[Antiretroviral drugs in severe acute respiratory syndrome].

Inhibition of viral assembly (protease inhibitors) and of fusion of viral and target membranes (fusion inhibitors) are general approaches to antiviral treatment, not specific for HIV. Nonetheless, the agents that induce these phenomena are most often specific for a given virus or virus family. Drugs developed for HIV treatment were reevaluated for use against severe acute respiratory syndrome-coronavirus (SARS-CoV) during and after the epidemic in 2003, in view of the absence of any other available treatment.

Absence of infection in asymptomatic contacts of index SARS case in France.

The first case of severe acute respiratory syndrome (SARS) in France was diagnosed in March 2003. We conducted a serological survey to assess whether or not asymptomatic persons who had been in contact with this patient during his infectious stage had been infected. They were interviewed and asked to provide a blood sample for SARS coronavirus immunoglobulin G antibody testing.

Risk factors for hepatitis C virus transmission to health care workers after occupational exposure: a European case-control study.

Background: Additional studies are required to identify risk factors for hepatitis C virus (HCV) transmission to health care workers after occupational exposure to HCV.

Methods: We conducted a matched case-control study in 5 European countries from 1 January 1991 through 31 December 2002. Case patients were health care workers who experienced seroconversion after percutaneous or mucocutaneous exposure to HCV.

Prevention and treatment of aspiration pneumonia in intensive care units.

Aspiration is a leading cause of nosocomial infection in the intensive care unit. Techniques to avoid or reduce aspiration are important in preventing pneumonia and pneumonitis. The most important preventive measures include the semi-recumbent position, the surveillance of enteral feeding, the use of promotility agents, and avoiding excessive sedation.

Clinical impact and cost-effectiveness of co-trimoxazole prophylaxis in patients with HIV/AIDS in Côte d'Ivoire: a trial-based analysis.

Background: In 2000, WHO/UNAIDS recommended co-trimoxazole prophylaxis for persons at early stages of HIV infection (WHO stage > or = 2) in sub-Saharan Africa.

Objective: To assess the cost-effectiveness of alternative strategies for initiation of co-trimoxazole in Côte d'Ivoire.

Design: Cost-effectiveness analysis with an HIV simulation model using clinical and cost data from a randomized trial of co-trimoxazole in HIV-infected adults.

Suspected SARS patients hospitalised in French isolation units during the early SARS epidemic: The French experience.

During the SARS epidemic, many patients were screened according to WHO criteria but never went on to develop SARS. In May 2003, early in the epidemic, we conducted a retrospective study to describe suspected SARS patients hospitalised in France and compared them with documented cases of patients with SARS to evaluate the screening strategy. A total of 117 patients were studied.

[Surgical antimicrobial prophylaxis: compliance to guidelines and impact of targeted information program].

Objectives: Surgical antimicrobial prophylaxis is used to decrease postoperative wound infection. We assessed the compliance to surgical antimicrobial prophylaxis guidelines in our hospital and the impact of an information program.

Patients And Methods: Observational study of clean or clean contamined surgery, during two 3-week periods, separated by a targeted information period.

[Viral pneumonia in immunocompetent patients].

Respiratory infections are frequently encountered in the community; these infections are usually associated with only minor consequences. Many different agents, such as influenza and parainfluenza virus, respiratory syncitial virus, rhinovirus, coronavirus, adenovirus and herpes virus can be found in immuno-competent patients. Among these pathogens, cytomegalovirus (CMV) has been found to be responsible for nosocomial pneumonia in ICU.

Costs associated with combination antiretroviral therapy in HIV-infected patients.

As more effective HIV therapies have become available, resource constraints and cost-effectiveness have increasingly been at the centre of the debate on HIV care. Economic analysis is an important methodological approach to the understanding and establishment of priorities for health interventions designed to combat HIV in both high-income and low-income countries. In this paper, I briefly discuss different types of clinical economic analysis, and then consider the cost, affordability and cost-effectiveness of combination antiretroviral therapy in HIV patients in high-income and low-income countries.

Clinical efficacy of antiretroviral combination therapy based on protease inhibitors or non-nucleoside analogue reverse transcriptase inhibitors: indirect comparison of controlled trials.

Objective: To compare the clinical efficacy of triple antiretroviral regimens based on protease inhibitors and non-nucleoside analogue reverse transcriptase inhibitors (NNRTIs) in adults positive for antibodies to HIV-1.

Design: Systematic review and meta-analysis using indirect comparisons of clinical trials comparing three drug regimens based on two nucleoside reverse transcriptase inhibitors (NRTIs) and either a protease inhibitor or an NNRTI with two drug regimens (two NRTIs). Participants had no previous exposure to protease inhibitors or NNRTIs.

Lifetime cost of HIV care in France during the era of highly active antiretroviral therapy.

Objective: To estimate the treatment and health care costs of HIV infection or AIDS in France during the era of highly active antiretroviral therapy (HAART).

Design: We used a clinical database of HIV-infected patients to calculate the resource use and cost of care for different stages of HIV infection. Costs were incorporated into a computer-based, probabilistic simulation model of the natural history and treatment of HIV infection to estimate the lifetime cost of treating patients with HIV disease.

Prevention of human immunodeficiency virus-related opportunistic infections in France: a cost-effectiveness analysis.

A simulation model of human immunodeficiency virus (HIV) disease, which incorporated French data on the progression of HIV disease in the absence of antiretroviral therapy and on cost, was used to determine the clinical impact and cost-effectiveness of different strategies for the prevention of opportunistic infections in French patients who receive highly active antiretroviral therapy (HAART). Compared with use of no prophylaxis, use of trimethoprim-sulfamethoxazole (TMP-SMZ) increased per-person lifetime costs from euro 185,600 to euro 187,900 and quality-adjusted life expectancy from 112.2 to 113.

[Edmond Sergent (1876-1969) and the Pasteur Institute of Algeria].

Edmond Sergent, supported by a distinguished team of colleagues, directed the Pasteur Institute of Algeria for over 60 years, from 1900 to 1963. As a student of Emile Roux, Sergent had received a Pasteurian training. His institute devoted extensive study to malaria.

[Availability of antiretroviral agents in the city: a 1-year assessment in the Lille metropolitan area].

Objectives: Dispensing antiretroviral drugs in private pharmacies has been allowed in France since October 1997. One year after this measure was implemented, we conducted a survey of patients and pharmacists in the Lille metropolitan area to assess its impact.

Method: Structured interviews with a representative sample of private pharmacists and HIV infected patients in the Lille metropolitan area were carried out.

Incidence of primary opportunistic infections in two human immunodeficiency virus-infected French clinical cohorts.

Background: Clinical guidelines for the prevention of opportunistic infections in human immunodeficiency virus (HIV)-infected individuals have been developed on the basis of natural history data collected in the USA. The objective of this study was to estimate the incidence of primary opportunistic infections in HIV-infected individuals in geographically distinct cohorts in France.

Methods: We conducted our study on 2664 HIV-infected patients from the Tourcoing AIDS Reference Centre and the hospital-based information system of the Groupe d'Epidémiologie Clinique du SIDA en Aquitaine enrolled from January 1987 to September 1995 and followed through December 1995.

[Severe community-acquired pneumonia].

Community-acquired pneumonia is severe when hospitalisation is required. The diagnosis is based on pulmonary involvement (chest radiography) associated with vital signs abnormalities (mental status, temperature, blood pressure and ventilatory rate) or immunosuppression (neoplastic diseases). No specific causative pathogen could be incriminated.

Symptomatic hyperlactataemia: an emerging complication of antiretroviral therapy.

Background: Fatal lactic acidosis is a serious complication of therapy with nucleoside analogues.

Objective: To examine symptomatic hyperlactataemia in HIV-infected adults treated with antiretroviral drugs.

Methods: In this prospective study, arterial blood lactate levels were measured in patients presenting with unexplained clinical symptoms.

Inhaled NO preadministration modulates local and remote ischemia-reperfusion organ injury in a rat model.

Inhaled nitric oxide (iNO) has been shown to have a protective effect in lung ischemia-reperfusion (I/R)-induced injuries. We studied the role of iNO (10 parts/million for 4 h) administered before I/R. In an isolated perfused lung preparation, iNO decreased the extravascular albumin accumulation from 2,059 +/- 522 to 615 +/- 105 microl and prevented the increase in lung wet-to-dry weight ratio.

Redox status of cytochrome a,a3: a noninvasive indicator of dysoxia in regional hypoxic or ischemic hypoxia.

Objective: Multiwavelength near infrared (NIR) spectrophotometry can monitor the redox state of cytochrome a,a3 (cyt a,a3) in vivo. Because cyt a,a3 is the most immediate reductant of oxygen, this technique has been proposed to evaluate tissue oxygenation. The purpose of this study was to examine the relationship between cyt a,a3 oxidation level as an indicator of dysoxia and oxygen uptake (VO2) when oxygen delivery (DO2) was progressively lowered in an in situ vascularly isolated hindlimb.

[ParaSight F in the diagnosis of Plasmodium falciparum malaria].

The ParaSight F is a new diagnostic test for Plasmodium falciparum infections and is based on the detection of a trophozoite-derived antigen, the histidine rich protein II (HRP-II). To assess the usefulness of this test, we conducted a prospective study and analyzed 62 blood specimens from 38 patients, using thin blood films, thick blood films and the ParaSight F test. Compared to thick blood film, on samples taken before and during treatment, the ParaSight F test had 86.

In vitro antibiotics testing and its relationship to clinical activity.

The need for predicting bacteriological and clinical antibiotic activity appeared early after development of the first antibiotics. Antimicrobial efficacy is significant among many therapeutic management factors, including surgery, drug interactions and non-antibiotic therapies. Clinical efficacy is not only related to antimicrobial efficacy, but also to host characteristics and causative organism attributes.

[Acute necrotizing enterocolitis during a prolonged treatment with neuroleptics].

A 32-year old man treated for several years with phenothiazine for chronic psychosis developed acute necrotizing colitis. The causal relationship with neuroleptics was reinforced by the absence of any other treatment and by histological findings including extensive mucosal necrosis without stenotic lesion and without mesenteric vessels alteration. The patient required emergency total colectomy and was discharged after 7 weeks of hospitalisation in the intensive care unit.