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Le Touquet – Paris-Plage, France

Duchateau F.-X.,Beaujon University Hospital | Gueye P.,Lariboisiere University Hospital | Curac S.,Beaujon University Hospital | Tubach F.,Bichat Claude Bernard University Hospital | And 5 more authors.
Intensive Care Medicine | Year: 2010

Purpose: Guidelines for advanced life support of cardiac arrest (CA) emphasize continuous and effective chest compressions as one of the main factors of cardiopulmonary resuscitation (CPR) success. The use of an automated load distributing chest compression device for CPR is promising but initial studies on survival show contradictory results. The aim of this study was to evaluate the effects of AutoPulse™ on blood pressure (BP) in out-of-hospital CA patients. Methods: This prospective study included adult patients presenting with in refractory out-of-hospital CA. Invasive arterial BP produced by AutoPulse™ was compared to BP generated by manual CPR (Active Compression Decompression). Systolic, diastolic and mean BP and end-tidal carbon dioxide were recorded before and after initiating the automated band device for each patient. The comparison of diastolic BP produced by manual CPR versus automated chest compressions was the primary end point. Results: Hemodynamics in 29 patients are reported and analyzed. Median diastolic BP increased after starting AutoPulse™ from 17[11-25] mmHg to 23[18-28] mmHg (P < 0.001). Median systolic BP increased from 72[55-105] mmHg to 106[78-135] mmHg (P = 0.02). Mean BP increased from 29[25-38] mmHg to 36[30-15] mmHg (P = 0.002). On the other hand, End-Tidal CO2 did not increase significantly with AutoPulse™ (21[13-36] vs. 22[12-35] mmHg, P = 0.80). Conclusions: In patients with out-of-hospital CA, the use of AutoPulse™ is associated with an increased diastolic BP compared to manual chest compressions. While its benefit to survival has yet to be demonstrated, the increase in diastolic and mean BP is a promising outcome for AutoPulse™ use. © 2010 Copyright jointly held by Springer and ESICM.

Koskas P.,Bretonneau Hospital | Henry Feugeas M.C.,Bichat Claude Bernard University Hospital | Saad S.,Bretonneau Hospital | Belqadi S.,Bretonneau Hospital | And 2 more authors.
Alzheimer Disease and Associated Disorders | Year: 2011

Background: The French government gave a consensual definition of reinforced care units for Behavioral and Psychological Symptoms in Dementia (BPSD) within the project "Plan Alzheimer 2008/2012." These Cognitive and Behavioral Units (CBU) differ in resources from the traditional reference units for BPSD management, the Acute Psychogeriatric Units (APU). However, a better understanding of their operational specificities may enhance the CBU and APU synergies. Objectives: To describe one of the first CBU experiments, with regard to preexisting BPSD management in an APU in the same geriatric hospital. Participants: A total of 129 patients with BPSD, 35 from the CBU and 94 admitted to the APU before opening the colocated CBU. Results: Patients from the CBU often showed comorbidities and a lower nutritional status, but these conditions were more frequent in the APU (P≤10). Severe dementia, night time and aberrant motor behavior, and agitation were more frequent in the CBU (P≤0.0015). In both the units, about 80% of patients were improved without increased use of psychotropic medications and there was a high discharge rate back home of about 30%. Conclusions: These findings that are still preliminary support a particular role for the CBU for elderly patients showing the most advanced dementia and disruptive BPSD. Colocated APU and CBU may allow for more effective integration of medical and psychiatric care in elderly patients with BPSD with frequent comorbidities. Copyright © 2011 by Lippincott Williams & Wilkins.

Vandekerckhove L.P.R.,Ghent University | Wensing A.M.J.,University Utrecht | Kaiser R.,University of Cologne | Brun-Vezinet F.,Bichat Claude Bernard University Hospital | And 18 more authors.
The Lancet Infectious Diseases | Year: 2011

Viral tropism is the ability of viruses to enter and infect specific host cells and is based on the ability of viruses to bind to receptors on those cells. Testing for HIV tropism is recommended before prescribing a chemokine receptor blocker. In most European countries, HIV tropism is identified with tropism phenotype testing. New data support genotype analysis of the HIV third hypervariable loop (V3) for the identification of tropism. The European Consensus Group on clinical management of tropism testing was established to make recommendations to clinicians and clinical virologists. The panel recommends HIV-tropism testing for the following groups: drug-naive patients in whom toxic effects are anticipated or for whom few treatment options are available; patients who have poor tolerability to or toxic effects from current treatment or who have CNS pathology; and patients for whom therapy has failed and a change in treatment is considered. In general, an enhanced sensitivity Trofile assay and V3 population genotyping are the recommended methods. Genotypic methods are anticipated to be used more frequently in the clinical setting because of their greater accessibility, lower cost, and faster turnaround time than other methods. For the interpretation of V3 loop genotyping, clinically validated systems should be used when possible. Laboratories doing HIV tropism tests should have adequate quality assurance measures. Similarly, close collaboration between HIV clinicians and virologists is needed to ensure adequate diagnostic and treatment decisions. © 2011 Elsevier Ltd.

Tattevin P.,Pontchaillou University Hospital | Tattevin P.,University of Rennes 1 | Saleh-Mghir A.,University of Versailles | Saleh-Mghir A.,Raymond Poincare University Hospital | And 10 more authors.
Antimicrobial Agents and Chemotherapy | Year: 2013

Concerns have recently emerged about the potency and the quality of generic vancomycin (VAN) products approved for use in humans, based on experiments in a neutropenic mouse thigh infection model. However, other animal models may be more appropriate to decipher the bactericidal activities of VAN generics in vivo and to predict their efficacy in humans. We aimed to compare the bactericidal activities of six generic VAN products currently used in France (Mylan and Sandoz), Spain (Hospira), Switzerland (Teva), and the United States (Akorn-Strides and American Pharmaceutical Products [APP]) in a rabbit model of aortic valve endocarditis induced by 8×107 CFU of methicillin-resistant Staphylococcus aureus (MRSA) strain COL (VAN MIC, 1.5 μg/ml). In vitro, there were no significant differences in the time-kill curve studies performed with the six generic VAN products. Ten rabbits in each group were treated with intravenous (i.v.) VAN, 60 mg/kg of body weight twice a day (b.i.d.) for 4 days. Mean peak serum VAN levels, measured 45 min after the last injection, ranged from 35.5 (APP) to 45.9 μg/ml (Teva). Mean trough serum VAN levels, measured 12 h after the last injection, ranged from 2.3 (Hospira) to 9.2 (APP) μg/ml. All generic VAN products were superior to controls (no treatment) in terms of residual organisms in vegetations (P<0.02 for each comparison) and in the spleen (P<0.005 for each comparison). Pairwise comparisons of generic VAN products found no significant differences. In conclusion, a stringent MRSA endocarditis model found no significant differences in the bactericidal activities of six generic VAN products currently used in Europe and America. Copyright © 2013, American Society for Microbiology.

Cecile M.,Bichat Claude Bernard University Hospital | Feugeas H.,Bichat Claude Bernard University Hospital
Alzheimer's Disease Research Journal | Year: 2011

The wide availibility of computed Xray tomography after the 1970s has allowed early enhancement of the hippocampal atrophy in Alzheimer's disease. More recently, three dimensional MR sequences have allowed identification of a more detailed and complex spatial pattern of mesiotemporal atrophy in this condition. Sole asessment of the hippocampus volume or any other single structure from the mesiotemporal lobe was not accurate at discriminating AD from normal aging, vascular cognitive impairment or Lewy bodies disease; conversely, the detailed spatial MR pattern of mesiotemporal atrophy now provides a macroscopic signature of AD. The severity of this complex MR atrophy parallels that of AD pathology; thus, as expected, it is already quite advanced by the time cognitive decline becomes clinically detectable. The currently used clinical definitions of AD lack any specific markers of AD and this pathognomic structural signature of Alzheimer pathology helps in vivo unmasking the pathogenic heterogeneity of such a clinically defined syndrome. The typical forms which combine concordant clinical and brain structural presentations are relatively unfrequent; late-onset Alzheimer's-like cognitive impairment frequently lacks any brain structural evidence of advanced Alzheimer's pathology but demonstrate an unexpected high frequency of neurologically "silent" cerebrovascular changes. Persistent errors in the diagnosis of vascular cognitive impairment have delayed focus on these cerebrovascular changes. However, recent advances in vascular cognitive impairment, use of functional rather than structural cerebrovascular MR examinations, now enhance the contribution of altered intracranial dynamics to the "Alzheimer's syndrome" and especially that of large artery stiffening. © 2011 Nova Science Publishers, Inc.

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