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Cattoir V.,Caen University Hospital Center | Cattoir V.,University of Caen Lower Normandy
Journal of Infection | Year: 2012

Actinobaculum schaalii is a facultative anaerobic, Gram-positive rod-shaped species phylogenetically related to Actinomyces that is likely part of the commensal flora of the human genitourinary tract. Because of its fastidious growth under aerobic conditions and its resemblance to bacteria of the resident flora, A. schaalii is frequently overlooked or considered as a contaminant. It is also difficult to identify phenotypically, still requiring molecular identification. Note that the recent technology of matrix-assisted laser desorption/ionisation time-of-flight-mass spectrometry could be a promising tool for its identification. Recent studies using sensitive PCR assays showed that its clinical significance was largely underestimated. Since its first description in 1997, A. schaalii has been responsible for numerous urinary tract infections (UTIs), mainly in elderly (usually >60 years) and patients with underlying urological conditions. Infected urines usually show many Gram-positive rods with significant leukocyturia and a negative test for nitrites. Numerous cases of severe infections have also been described, such as urosepsis, bacteremia, cellulitis, spondylodiscitis, and endocarditis. Invitro, A. schaalii is highly susceptible to β-lactams but it is resistant to ciprofloxacin and cotrimoxazole, first-choice antimicrobials for the oral treatment of UTIs. A penicillin (e.g. amoxicillin) or a cephalosporin (e.g. cefuroxime, ceftriaxone) should be the preferred treatment. © 2012 The British Infection Association. Source

Vincent F.B.,Monash University | Morand E.F.,Monash University | Murphy K.,Monash University | Mackay F.,Monash University | And 2 more authors.
Annals of the Rheumatic Diseases | Year: 2013

The introduction of biologics, especially tumour necrosis factor (TNF) inhibitors, has revolutionized the management of chronic inflammatory diseases. However, at least one third of patients with these diseases, receiving TNF inhibitors either do not respond to treatment, or lose initial responsiveness. For a significant proportion, improvement of clinical response is achieved after switching to another anti-TNF drug, suggesting a basis for failure unrelated to the therapeutic target itself. A likely explanation for this is immunogenicity, as all biologics are potentially immunogenic, and the resulting anti-drug antibodies (ADAb) can theoretically decrease the efficacy of biologics and/or induce adverse events. Indeed, in these chronic inflammatory diseases, many studies have now established correlations between ADAb formation, low serum drug levels, and the failure or loss of response to anti-TNF antibodies. This article will review key findings related to ADAb, and propose a model wherein monitoring of drug levels and ADAb may be a predictive tool leading to a better choice of biologics. Such an approach could improve chronic inflammatory disease management toward a personalized and more cost-effective approach. Source

Continuous subcutaneous insulin infusion (CSII) using an external pump is widely used for the treatment of type 1 diabetes, but has been less evaluated in type 2 diabetes. This review analyzes the open-label as well as randomized controlled studies performed in type 2 diabetic patients. The efficacy of CSII is compared with multiple daily injections (MDI) in terms of glycaemic control, weight variation, insulin requirements, treatment satisfaction and hypoglycaemic events. CSII may be offered as an alternative treatment to type 2 diabetic patients with poor glycaemic control despite high-dose insulin requirements administered through MDI. L'administration sous-cutanée continue d'insuline par pompe externe est largement utilisée pour le traitement du diabète de type 1, mais son usage dans le diabète de type 2 est moins bien évalué. Cette revue analyse les études ouvertes et controlées réalisées dans cette indication, études qui à ce jour sont peu nombreuses. L'efficacité de la pompe à insuline est comparée aux multi-injections sous-cutanées, en termes d'équilibre glycémique, de variation pondérale, de besoins en insuline, de satisfaction du traitement et d'incidence des hypoglycémies. La pompe à insuline pourrait être une alternative intéressante chez les patients diabétiques de type 2 dont l'équilibre glycémique reste médiocre en dépit de l'administration de fortes doses d'insuline en injections sous-cutanées discontinues. © 2010 Elsevier Masson SAS. Source

Churg A.,University of British Columbia | Galateau-Salle F.,Caen University Hospital Center
Archives of Pathology and Laboratory Medicine | Year: 2012

The separation of benign from malignant mesothelial proliferations is crucial to patient management but is often a difficult problem for the pathologist. Objective.-To review the pathologic features that allow separation of benign from malignant mesothelioma proliferations, with an emphasis on new findings. Data Sources.-Literature review and experience of the authors. Conclusions.-Invasion is still the most reliable indicator of malignancy. The distribution and amount of proliferating mesothelial cells are important in separating benignity from malignancy, and keratin stains can be valuable because they highlight the distribution of mesothelial cells. Hematoxylin-eosin examination remains the gold standard, and the role of immunochemistry is extremely controversial; we believe that at present there is no reliable immunohistochemical marker of malignancy in this setting. Mesothelioma in situ is a diagnosis that currently cannot be accurately made by any type of histologic examination. Desmoplastic mesotheliomas are characterized by downward growth of keratin-positive spindled cells between S100-positive fat cells; some cases of organizing pleuritis can mimic involvement of fat, but these fatlike spaces are really S100-negative artifacts aligned parallel to the pleural surface. Fluorescence in situ hybridization on tissue sections to look for homozygous p16 gene deletions is occasionally useful, but many mesotheliomas do not show homozygous p16 deletions. Equivocal biopsy specimens should be diagnosed as atypical mesothelial hyperplasia and another biopsy requested if the clinicians believe the process is malignant. Copyright © 2012 College of American Pathologists. Source

Beucher G.,Caen University Hospital Center
Diabetes & metabolism | Year: 2010

To estimate maternal outcome of treated or untreated gestational diabetes mellitus (GDM). French and English publications were searched using PubMed and the Cochrane library. The diagnosis of GDM includes a high risk population for preeclampsia and Caesarean sections (EL3). The risks are positively correlated with the level of hyperglycaemia in a linear way (EL2). Intensive treatment of mild GDM compared with routine care reduces the risk of pregnancy-induced hypertension (preeclampsia, gestational hypertension). Moreover, it does not increase the risk of operative vaginal delivery, Caesarean section and postpartum haemorrhage (EL1). Being overweight, obesity and maternal hyperglycaemia are independent risk factors for preeclampsia (EL2). Their association with GDM increases the risk of preeclampsia and Caesarean section compared to diabetic women with a normal body mass index (EL3). The association of several risk factors (such as advanced maternal age, pre-existing chronic hypertension, pre-existing nephropathy, obesity, suboptimal glycaemic control) increases the risk of preeclampsia. In that case, the classic follow-up (blood pressure measurement, proteinuria) should be more frequent than monthly (professional consensus). The risk of Caesarean section is increased by macrosomia, whether suspected prenatally or not, but this increased risk remains whatever the birth weight (EL3). Diagnosis and treatment of GDM do not reduce the risk of severe perineal lesions, operative vaginal delivery and postpartum haemorrhage (EL2). Some psychological symptoms, such as anxiety and alteration of self-perception, can occur upon diagnosis of GDM (EL3). The treatment of GDM appears to reduce the risk of postpartum depression symptoms (EL2). Most of the information published on GDM covers the risks of preeclampsia and Caesarean section; intensive care of GDM reduces these risks. Pregnancy care should be adjusted to the risk factors. Source

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