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Aulnay-sous-Bois, France

Zucman D.,Foch Hospital | De Truchis P.,Raymond Poincare hospital | Peytavin G.,Bichat Claude Bernard Hospital | Descamps D.,Bichat Claude Bernard Hospital | And 8 more authors.
Scandinavian Journal of Infectious Diseases | Year: 2013

Objective and methods: The efficacy and safety of switching to a combined regimen containing darunavir/ritonavir (DRV/r) was investigated in a retrospective study. Results: Sixty-six experienced patients receiving once-daily DRV/r (900/100 mg) in various regimens were included (median age 51 y; male 82%; Centers for Disease Control and Prevention (CDC) stages B or C 70%). The number of patients with plasma HIV RNA < 50 copies/ml increased from 71% (45/63) at baseline (before switch) to 84% (52/62) at visit 1 (weeks 3-11), and to 92% (60/65) at visit 2 (weeks 12-24). CD4 cells increased from 498 ± 201 cells/mm3 at baseline to 567 ± 232 cells/mm 3 by visit 2. Good digestive and metabolic tolerance was observed. The median steady-state DRV plasma concentration, measured 24 ± 4 h after the last drug intake, was 1427 ng/ml. All DRV plasma concentrations were above the protein-binding corrected median effective concentration (EC50) for the wild-type virus (55 ng/ml). Conclusions: Once-daily DRV/r (900/100 mg) was efficacious in pretreated patients, with safe responses. © 2013 Informa Healthcare.

Bihan H.,University of Paris 13 | Cosson E.,University of Paris 13 | Khiter C.,De La Fontaine Hospital | Vittaz L.,Ballanger Hospital | And 6 more authors.
Diabetes and Metabolism | Year: 2014

Introduction: Although it is important to screen women who have had gestational diabetes mellitus (GDM) for abnormal post-partum glucose levels, such testing is rarely performed. The aim of this study was to use data from the first observational phase of the IMPACT study to determine rates of screening within 6 months of delivery in a multiethnic cohort, focusing in particular on the effects of social deprivation and the risk of future diabetes. Patients and methods: To investigate the frequency of post-partum screening, charts were analyzed, and all women attending four centres located in a deprived area who had had GDM between January 2009 and December 2010 were contacted by phone. The Evaluation of Precarity and Inequalities in Health Examination Centres (EPICES) deprivation index and Finnish Diabetes Risk Score (FINDRISK) questionnaire were also evaluated. Results: Data were evaluable for 589 of the 719 women contacted (mean age: 33.4±5.2years; mean body mass index: 27.6±5.4kg/m2), and 196 (33.3%) reported having been screened. On multivariate analysis, factors associated with a lack of screening were smoking [odds ratio (OR): 0.42 (0.20-0.90), P<0.05], low consumption of fruit and vegetables [OR: 0.58 (0.39-0.82), P<0.01] and heavier offspring birth weight (P<0.05), although there were no differences in FINDRISK and EPICES scores between screened and unscreened women. Conclusion: One-third of women who had had GDM reported having been screened for dysglycaemia at 6 months post-partum. However, it is expected that the interventional phase of the IMPACT study will increase screening rates, especially in women with the risk factors associated with lower screening rates during this observational phase. © 2014 Elsevier Masson SAS.

Cosson E.,University of Paris 13 | Bihan H.,University of Paris 13 | Reach G.,University of Paris 13 | Vittaz L.,Ballanger Hospital | And 2 more authors.
BMJ Open | Year: 2015

Objective: To evaluate the prognoses associated with psychosocial deprivation in women with gestational diabetes mellitus (GDM). Design: Observational study considering the 1498 multiethnic women with GDM who gave birth between January 2009 and February 2012. Setting: Four largest maternity units in the northeastern suburban area of Paris. Participants: The 994 women who completed the Evaluation of Precarity and Inequalities in Health Examination Centers (EPICES) questionnaire. Main outcome measure: Main complications of GDM (large infant for gestational age (LGA), shoulder dystocia, caesarean section, pre-eclampsia). Results: Psychosocial deprivation (EPICES score ≥30.17) affected 577 women (56%) and was positively associated with overweight/obesity, parity and non-European origin, and negatively associated with family history of diabetes, fruit and vegetable consumption and working status. The psychosocially deprived women were diagnosed with GDM earlier, received insulin treatment during pregnancy more often and were more likely to have LGA infants (15.1% vs 10.6%, OR=1.5 (95% CI 1.02 to 2.2), p<0.05) and shoulder dystocia (3.1% vs 1.2%, OR=2.7 (0.97 to 7.2), p<0.05). In addition to psychosocial deprivation, LGA was associated with greater parity, obesity, history of GDM, ethnicity, excessive gestational weight gain and insulin therapy. A multivariate analysis using these covariates revealed that the EPICES score was independently associated with LGA infants (per 10 units, OR=1.12 (1.03 to 1.20), p<0.01). Conclusions: In our area, psychosocial deprivation is common in women with GDM and is associated with earlier GDM diagnoses and greater insulin treatment, an increased likelihood of shoulder dystocia and, independently of obesity, gestational weight gain and other confounders with LGA infants. © 2015, BMJ. All rights reserved.

Cosson E.,University of Paris 13 | Bihan H.,University of Paris 13 | Vittaz L.,Ballanger Hospital | Khiter C.,De La Fontaine Hospital | And 7 more authors.
Diabetic Medicine | Year: 2015

Aims: To evaluate a mobilization campaign, the IMPACT initiative, which included multidisciplinary meetings, provision of information and a systematic prescription of an oral glucose tolerance test to improve the rate of glucose screening in women with gestational diabetes mellitus in the four largest maternity units in our area, starting in March 2011. Methods: We retrospectively compared the level of self-reported screening during the first 6 months postpartum of women who gave birth after having been diagnosed with gestational diabetes before (January 2009 to December 2010) and after the IMPACT campaign (April 2011 to February 2012). Results: We included 961 women (589 in the period before and 372 in the period after the campaign was initiated) with a mean ± sd age of 33.2 ± 5.3 years and BMI of 27.8 ± 5.3 kg/m2. Multivariate analysis, stratified using a propensity score in order to limit bias caused by imbalance between both periods, showed that the postpartum screening rate was higher after the campaign began (48.9 vs 33.3%, odds ratio 1.7, 95% CI 1.1-2.5; P = 0.019) and higher in women who received insulin treatment during pregnancy (odds ratio 2.3, 95% CI 1.5-3.6; P < 0.001), consumed fruit and vegetables daily (odds ratio 1.6, 95% CI 1.1-2.4; P = 0.035) and did not smoke (smoking vs non-smoking: odds ratio 0.3, 95% CI 0.1-0.7; P = 0.01). There was no interaction between the campaign effect and these particular conditions. The proportion of oral glucose tolerance tests performed in women who underwent screening increased from 6.3 to 33.0%. Conclusions: The IMPACT campaign increased postpartum screening, and the use the oral glucose tolerance test in particular. The effect of this initiative might be reinforced in women who are non-daily consumers of fruit and vegetables, smokers and those who do not receive insulin treatment during pregnancy. © 2014 Diabetes UK.

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