifient un suivi accru des pathologies chroniques au décours de l’épisode aigu. Enfin, nous avons noté une prévalence plus importante des troubles psychologiques que celles relevées rétrospectivement (dossier informatisé) dans une autre étude [3], renforçant, selon nous, la nécessité d’un dépistage systématique des troubles psychiatriques. Conclusion De nombreux patients présentent des séquelles à distance d’une COVID sévère nous incitant à un dépistage systématique afin de proposer une prise en charge adaptée.
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Ughetto A, Eliet J, Nagot N, David H, Bazalgette F, Marin G, Mourad M, Kollen S, Gaudard P, Colson P. Impact of temporary mechanical circulatory support on mortality in cardiogenic shock: an emulated target trial with a prospective, multicenter, French cohort study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The field of temporary mechanical circulatory support (TMCS) has advanced in last decade justifying that TMCS is increasingly used for treatment of refractory cardiogenic shock (CS). Nevertheless, the efficacy of TMCS (extracorporeal life support (ECLS) and Impella) in CS remains controversial due to the lack of high-quality evidence. The aim of this prospective multicenter observational study simulating a randomized trial was to assess the impact of TMCS on the hospital mortality in patients with CS.
Methods
This study (ClinicalTrials.gov ID: NCT03528291) was conducted at 3 TMCS centers organized in a cardiac assistance network, one as a level 1 TMCS center (expert center), and 2 as level 2 centers (hub centers). The study was designed and led by the heart team of the expert center with input from the hub centers.
All patients admitted to an intensive care unit between July 2017 and May 2020 either directly at the TMCS centers or after transfer from a non-specialized hospital, were screened for TMCS indication provided they were admitted for CS. CS was defined according to the European Society of Cardiology criteria. Were excluded patients younger than 18 years, CS after cardiac surgery, or after cardiac arrest if it was refractory or with a no flow >3 min and/or out-of-hospital cardiac arrest with non-shockable rhythm, or CS in the context of myocardial infarction complications, massive pulmonary embolism, and if TMCS was contraindicated
TMCS indication was decided after a multidisciplinary discussion carried out by the “heart team”. Implantation of TMCS resulted from an agreement of the heart team within the first 24 hours after admission mainly based on the initial severity of the CS, or if CS was refractory to the medical treatment.
The primary outcome was in-hospital survival. A propensity score-weighted analysis was done for treatment-effect estimation. This method, which weights each patient according to their propensity score, includes all participants in the analysis.
Results
246 patients with CS were included in the study: 121 in TMCS group (72% ECLS, 14% Impella, 14% both ECLS and Impella) and 125 in control group. After adjustment by a propensity score, hospital mortality was comparable in the two groups (32% TMCS group vs 27% control group; Odds ratio with TMCS, 1.28; 95% confidence interval, 0.87 to 1.88; p=0.21). Mortality at D180 was also similar in the two group (33% vs 30% respectively; p=0.51). Thromboembolic events were significantly higher in the TCMS group (14% vs 4%; p<0.01) as well as the transfusion rate ((median (IQR); 4.0 (0.0; 9.0) vs 0.0 (0.0; 0.0); p<0.01).
Conclusion
In our study, the use of TMCS does not seem to improve hospital survival in patients with cardiogenic shock. Thus, TMCS, which are iatrogenic side effects providers, should be reserved for the most severe patient and discussed by a multidisciplinary team.
Funding Acknowledgement
Type of funding sources: None. Flow chart
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Affiliation(s)
- A Ughetto
- University Hospital Arnaud de Villeneuve, Department of Anesthesiology and Critical Care Medicine, Montpellier, France
| | - J Eliet
- University Hospital Arnaud de Villeneuve, Department of Anesthesiology and Critical Care Medicine, Montpellier, France
| | - N Nagot
- University of Montpellier, Epidemiology and Clinical Research, Montpellier, France
| | - H David
- University Hospital Arnaud de Villeneuve, Department of Anesthesiology and Critical Care Medicine, Montpellier, France
| | - F Bazalgette
- University Hospital of Nimes, Department of Critical care medicine, Nimes, France
| | - G Marin
- University of Montpellier, Epidemiology and Clinical Research, Montpellier, France
| | - M Mourad
- University Hospital Arnaud de Villeneuve, Department of Anesthesiology and Critical Care Medicine, Montpellier, France
| | - S Kollen
- Perpignan Hospital Centre, Department of Critical care medicine, Perpignan, France
| | - P Gaudard
- University Hospital Arnaud de Villeneuve, Department of Anesthesiology and Critical Care Medicine, Montpellier, France
| | - P Colson
- University Hospital Arnaud de Villeneuve, Department of Anesthesiology and Critical Care Medicine, Montpellier, France
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Filleron A, Laurens ME, Marin G, Marchandin H, Prodhomme O, Alkar F, Godreuil S, Nagot N, Cottalorda J, L'Kaissi M, Rodiere M, Vigue MG, Didelot MN, Michon AL, Delpont M, Louahem D, Jeziorski E. Short-course antibiotic treatment of bone and joint infections in children: a retrospective study at Montpellier University Hospital from 2009 to 2013. J Antimicrob Chemother 2020; 74:3579-3587. [PMID: 31504582 DOI: 10.1093/jac/dkz358] [Citation(s) in RCA: 7] [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] [Received: 02/01/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Acute haematogenous bone and joint infections (AHBJI) represent a diagnostic and therapeutic emergency in children, with significant potential sequelae in the case of delayed treatment. Although historically the recommendations for treatment have been based on surgery and prolonged antibiotic therapy, recent studies have demonstrated that short-course antibiotic therapy is also effective. OBJECTIVES We evaluated a short-term antibiotic protocol for both osteomyelitis and septic arthritis in a 6 year retrospective study at the University Hospital of Montpellier. METHODS This protocol was based on an initial intravenous treatment with a re-evaluation after 48 h and an early switch to oral therapy in the case of a favourable clinical course for a minimum total duration of 15 days. Antibiotics were selected based on local microbiological epidemiology and systematically adapted to bacteriological results. RESULTS One hundred and seventy-six cases of AHBJI were included, comprising 56 patients with osteomyelitis, 95 with septic arthritis and 25 who had both of these. The aetiological agent was identified in 42% of the cases, with the main pathogens being Staphylococcus aureus (39%) and Kingella kingae (27%). The mean intravenous treatment duration was 4 days, while the total treatment duration was 15 days. There were no treatment failures, mild sequelae occurred in 1% of the cases and the secondary surgical revision rate was 7%. CONCLUSIONS The results of this study are comparable to those reported for evaluations of prolonged antibiotic therapy protocols, thus indicating that a common short-term antimicrobial therapy for the management of both osteomyelitis and septic arthritis (minimum of 15 days) is a viable option for treating AHBJI in children. Further prospective studies to confirm these findings are hence warranted.
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Affiliation(s)
- A Filleron
- Service de pédiatrie, CHU de Nîmes, Nîmes, France; INSERM U 1183, Université Montpellier-Nîmes, Nîmes, France
| | - M E Laurens
- Département de pédiatrie néonatale et de réanimation, CHU de Montpellier, Montpellier, France
| | - G Marin
- Department d'Information Medicale, CHU Montpellier, Montpellier, France
| | - H Marchandin
- HydroSciences Montpellier, University of Montpellier, CNRS, IRD, Montpellier, France; Laboratoire de microbiologie, CHU Nîmes, Nîmes, France
| | - O Prodhomme
- Département d'imagerie pédiatrique, CHU de Montpellier, Montpellier, France
| | - F Alkar
- Service de chirurgie orthopédique infantile, CHU Montpellier, Montpellier, France
| | - S Godreuil
- Service de bactériologie, CHU Montpellier, Montpellier, France.,Université de Montpellier UMR MIVEGEC, UMR IRD 224-CNRS Inserm, 1058, Montpellier, France
| | - N Nagot
- Department d'Information Medicale, CHU Montpellier, Montpellier, France.,Pathogenesis and Control of Chronic Infections, INSERM, Université de Montpellier, Montpellier, France
| | - J Cottalorda
- Service de chirurgie orthopédique infantile, CHU Montpellier, Montpellier, France
| | - M L'Kaissi
- Service de chirurgie infantile, CHU de la réunion, Saint-Denis, France
| | - M Rodiere
- Département urgences post-urgences, CHU Montpellier, Montpellier, France
| | - M G Vigue
- Département urgences post-urgences, CHU Montpellier, Montpellier, France
| | - M N Didelot
- Service de bactériologie, CHU Montpellier, Montpellier, France.,Pathogenesis and Control of Chronic Infections, INSERM, Université de Montpellier, Montpellier, France
| | - A L Michon
- Service de bactériologie, CHU Montpellier, Montpellier, France
| | - M Delpont
- Service de chirurgie orthopédique infantile, CHU Montpellier, Montpellier, France
| | - D Louahem
- Service de chirurgie orthopédique infantile, CHU Montpellier, Montpellier, France
| | - E Jeziorski
- Pathogenesis and Control of Chronic Infections, INSERM, Université de Montpellier, Montpellier, France.,Département urgences post-urgences, CHU Montpellier, Montpellier, France
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Nobile B, Durand M, Courtet P, Van de Perre P, Nagot N, Molès JP, Olié E. Could the antipsychotic chlorpromazine be a potential treatment for SARS-CoV-2? Schizophr Res 2020; 223:373-375. [PMID: 32773341 PMCID: PMC7381925 DOI: 10.1016/j.schres.2020.07.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/10/2020] [Accepted: 07/21/2020] [Indexed: 12/27/2022]
Affiliation(s)
- B Nobile
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France.
| | - M Durand
- Pathogenesis and Control of Chronic Infection, INSERM, EFS, Université de Montpellier, Montpellier, France
| | - P Courtet
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France; FondaMental Foundation, France
| | - P Van de Perre
- Pathogenesis and Control of Chronic Infection, INSERM, EFS, Université de Montpellier, Montpellier, France
| | - N Nagot
- Pathogenesis and Control of Chronic Infection, INSERM, EFS, Université de Montpellier, Montpellier, France; Department of Medical Information, CHU Montpellier, France
| | - J P Molès
- Pathogenesis and Control of Chronic Infection, INSERM, EFS, Université de Montpellier, Montpellier, France
| | - E Olié
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France; FondaMental Foundation, France
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Lattuca B, Meilhac A, Akodad M, Robert C, Vandenberghe D, Manna F, Nagot N, Chettouh M, Gandet T, Macia J, Delseny D, Schmutz L, Albat B, Cayla G, Leclercq F. Eight-year clinical outcome and valve durability after trans-catheter aortic-valve implantation. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.169] [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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Lattuca B, Meilhac A, Robert C, Vandenbergh D, Manna F, Nagot N, Chettouh M, Akodad M, Gandet T, Macia JC, Delseny D, Schmutz L, Albat B, Cayla G, Leclercq F. P1793Eight-year clinical outcome and valve durability after transcatheter aortic valve implantation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
With the growing indications of transcatheter aortic valve implantation (TAVI) worldwide and among lower risk patients, valve durability has become a crucial issue.
Purpose
To assess mid and long-term evolution of different generations of percutaneous balloon-expandable prostheses, predictive factors of valve deterioration and its correlation with long-term mortality.
Methods
All consecutive patients undergoing TAVI for severe aortic stenosis with balloon-expandable prosthesis between 2009 and 2014 and with a minimum follow-up of one-year were included in this monocentric prospective study. All echocardiograms were reviewed by two independent experts. Clinical events were defined according to the Valve Academic Research Consortium criteria. Valve deterioration was defined according to the 2017 EAPCI-ESC-EACTS international consensus statement at the longest follow-up.
Results
A total of 160 patients were included with a median follow-up of 3.4 years [1.5–4.9] and a maximum of 8 years. Patients were mostly implanted with the first generation Sapien XT valve (n=138, 86.2%). Median age was 85 [79–86] years, with 42.5% of women and a median logistic Euro-SCORE of 14.2% [10.6–23.2]. Immediately after TAVI, mean aortic gradient decreased dramatically from 51±12mmHg to 9±2.6mmHg (p<0.0001) and remained overall stable with a mean gradient of 12±1mmHg at 8 years. Valve deterioration occurred in 5.6% (n=9) of patients, of which 3.7% (n=6) with severe deterioration. Moderate or severe peri-prosthetic aortic regurgitation was observed in 2.5% (n=4) of patients. The eight-year survival rate was 12.9%. During follow-up, hospitalization for acute heart failure was required for 23.7% (n=38) of patients, a myocardial infarction or a stroke occurred respectively among 1.9% (n=3) and 5% (n=8) of patients. After multivariate analysis, size or generation of valves were not independent predictive factors of valve deterioration.
Evolution of mean aortic gradient
Conclusions
After a maximal 8-year follow-up, valve deterioration after balloon-expandable TAVI is very low. In this high-risk population, TAVI seems to be a safe and durable alternative to surgery in severe aortic stenosis regardless of prosthesis generation.
Acknowledgement/Funding
Edwards Lifesciences
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Affiliation(s)
- B Lattuca
- University Hospital of Nimes, Nimes, France
| | - A Meilhac
- University Hospital Arnaud de Villeneuve, Montpellier, France
| | - C Robert
- University Hospital of Nimes, Nimes, France
| | - D Vandenbergh
- University Hospital Arnaud de Villeneuve, Montpellier, France
| | - F Manna
- University Hospital of Montpellier, Montpellier, France
| | - N Nagot
- University Hospital of Montpellier, Montpellier, France
| | - M Chettouh
- University Hospital Arnaud de Villeneuve, Montpellier, France
| | - M Akodad
- University Hospital Arnaud de Villeneuve, Montpellier, France
| | - T Gandet
- University Hospital Arnaud de Villeneuve, Montpellier, France
| | - J C Macia
- University Hospital Arnaud de Villeneuve, Montpellier, France
| | - D Delseny
- University Hospital Arnaud de Villeneuve, Montpellier, France
| | - L Schmutz
- University Hospital of Nimes, Nimes, France
| | - B Albat
- University Hospital Arnaud de Villeneuve, Montpellier, France
| | - G Cayla
- University Hospital of Nimes, Nimes, France
| | - F Leclercq
- University Hospital Arnaud de Villeneuve, Montpellier, France
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Jacquet JM, Donnadieu-Rigole H, Peries M, Makinson A, Nagot N, Reynes J, Peyriere H. Implementing screening, brief intervention and referral to treatment in a French cohort of people living with HIV: a pilot study. HIV Med 2019; 20:286-290. [PMID: 30706622 DOI: 10.1111/hiv.12709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Screening, brief intervention and referral to treatment (SBIRT) is an evidence-based practice used to identify, reduce and prevent problematic use and abuse of, and dependence on, tobacco, alcohol and psychoactive substances. To date, the pertinence of this practice among people living with HIV (PLHIV) is unknown. In this pilot study, we aimed to assess the acceptability of SBIRT in a cohort of HIV-infected out-patients who were asked about their consumption of alcohol, tobacco and psychoactive substances. METHODS A monocentric study was performed at the University Hospital of Montpellier. In a 6-month period, 20 trained physicians screened for the consumption of alcohol [using the Alcohol Use Disorders Identification Test (AUDIT)], tobacco (using the Short Fagerstrom Test) and psychoactive substances [using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) V3.0] via an auto-questionnaire and proposed a brief intervention to patients with misusage. RESULTS One thousand and eighteen PLHIV completed the questionnaire, and 861 [84.6%; 95% confidence interval (CI) 82.2-86.7%] PLHIV returned it to the physician. Among the latter, 650 patients wished to discuss the answers with their physician (75.5%; 95% CI 72.5-78.3%), and brief interventions were realized in 405 patients (62.3%). CONCLUSIONS SBIRT is a simple screening and harm reduction tool that is well accepted by PLHIV in out-patient clinics. This method could be implemented in routine HIV care to screen and manage patients systematically for harmful substance use.
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Affiliation(s)
- J-M Jacquet
- Department of Infectious Diseases, Montpellier University Hospital, Montpellier, France.,Department of Addictology, Nimes University Hospital, Nimes, France
| | - H Donnadieu-Rigole
- Department of Addictology, Montpellier University Hospital, Montpellier, France
| | - M Peries
- Pathogenesis and Control of Chronic Infections, Montpellier University, INSERM UMR1058, CHU Montpellier, Montpellier, France
| | - A Makinson
- Department of Infectious Diseases, Montpellier University Hospital, Montpellier, France.,INSERM U1175/IRD UMI 233, Montpellier University, Montpellier, France
| | - N Nagot
- Pathogenesis and Control of Chronic Infections, Montpellier University, INSERM UMR1058, CHU Montpellier, Montpellier, France
| | - J Reynes
- Department of Infectious Diseases, Montpellier University Hospital, Montpellier, France.,INSERM U1175/IRD UMI 233, Montpellier University, Montpellier, France
| | - H Peyriere
- Pathogenesis and Control of Chronic Infections, Montpellier University, INSERM UMR1058, CHU Montpellier, Montpellier, France.,INSERM U1175/IRD UMI 233, Montpellier University, Montpellier, France
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Tourniaire G, Milési C, Baleine J, Crozier J, Lapeyre C, Combes C, Nagot N, Cambonie G. [Anemia, a new severity factor in young infants with acute viral bronchiolitis?]. Arch Pediatr 2018. [PMID: 29523379 DOI: 10.1016/j.arcped.2018.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The role of anemia is raised as a risk of low respiratory infection of the child, but there are no data on anemia as a severity factor in acute viral bronchiolitis (AVB) in infants. METHODS All infants less than 16 weeks old admitted to Montpellier University Hospital from 2015/10/01 to 2016/04/01 for AVB were included in a retrospective observational study. The primary objective was to determine whether the hemoglobin (Hb) concentration on admission was an independent factor of clinical severity, judged by the modified Wood's clinical asthma score (m-WCAS). The secondary objective was to assess the impact of Hb level on the characteristics of hospitalization, including the type and duration of respiratory support. RESULTS The m-WCAS was used at least once during hospitalization in 180 out of 220 patients (82%), making it possible to distinguish patients with mild AVB (maximum m-WCAS<2, n=81) from patients with severe AVB (maximum m-WCAS>2, n=99). A logistic regression model indicated that the Hb concentration, for every 1g/dL decrement, was an independent factor of AVB severity (OR 1.16 [1.03-1.29], P=0.026). A level under 10g/dL on admission was associated with a higher use of continuous positive airway pressure (P<0.001), as well as a longer duration of respiratory support (P=0.01). CONCLUSION This study suggested that anemia may influence the clinical expression of AVB in young infants.
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Affiliation(s)
- G Tourniaire
- Département de pédiatrie néonatale et réanimations, centre hospitalier universitaire de Montpellier, hôpital Arnaud-de-Villeneuve, pôle hospitalo-universitaire femme-mère-enfant, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - C Milési
- Département de pédiatrie néonatale et réanimations, centre hospitalier universitaire de Montpellier, hôpital Arnaud-de-Villeneuve, pôle hospitalo-universitaire femme-mère-enfant, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - J Baleine
- Département de pédiatrie néonatale et réanimations, centre hospitalier universitaire de Montpellier, hôpital Arnaud-de-Villeneuve, pôle hospitalo-universitaire femme-mère-enfant, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - J Crozier
- Département de pédiatrie néonatale et réanimations, centre hospitalier universitaire de Montpellier, hôpital Arnaud-de-Villeneuve, pôle hospitalo-universitaire femme-mère-enfant, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - C Lapeyre
- Département de pédiatrie néonatale et réanimations, centre hospitalier universitaire de Montpellier, hôpital Arnaud-de-Villeneuve, pôle hospitalo-universitaire femme-mère-enfant, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - C Combes
- Département de pédiatrie néonatale et réanimations, centre hospitalier universitaire de Montpellier, hôpital Arnaud-de-Villeneuve, pôle hospitalo-universitaire femme-mère-enfant, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - N Nagot
- Département de l'information médicale, centre hospitalier universitaire de Montpellier, hôpital Arnaud-de-Villeneuve, pôle hospitalo-universitaire femme-mère-enfant, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - G Cambonie
- Département de pédiatrie néonatale et réanimations, centre hospitalier universitaire de Montpellier, hôpital Arnaud-de-Villeneuve, pôle hospitalo-universitaire femme-mère-enfant, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
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Vandenberghe D, Lattuca B, Roubille F, Cayla G, Pasquie J, Amedro P, Macia J, Nagot N, Nogue E, Bredy C, Sorbets E, Cade S, Cransac F, Verges M, Solecki K, Hedon C, Lavastre K, Leclercq F. Evaluation of a pre-consultation questionnaire on patient knowledge concerning oral anticoagulant therapy: The EDUCONSULT randomized trial. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2017.11.165] [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: 11/27/2022]
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Bonnal A, Dehon A, Nagot N, Macioce V, Nogue E, Morau E. Patient-controlled oral analgesia versus nurse-controlled parenteral analgesia after caesarean section: a randomised controlled trial. Anaesthesia 2016; 71:535-43. [PMID: 26931110 DOI: 10.1111/anae.13406] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2016] [Indexed: 12/21/2022]
Abstract
We assessed the effectiveness of early patient-controlled oral analgesia compared with parenteral analgesia in a randomised controlled non-inferiority trial of women undergoing elective caesarean section under regional anaesthesia. Seventy-seven women received multimodal paracetamol, ketoprofen and morphine analgesia. The woman having patient-controlled oral analgesia were administered four pillboxes on the postnatal ward containing tablets and instructions for self-medication, the first at 7 h after the spinal injection and then three more at 12-hourly intervals. Pain at rest and on movement was evaluated using an 11-point verbal rating scale at 2 h and then at 6-hourly intervals for 48 h. The pre-defined non-inferiority limit for the difference in mean pain scores (patient-controlled oral analgesia minus parenteral) was one. The one-sided 95% CI of the difference in mean pain scores was significantly lower than one at all time-points at rest and on movement, demonstrating non-inferiority of patient-controlled oral analgesia. More women used morphine in the patient-controlled oral analgesia group (22 (58%)) than in the parenteral group (9 (23%); p = 0.002). The median (IQR [range]) number of morphine doses in the patient-controlled oral analgesia group was 2 (1-3 [1-7]) compared with 1 (1-1 [1-2]); p = 0.006) in the parenteral group. Minor drug errors or omissions were identified in five (13%) women receiving patient-controlled oral analgesia. Pruritus was more frequent in the patient-controlled oral analgesia group (14 (37%) vs 6 (15%) respectively; p = 0.03), but no differences were noted for other adverse events and maternal satisfaction. After elective caesarean section, early patient-controlled oral analgesia is non-inferior to standard parenteral analgesia for pain management, and can be one of the steps of an enhanced recovery process.
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Affiliation(s)
- A Bonnal
- Department of Anaesthesiology, Arnaud de Villeneuve University Hospital, Montpellier, France
| | - A Dehon
- Department of Anaesthesiology, Arnaud de Villeneuve University Hospital, Montpellier, France
| | - N Nagot
- Clinical Research and Epidemiology Unit, Medical Information Department, Montpellier University Hospital, Montpellier, France
| | - V Macioce
- Clinical Research and Epidemiology Unit, Medical Information Department, Montpellier University Hospital, Montpellier, France
| | - E Nogue
- Clinical Research and Epidemiology Unit, Medical Information Department, Montpellier University Hospital, Montpellier, France
| | - E Morau
- Department of Anaesthesiology, Arnaud de Villeneuve University Hospital, Montpellier, France
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Astaing J, Schaub R, Maestracci M, Guyon G, Nagot N, Jeziorski E. P-051 – Recherche de cycle épidémiologique dans les pathologie pédriques d'étiologie indéterminées. Arch Pediatr 2015. [DOI: 10.1016/s0929-693x(15)30236-0] [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: 10/23/2022]
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Kania D, Bekalé A, Nagot N, Mondain AM, Ottomani L, Meda N, Traoré M, Ouédraogo J, Ducos J, Van de Perre P, Tuaillon E. Combining rapid diagnostic tests and dried blood spot assays for point-of-care testing of human immunodeficiency virus, hepatitis B and hepatitis C infections in Burkina Faso, West Africa. Clin Microbiol Infect 2013; 19:E533-41. [DOI: 10.1111/1469-0691.12292] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 05/20/2013] [Accepted: 05/30/2013] [Indexed: 11/28/2022]
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Traore H, Meda N, Nagot N, Somé E, Neboua D, Kankasa C, Hofmeyr J, Tumwine J, Vallo R, Ye D, Tylleskar T, Van de Perre P. Déterminants du faible poids de naissance chez des enfants nés de mères séropositives pour le VIH, non éligibles au traitement antirétroviral, en Afrique. Rev Epidemiol Sante Publique 2013; 61:413-20. [DOI: 10.1016/j.respe.2013.05.022] [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] [Received: 08/30/2012] [Revised: 04/11/2013] [Accepted: 05/03/2013] [Indexed: 10/26/2022] Open
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Konate I, Ouédraogo A, Bazié WW, Traoré IT, Sanon A, Huet C, Méda N, Mayaud P, Perre PVD, Nagot N. S04.3 Antiretroviral Therapy Among Female Sex Workers in Burkina Faso: Current Situation. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0027] [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: 11/03/2022]
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Traore IT, Hema MN, Meda N, Konate I, Some F, Bazie W, Mayaud P, Perre PVD, Nagot N. P3.402 Effect of a Tailored Intervention Package on HIV-1 Acquisition Among Young Female Sex Workers in Ouagadougou, Burkina Faso. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Konate I, Ouédraogo A, Bazié WW, Sanon A, Sawadogo HA, Traoré IT, Méda N, Mayaud P, Perre PVD, Nagot N. P3.399 Who Are Regular Sex Partners of Female Sex Workers in Bobo-Dioulasso, Burkina Faso? Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0852] [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: 11/04/2022]
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Kelly H, Ngou J, Sawadogo B, Muzah B, Gilham C, Nagot N, Meda N, Delany S, Segondy M, Mayaud P. P3.223 HPV Genotype Distribution in HIV-Positive African Women and Associations with High Grade Histological Lesions by CD4+ Count: Abstract P3.223 Table 1. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0680] [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: 11/04/2022]
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Traore IT, Konate I, Meda N, Bazie W, Hema MN, Kabore A, Kania D, Mayaud P, Perre PVD, Nagot N. P3.224 Effect of Herpes Simplex Virus Type 2 (HSV-2) Infection on Progression of HIV Infection Among Female Sex Workers in Burkina Faso. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0681] [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: 11/04/2022]
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Vendrell JF, Mernes R, Nagot N, Milhaud D, Lobotesis K, Costalat V, Machi P, Maldonado IL, Riquelme C, Arquizan C, Bonafe A. Evaluation of an intravenous-endovascular strategy in patients with acute proximal middle cerebral artery occlusion. AJNR Am J Neuroradiol 2012; 34:603-8. [PMID: 22878011 DOI: 10.3174/ajnr.a3230] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE IVT administered in acute ischemic stroke provides low recanalization rates in proximal intracranial occlusions, with consequently poor clinical outcome. The safety and efficacy of an IES by using mechanical thrombectomy after IVT failure were assessed in acute MCA occlusions. MATERIALS AND METHODS Patients presenting with acute MCA occlusion within 4.5 hours with an NIHSS score between 8 and 25 and a DWI ASPECTS of >5 were eligible. From September 2009 to September 2010, mechanical thrombectomy by using the Solitaire FR device was systematically performed if no clinical improvement was observed 1 hour after the initiation of IVT (IES group). Results in terms of clinical outcome were compared with those from an IVT series from January 2007 to August 2009 (IVT group). RESULTS Alteplase was administered in 123 patients with proximal intracranial occlusion. Fifty-six had a confirmed MCA occlusion: 32 were included in the IVT group; and 24, in the IES group. At 24 hours, the median NIHSS improvement was 8.5 points in the IES group (25%-75% CI, 1.5-13) and 3 points in the IVT group (25%-75% CI, 1-5) (P = .001). At 3 months, 17/22 (77%) patients from the IES group and 15/30 (50%) from the IVT group had an mRS score of ≤2. After adjustment for confounding variables, IES was strongly associated with favorable clinical outcome (77% versus 50%; adjusted odds ratio = 11.9; 95% CI, 1.6-89.1; P < .02). No symptomatic intracranial hemorrhage was observed. CONCLUSIONS IES by using systematic mechanical thrombectomy after IVT failure safely improves the clinical outcome at 3 months and could represent an interesting alternative in the management of patients with acute MCA occlusion.
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Affiliation(s)
- J-F Vendrell
- Department of Neuroradiology, Montpellier University Hospital, Montpellier, France.
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Van de Perre P, Rubbo PA, Viljoen J, Nagot N, Tylleskar T, Lepage P, Vendrell JP, Tuaillon E. HIV-1 Reservoirs in Breast Milk and Challenges to Elimination of Breast-Feeding Transmission of HIV-1. Sci Transl Med 2012; 4:143sr3. [DOI: 10.1126/scitranslmed.3003327] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Traore HA, Some E, Meda N, Nagot N, Van De Perre P. P1-S6.11 Prevention of mother to child transmission of HIV (PMTCT) program in Burkina Faso: how high is the coverage of voluntary counselling and HIV Testing (VCT) services within a clinical trial supporting environment? Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.235] [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: 11/04/2022]
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Low A, Didelot-Rousseau MN, Nagot N, Ouedraougo A, Clayton T, Konate I, Van de Perre P, Segondy M, Mayaud P. Cervical infection with human papillomavirus (HPV) 6 or 11 in high-risk women in Burkina Faso. Sex Transm Infect 2010; 86:342-4. [DOI: 10.1136/sti.2009.041053] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Berthe A, Meda N, Traoré IT, Some J, Salouka S, Sanou L, Some F, Rouamba J, Ouedraogo D, M'Boutiki G, Mayaud P, Nagot N, perre PVD. P15-25. Preparation for HIV vaccine trials in Africa: barriers and facilitators for the establishment of a community advisory board in Burkina Faso. Retrovirology 2009. [PMCID: PMC2767722 DOI: 10.1186/1742-4690-6-s3-p226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Rubbo P, Tuaillon E, Nagot N, Bolloré K, Valéa D, Vendrell J, Konaté I, Ouédraogo A, Huet C, Foulongne V, Perre PVD. P07-11 LB. Impact of highly active antiretroviral therapy on cell-free and cell-associated HIV-1 in cervicovaginal secretions and blood. Retrovirology 2009. [PMCID: PMC2767911 DOI: 10.1186/1742-4690-6-s3-p397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Nagot N, Ouedraogo A, Konate I, Weiss HA, Foulongne V, Defer MC, Sanon A, Becquart P, Segondy M, Sawadogo A, Van de Perre P, Mayaud P. Roles of clinical and subclinical reactivated herpes simplex virus type 2 infection and human immunodeficiency virus type 1 (HIV-1)-induced immunosuppression on genital and plasma HIV-1 levels. J Infect Dis 2008; 198:241-9. [PMID: 18593294 DOI: 10.1086/589621] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [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] Open
Abstract
BACKGROUND Few longitudinal studies have described the interactions between reactivation of herpes simplex virus type 2 (HSV-2) infection (hereafter, "HSV-2 reactivation") and genital and systemic replication of human immunodeficiency virus type 1 (HIV-1). METHODS Women in Burkina Faso who were seropositive for both HIV-1 and HSV-2 were enrolled in a randomized placebo-controlled trial of therapy to suppress reactivation of HSV-2 infection (hereafter, "HSV suppressive therapy"). During the baseline phase, 6 enriched cervicovaginal lavage specimens were obtained over 12 weeks to detect and quantify the HIV-1 RNA and HSV-2 DNA loads. RESULTS Women with genital ulcer disease (GUD) detected at least once were more likely than women in whom GUD was not detected (risk ratio [RR], 1.23; 95% confidence interval [CI], 1.09-1.37) to have genital HIV-1 RNA detected during >or=1 visit. Similarly, women with genital HSV-2 DNA detected during >or=1 clinic visit were more likely than women in whom genital HSV-2 DNA was not detected (RR, 1.17; 95% CI, 1.01-1.34) to have genital HIV-1 RNA detected at least once. In addition, the mean genital HIV-1 RNA loads for women with GUD detected during >or=1 visit and women with HSV-2 genital shedding detected during >or=1 visit were greater than that for women in whom genital HSV-2 DNA or GUD was never detected. The plasma HIV-1 RNA load was increased among women for whom >or=1 visit revealed GUD (+0.25 log(10) copies/mL; 95% CI, -0.05-0.55) or genital HSV-2 DNA (+0.40 log(10) copies/mL; 95% CI, 0.15-0.66), compared with women who did not experience GUD or HSV-2 genital shedding, respectively. The association of HSV-2 reactivations on HIV-1 replication tended to be stronger in patients with a higher CD4(+) cell count (i.e., >500 cells/microL). The contribution of HSV-2 to HIV-1 replication among women with CD4(+) cell count of <or=500 cells/microL was reduced because almost all experienced HIV-1 genital shedding. CONCLUSIONS Both clinical and subclinical HSV-2 reactivations play a role in increasing the rate of HIV-1 replication. HSV suppressive therapy is a promising tool for HIV control. Initiation of such therapy when the CD4(+) cell count is >500 cells/microL deserves further investigation. CLINICAL TRIALS REGISTRATION The ANRS 1285 Study is registered with the National Institutes of Health (registration number NCT00158509).
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Mayaud P, Nagot N, Konaté I, Ouedraogo A, Weiss HA, Foulongne V, Defer MC, Sawadogo A, Segondy M, Van de Perre P. Effect of HIV-1 and antiretroviral therapy on herpes simplex virus type 2: a prospective study in African women. Sex Transm Infect 2008; 84:332-7. [PMID: 18596069 DOI: 10.1136/sti.2008.030692] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [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] Open
Abstract
OBJECTIVES To document the natural history of herpes simplex virus type 2 (HSV-2) in relation to HIV and highly active antiretroviral therapy (HAART) in Africa, a longitudinal study was conducted of women in the placebo arms of two randomised controlled trials of HSV-suppressive therapy in Burkina Faso. METHODS 22 HIV-uninfected women (group 1), 30 HIV-1-infected women taking HAART (group 2), and 68 HIV-1-infected women not eligible for HAART (group 3) were followed over 24 weeks. HSV-2 DNA was detected on alternate weeks using real-time PCR from cervicovaginal lavages. Plasma HIV-1 RNA was measured every month. CD4 cell counts were measured at enrollment. RESULTS Ulcers occurred on 1.9%, 3.1% and 7.2% of visits in groups 1, 2 and 3 (p = 0.02). Cervicovaginal HSV-2 DNA was detected in 45.5%, 63.3% and 67.6% of women (p = 0.11), and on 4.3%, 9.7% and 15.5% of visits in the three groups (p<0.001). Among HIV-infected women, cervicovaginal HSV-2 DNA was detected more frequently during ulcer episodes (adjusted risk ratio (aRR) 2.79, 95% CI 2.01 to 3.86) and less frequently among women practising vaginal douching (aRR 0.60, 95% CI 0.40 to 0.91). Compared with women not taking HAART and with CD4 cell counts of 500 cells/microl or greater, women on HAART had a similar risk of HSV-2 shedding (aRR 0.95, 95% CI 0.52 to 1.73), whereas women with CD4 cell counts of 200-500 cells/microl were more likely to shed HSV-2 (aRR 1.71, 95% CI 1.02 to 2.86). CONCLUSIONS HSV-2 reactivations occur more frequently among HIV-infected women, particularly those with low CD4 cell counts, and are only partly reduced by HAART. HSV therapy may benefit HIV-infected individuals during HAART.
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Affiliation(s)
- P Mayaud
- Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E7HT, UK.
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Nagot N, Ouedraogo A, Weiss HA, Konate I, Sanon A, Defer MC, Sawadogo A, Andonaba JB, Vallo R, Becquart P, Segondy M, Mayaud P, Van de Perre P. Longitudinal effect following initiation of highly active antiretroviral therapy on plasma and cervico-vaginal HIV-1 RNA among women in Burkina Faso. Sex Transm Infect 2007; 84:167-70. [PMID: 18055582 DOI: 10.1136/sti.2007.027987] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Highly active antiretroviral therapy (HAART) could decrease HIV-1 transmissibility by reducing genital and plasma HIV-1 RNA. METHODS We evaluated the effect of HAART on genital and plasma HIV-1 RNA in a cohort of 39 antiretroviral-naïve women in Burkina Faso. Cervico-vaginal lavages were collected before HAART initiation and at six visits over 28 weeks while on HAART. Blood samples were collected at baseline and at three and four visits for CD4 and plasma HIV-1 RNA measurements, respectively. RESULTS Before HAART, 72% of women had detectable genital HIV-1 RNA. After 18 weeks on HAART, only one woman (2.5%) had detectable plasma HIV-1 RNA and two women (5.1%) had detectable genital HIV-1 RNA. Similar results were observed at each follow-up visit. However, 16/34 (47%) women with consistently undetectable plasma HIV-1 RNA shed HIV-1 at least once between weeks 18 and 28. In samples with detectable genital HIV-1, the mean quantity of HIV-1 RNA decreased from 3.87 prior to HAART to 3.04 log(10) copies/mL at last visit (median 29 weeks; a 6.8-fold decrease in absolute number of copies/mL) (p = 0.04). A significant median CD4 lymphocyte cell gain of 121 cells/muL (interquartile range 59 to 204) was measured between pre-HAART and last visit. CONCLUSION These findings suggest that HAART could play a role in reducing HIV transmission in Africa; however, they underscore the need to emphasise safe sex practices with patients taking HAART.
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Affiliation(s)
- N Nagot
- Université Montpellier 1, EA 4205 Transmission, Pathogenese et Prevention de l'infection par le VIH and CHU Montpellier, CHU Arnaud de Villeneuve, Montpellier, France.
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Konate I, Ouedraogo A, Andonaba J, Sanon A, Sawadogo A, Nagot N, Foulongne V, Weiss H, Vergne L, Defer M, Djagbare D, Becquart P, Segondy M, Vallo R, Van de Perre P, Mayaud P. CO25 - Impact du traitement suppressif de l’herpès simplex virus type 2 (HSV-2) sur le portage génital de HSV-2 et la survenue d’ulcération génitale (UG) chez les femmes co-infectées par HSV-2 et VIH-1. Ann Dermatol Venereol 2007. [DOI: 10.1016/s0151-9638(07)89058-2] [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: 10/22/2022]
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Konate I, Ouedraogo A, Andonaba J, Sanon A, Sawadogo A, Nagot N, Foulongne V, Weiss H, Vergne L, Defer M, Djagbare D, Becquart P, Segondy M, Vallo R, Van de Perre P, Mayaud P. CO24 - Effet du traitement suppressif de l’herpès simplex virus type 2 (HSV-2) sur le portage génital et la charge virale plasmatique VIH-1 chez les femmes co-infectées ne prenant pas d’ARV à Bobo-Dioulasso (Burkina Faso). Ann Dermatol Venereol 2007. [DOI: 10.1016/s0151-9638(07)89057-0] [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: 11/16/2022]
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Konate I, Ouedraogo A, Andonaba J, Mayaud P, Nagot N, Foulongne V, Weiss H, Vergne L, Defer M, Djagbare D, Sawadogo A, Becquart P, Segondy M, Van de Perre P. CO27 - Histoire naturelle de l’infection à Herpes simplex virus de type 2 (HSV-2) chez des femmes infectées ou non par le VIH-1, et prenant ou pas une trithérapie antirétrovirale au Burkina Faso. Ann Dermatol Venereol 2007. [DOI: 10.1016/s0151-9638(07)89060-0] [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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Perrochia H, Didelot M, Nagot N, Vallès X, Ouedraogo A, Konate I, Weiss H, Vande perre P, Mayaud P, Segondy M, Costes V. Prévalence de l’infection à HPV (human papillomavirus), distribution des génotypes d’HPV et fréquence des lésions cervicales, en rapport avec l’infection à HIV-1 dans une population à risque du Burkina Faso. Ann Pathol 2006. [DOI: 10.1016/s0242-6498(06)78420-6] [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: 11/28/2022]
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Didelot-Rousseau MN, Nagot N, Costes-Martineau V, Vallès X, Ouedraogo A, Konate I, Weiss HA, Van de Perre P, Mayaud P, Segondy M. Human papillomavirus genotype distribution and cervical squamous intraepithelial lesions among high-risk women with and without HIV-1 infection in Burkina Faso. Br J Cancer 2006; 95:355-62. [PMID: 16832413 PMCID: PMC2360631 DOI: 10.1038/sj.bjc.6603252] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Human papillomavirus (HPV) infection and cervical squamous intraepithelial lesions (SILs) were studied in 379 high-risk women. Human papillomavirus DNA was detected in 238 of 360 (66.1%) of the beta-globin-positive cervical samples, and 467 HPV isolates belonging to 35 types were identified. Multiple (2-7 types) HPV infections were observed in 52.9% of HPV-infected women. The most prevalent HPV types were HPV-52 (14.7%), HPV-35 (9.4%), HPV-58 (9.4%), HPV-51 (8.6%), HPV-16 (7.8%), HPV-31 (7.5%), HPV-53 (6.7%), and HPV-18 (6.4%). Human immunodeficiency virus type 1 (HIV-1) seroprevalence was 36.0%. Human papillomavirus prevalence was significantly higher in HIV-1-infected women (87 vs 54%, prevalence ratio (PR) = 1.61, 95% confidence interval (CI): 1.4-1.8). High-risk HPV types (71 vs 40%, PR = 1.79, 95% CI: 1.5-2.2), in particular HPV-16+18 (22 vs 9%, PR = 2.35, 95% CI: 1.4-4.0), and multiple HPV infections (56 vs 23%, PR = 2.45, 95% CI: 1.8-3.3) were more prevalent in HIV-1-infected women. High-grade SIL (HSIL) was identified in 3.8% of the women. Human immunodeficiency virus type 1 infection was strongly associated with presence of HSIL (adjusted odds ratio = 17.0; 95% CI 2.2-134.1, P = 0.007) after controlling for high-risk HPV infection and other risk factors for HSIL. Nine of 14 (63%) HSIL cases were associated with HPV-16 or HPV-18 infection, and might have been prevented by an effective HPV-16/18 vaccine.
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Affiliation(s)
- M-N Didelot-Rousseau
- Department of Virology, Montpellier University Hospital, 34295 Montpellier, France
- Laboratory of Virology, UMR145 (University of Montpellier and Institut de Recherche pour le Développement), Saint-Eloi Hospital, 80 Augustin Fliche Ave., 34295 Montpellier Cedex 5, France
| | - N Nagot
- Centre Muraz, BP153, Bobo Dioulasso, Burkina Faso
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC 1E 7HT, UK
| | - V Costes-Martineau
- Department of Pathology, Montpellier University Hospital, 34295 Montpellier, France
| | - X Vallès
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC 1E 7HT, UK
| | - A Ouedraogo
- Centre Muraz, BP153, Bobo Dioulasso, Burkina Faso
| | - I Konate
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC 1E 7HT, UK
| | - H A Weiss
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC 1E 7HT, UK
| | - P Van de Perre
- Department of Virology, Montpellier University Hospital, 34295 Montpellier, France
- Laboratory of Virology, UMR145 (University of Montpellier and Institut de Recherche pour le Développement), Saint-Eloi Hospital, 80 Augustin Fliche Ave., 34295 Montpellier Cedex 5, France
| | - P Mayaud
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC 1E 7HT, UK
| | - M Segondy
- Department of Virology, Montpellier University Hospital, 34295 Montpellier, France
- Laboratory of Virology, UMR145 (University of Montpellier and Institut de Recherche pour le Développement), Saint-Eloi Hospital, 80 Augustin Fliche Ave., 34295 Montpellier Cedex 5, France
- E-mail:
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Barennes H, Valea I, Boudat AM, Idle JR, Nagot N. Early glucose and methylene blue are effective against unripe ackee apple (Blighia sapida) poisoning in mice. Food Chem Toxicol 2004; 42:809-15. [PMID: 15046827 DOI: 10.1016/j.fct.2004.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2003] [Accepted: 01/12/2004] [Indexed: 10/26/2022]
Abstract
The ingestion of unripe ackee fruit (Blighia sapida) is responsible for lethal epidemic encephalopathy in West Africa and the Caribbean. The treatment of ackee poisoning remains empirical and lethality was 100% in a recent epidemic in Burkina Faso. Because ackee poisoning has certain biochemical similarities to ifosfamide encephalopathy, we evaluated the efficacy of methylene blue (MB) and glucose (G), alone and in combination (MB+G) in mice, as a treatment for ackee poisoning. MB administration showed some efficacy towards early mortality (P=0.07) but not to late mortality. No deaths were observed when 8 mg/kg MB was administrated within 1h of the ackee poisoning. The treatment was ineffective if given 6h or later after poisoning. Survival in G and G+MB groups was higher than in MB group (75% and 25% respectively) (P=0.008, R=2.0, 1.14<RR<3.52). Neither hepatitis nor the development of hepatic cirrhosis was observed in animals from any groups. Glucose was more effective than MB and elicited the same survival as MB in conditions of early treatment. MB must be given in multiple doses and the first administration should be performed early, at least within 3 h of poisoning, which may decrease the practical value of MB in the field. In conclusion, considering the high lethality of the ackee apple intoxication, the total absence of any existing treatment and the safety of glucose administration, we recommend at this stage to use early sugar or glucose administration in the field, in addition to a specific population-based prevention programme.
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Affiliation(s)
- H Barennes
- Médecin Chef de l'Unité d'Epidémiologie d'Intervention Centre Muraz, Bobo Dioulasso, Burkina Faso.
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Nagot N, Meda N, Ouangre A, Ouedraogo A, Yaro S, Sombie I, Defer MC, Barennes H, Van de Perre P. Review of STI and HIV epidemiological data from 1990 to 2001 in urban Burkina Faso: implications for STI and HIV control. Sex Transm Infect 2004; 80:124-9. [PMID: 15054175 PMCID: PMC1744820 DOI: 10.1136/sti.2002.004150] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [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: 11/04/2022] Open
Abstract
OBJECTIVES To better understand the sexually transmitted infection (STI)/HIV dynamics in an urban west African setting in order to adapt STI/HIV control efforts accordingly. METHODS Review of STI and HIV epidemiological studies performed over the past decade in Bobo-Dioulasso, the second city of Burkina Faso. Trends in STI prevalence among commercial sex workers and the general population were assessed over time through studies that used the same recruitment and laboratory diagnostic procedures. Variations in aetiologies of vaginal discharge, urethral discharge, and genital ulcers were also evaluated among patients consulting for genital infection complaints. Antenatal clinic based surveys provided data to assess HIV trend among the general population. RESULTS We observed an important decline of classic bacterial STI such as syphilis, Neisseria gonorrhoea, Chlamydia trachomatis, and Haemophilus ducrey infections in all study groups. Trichomoniasis also declined but to a lesser extent. HIV infection followed the same trend at the same time, with a significant decline in the 15-19 year age group of pregnant women, suggesting a possible decrease of HIV incidence. Although no evidence of a causal relation can be drawn from this review, adoption of safer sex behaviour, introduction of the syndromic management (SM) approach, or higher antibiotic use may have contributed to these changes. CONCLUSIONS Classic bacterial STI declined over the past decade in parallel with a stabilisation of HIV infection. Variations in syndromes aetiology and sexual behaviours should be monitored as part of STI surveillance in order to improve STI syndromic management algorithms and to adapt HIV/STI prevention efforts.
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Affiliation(s)
- N Nagot
- Centre Muraz, Bobo-Dioulasso, Burkina Faso.
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Barennes H, Sterlingot H, Nagot N, Meda H, Kaboré M, Sanou M, Nacro B, Bourée P, Pussard E. Intrarectal pharmacokinetics of two formulations of quinine in children with falciparum malaria. Eur J Clin Pharmacol 2003; 58:649-52. [PMID: 12610739 DOI: 10.1007/s00228-002-0546-2] [Citation(s) in RCA: 12] [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] [Received: 03/18/2002] [Accepted: 11/23/2002] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare the intrarectal bioavailabilities of two parenteral formulations of quinine most available in French- (Cinchona alkaloid mixture) and English (hydrochloride salt) -speaking areas of Africa. METHODS The pharmacokinetics of quinine was investigated in four groups of 12 children with acute Plasmodium falciparum malaria receiving 8 mg/kg quinine base every 8 h either as hydrochloride salt or Cinchona alkaloid mixture by a slow 4-h intravenous infusion or intrarectal administration. Body temperature and parasitaemia were monitored, and blood quinine concentrations were measured by means of high-performance liquid chromatography. RESULTS At 72 h, all the children were aparasitaemic and apyretic. Quinine C(max) values were higher after intravenous infusion of the hydrochloride salt and Cinchona alkaloid mixture (6.9+/-1.9 micro g/ml and 5.2+/-1.3 micro g/ml) than after intrarectal administration (3.5+/-1.4 micro g/ml and 3.1+/-1.6 micro g/ml), but t(max) values were similar (3.6+/-1.5, 4.2+/-1.0, 4.0+/-1.9, and 4.7+/-2.0 h, respectively). Intrarectal relative bioavailabilities of hydrochloride salt solution (57%) and Cinchona alkaloid mixture (62%) were similar. CONCLUSION Whatever the parenteral formulation of quinine, the blood concentration-time profiles of quinine were similar after intrarectal administration. Intrarectal administration of hydrochloride salt solution is a possible mode of quinine delivery in remote rural areas of Africa.
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Affiliation(s)
- H Barennes
- Centre Muraz, Bobo Dioulasso, Burkina Faso
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