Blanc F.-X.,Bicetre Hospital |
Sok T.,Cambodian Health Committee |
Laureillard D.,Cambodian Health Committee |
Laureillard D.,Georges Pompidou European Hospital |
And 25 more authors.
New England Journal of Medicine | Year: 2011
BACKGROUND: Tuberculosis remains an important cause of death among patients infected with the human immunodeficiency virus (HIV). Robust data are lacking with regard to the timing for the initiation of antiretroviral therapy (ART) in relation to the start of antituberculosis therapy. METHODS: We tested the hypothesis that the timing of ART initiation would significantly affect mortality among adults not previously exposed to antiretroviral drugs who had newly diagnosed tuberculosis and CD4+ T-cell counts of 200 per cubic millimeter or lower. After beginning the standard, 6-month treatment for tuberculosis, patients were randomly assigned to either earlier treatment (2 weeks after beginning tuberculosis treatment) or later treatment (8 weeks after) with stavudine, lamivudine, and efavirenz. The primary end point was survival. RESULTS: A total of 661 patients were enrolled and were followed for a median of 25 months. The median CD4+ T-cell count was 25 per cubic millimeter, and the median viral load was 5.64 log10 copies per milliliter. The risk of death was significantly reduced in the group that received ART earlier, with 59 deaths among 332 patients (18%), as compared with 90 deaths among 329 patients (27%) in the later-ART group (hazard ratio, 0.62; 95% confidence interval [CI]; 0.44 to 0.86; P = 0.006). The risk of tuberculosis-associated immune reconstitution inflammatory syndrome was significantly increased in the earlier-ART group (hazard ratio, 2.51; 95% CI, 1.78 to 3.59; P<0.001). Irrespective of the study group, the median gain in the CD4+ T-cell count was 114 per cubic millimeter, and the viral load was undetectable at week 50 in 96.5% of the patients. CONCLUSIONS: Initiating ART 2 weeks after the start of tuberculosis treatment significantly improved survival among HIV-infected adults with CD4+ T-cell counts of 200 per cubic millimeter or lower. (Funded by the French National Agency for Research on AIDS and Viral Hepatitis and the National Institutes of Health; CAMELIA ClinicalTrials.gov number, NCT01300481.) Copyright © 2011 Massachusetts Medical Society. All rights reserved.
PubMed | Institute Pasteur in Cambodia, Ministry of Health, Sonja Kill Memorial Hospital and Calmette Hospital
Type: Case Reports | Journal: Journal of travel medicine | Year: 2016
A case of confirmed rabies in a French resident is a wake-up call for improved access to timely and adequate rabies post-exposure prophylaxis for all those living in Cambodia, as well as for improved pre-exposure prevention in travellers to Cambodia and other highly endemic settings.
Laureillard D.,French National Agency for Research on AIDS and Viral Hepatitis ANRS |
Marcy O.,Institute Pasteur in Cambodia |
Marcy O.,Cambodian Health Committee |
Madec Y.,Institute Pasteur Paris |
And 16 more authors.
AIDS | Year: 2013
OBJECTIVE: To analyze cases of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) in the CAMbodian Early versus Late Introduction of Antiretrovirals (CAMELIA) randomized trial designed to compare early (2 weeks) versus late (8 weeks) antiretroviral therapy (ART) initiation after tuberculosis treatment onset in Cambodia (NCT00226434). METHODS: ART-naive adults with CD4 cell count of 200 cells/μl or less, newly diagnosed tuberculosis, and at least one follow-up visit after ART initiation were included in this analysis. Each case of suspected TB-IRIS was systematically validated by two physicians not involved in patients' management. Factors associated with occurrence of TB-IRIS were identified using the Cox proportional hazard model. RESULTS: Among 597 patients, 26% experienced TB-IRIS with an incidence rate of 37.9 cases per 100 person-years [95% confidence interval (CI) 32.4-44.4]. Main clinical manifestations included new or worsening lymphadenopathy (77.4%) and fever (68.4%). Chest radiograph revealed new or worsening abnormalities in 53.4%. Symptoms resolved in 95.5% of patients. Six deaths were directly related to TB-IRIS. Initiating ART early increased the risk of TB-IRIS by 2.61 (95% CI 1.84-3.70). Extrapulmonary or disseminated tuberculosis, CD4 cell count of 100 cells/μl or less, and HIV RNA concentration more than 6 log10 copies/ml were also significantly associated with higher risk of TB-IRIS. CONCLUSION: Shortening the delay between tuberculosis treatment onset and ART initiation to 2 weeks was associated with an increased risk of developing TB-IRIS. However, TB-IRIS was generally easily manageable. Given the marked reported survival advantage of early ART initiation after tuberculosis treatment onset, these data indicate that fear of TB-IRIS should not be an impediment to early ART in adults with advanced immunodeficiency in resource-limited, high burden settings. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Lemyze M.,Lille University Hospital |
Favory R.,Lille University Hospital |
Alves I.,Lille University Hospital |
Perez T.,Calmette Hospital |
Mathieu D.,Lille University Hospital
Journal of Critical Care | Year: 2012
Purpose: The aim of this study was to evaluate the manual compression of the abdomen (MCA) during expiration as a simple bedside method to detect expiratory flow limitation (EFL) during daily clinical practice of mechanical ventilation (MV). Methods: We studied 44 semirecumbent intubated and sedated critically ill patients. Flow-volume loops obtained during MCA were superimposed upon the preceding breaths and recorded with the ventilator. Expiratory flow limitation was expressed as percentage of expiratory tidal volume without any increase in flow during MCA (MCA [%V T]). In the first 13 patients, MCA was validated by comparison with the negative expiratory pressure (NEP) technique. Esophageal pressure changes during MCA and intrinsic positive end-expiratory pressure were also recorded in all the patients. Results: Manual compression of the abdomen and NEP agreed in all cases in detecting EFL with a bias of -0.16%. Percentage of expiratory tidal volume without any increase in flow during MCA is highly correlated with percentage of expiratory tidal volume without any increase in flow during NEP (n = 13, P < .0001, r 2 = 0.99) and intrinsic positive end-expiratory pressure (n = 44, P < .001, r 2 = 0.78), with a good repeatability (n = 44; within-subject SD, 5.7%) and reproducibility (n = 13; within-subject SD, 2.41%). Two third of the patients were flow limited, among whom one third had no previously known respiratory disease. Conclusions: Manual compression of the abdomen provides a simple, rapid, and safe bedside reliable maneuver to detect and quantify EFL during mechanical ventilation. © 2012 Elsevier Inc.
Lemyze M.,Schaffner Hospital |
Dharancy S.,Huriez Hospital |
Wallaert B.,Calmette Hospital
Digestive and Liver Disease | Year: 2013
End-stage liver cirrhosis is a systemic disease carrying a short-term desperate prognosis without liver transplantation. Given the discrepancy between the growing number of candidates and the limited available liver grafts, the pre-transplantation screening process has become a challenging task. Cardiopulmonary exercise testing, by measuring maximal oxygen consumption at peak exercise, provides a global integrative approach of the health status of an individual. In the setting of liver cirrhosis, decreased oxygen consumption at peak exercise may result from a combination of multiple extra-hepatic complications, including deconditioning, malnutrition-associated muscle weakness, anaemia, cirrhotic cardiomyopathy, and hepato-pulmonary syndrome for instance. In addition, oxygen consumption at peak exercise not only correlated with the severity of the liver disease, but it is also independently associated with survival following liver transplantation. The present article aims to review the numerous determinants of impaired aerobic capacity in patients with severe liver disease, and to discuss how useful is cardiopulmonary exercise testing as a critical tool in the pre-transplantation assessment of these patients. © 2012 Editrice Gastroenterologica Italiana S.r.l.
Nseir S.,Intensive Care Unit |
Nseir S.,Lille University |
Zerimech F.,University Hospital of Lille |
Fournier C.,Calmette Hospital |
And 6 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2011
Rationale: Underinflation of the tracheal cuff frequently occurs in critically ill patients and represents a risk factor for microaspiration of contaminated oropharyngeal secretions and gastric contents that plays a major role in the pathogenesis of ventilator-associated pneumonia (VAP). Objectives: To determine the impact of continuous control of tracheal cuff pressure (P cuff) on microaspiration of gastric contents. Methods: Prospective randomized controlled trial performed in a single medical intensive care unit. A total of 122 patients expected to receive mechanical ventilation for at least 48 hours through a tracheal tube were randomized to receive continuous control of P cuffusing a pneumatic device (intervention group, n = 61) or routine care of P cuff (control group, n = 61). Measurements and Main Results: The primary outcome was microaspiration of gastric contents as defined by the presence of pepsin at a significant level in tracheal secretions collected during the 48 hours after randomization. Secondary outcomes included incidence of VAP, tracheobronchial bacterial concentration, and tracheal ischemic lesions. The pneumatic device was efficient in controlling P cuff. Pepsin was measured in 1,205 tracheal aspirates. Percentage of patients with abundant microaspiration (18 vs. 46%; P = 0.002; OR [95% confidence interval], 0.25 [0.11-0.59]), bacterial concentration in tracheal aspirates (mean ± SD 1.6 ± 2.4 vs. 3.1 ± 3.7 log 10 cfu/ml, P = 0.014), and VAP rate (9.8 vs. 26.2%; P = 0.032; 0.30 [0.11-0.84]) were significantly lower in the intervention group compared with the control group. However, no significant difference was found in tracheal ischemia score between the two groups. Conclusions: Continuous control of P cuff is associated with significantly decreased microaspiration of gastric contents in critically ill patients.
Munck C.,French Institute of Health and Medical Research |
Mordon S.R.,French Institute of Health and Medical Research |
Scherpereel A.,Calmette Hospital |
Porte H.,Calmette Hospital |
And 2 more authors.
Annals of Thoracic Surgery | Year: 2015
In the surgical multimodal management of malignant pleural mesothelioma, it seems crucial to proceed with an efficient local adjuvant treatment to kill residual tumor cells. Intrapleural photodynamic therapy has recently emerged as a potential candidate in this goal. In this review, we analyzed and classified 16 articles in which patients with malignant pleural mesothelioma received intrapleural photodynamic therapy after maximal surgical resection. The toxicity, effect on survival, and development of the technique were assessed. After two decades of clinical studies, intrapleural photodynamic therapy after surgical resection became a safe treatment that significantly improved the survival of patients. © 2015 The Society of Thoracic Surgeons.
Goffard A.,Lille Hospital |
Goffard A.,French Institute of Health and Medical Research |
Lambert V.,Lille Hospital |
Salleron J.,Lille Hospital |
And 11 more authors.
Journal of Clinical Virology | Year: 2014
Background: Few studies have suggested the potential role of respiratory viruses in cystic fibrosis (CF) exacerbation, but their real impact is probably underestimated. Method: Sixty-four sputum samples collected from 46 adult patients were included in the study: 33 samples were collected during exacerbation of CF, and 31 during the stable phase. After extraction, nucleic acids were tested for the presence of respiratory viruses. When rhinovirus (HRV) was detected, the 5'UTR and VP4/2 regions were sequenced, and phylogenetically analyzed. The characteristics of patients in exacerbation and stable phase were compared. Results: Viruses were found in 25% of samples. The HRV viruses were the most frequently detected followed by coronaviruses. Only the HRV detection was significantly associated with the occurrence of CF pulmonary exacerbation (p< 0.027). Characterization of 5'UTR and VP4/2 regions of the HRV genome specified that HRV-A, -B, -C were detected. All HRV-C were recombinant HRV-Ca. Conclusions: HRV were the most frequently detected viruses; their detection was significantly associated with the occurrence of an exacerbation. The reality of viral recombination between HRV was demonstrated in CF patients for the first time, raising the role of viruses in lung microbiota. Further studies are now warranted to decipher virus impact in CF. © 2014 Elsevier B.V.
Nevoux P.,Calmette Hospital |
Mitchell V.,Calmette Hospital |
Chevallier D.,Hopital University Pasteur |
Rigot J.-M.,Calmette Hospital |
Marcelli F.,Calmette Hospital
Current Opinion in Obstetrics and Gynecology | Year: 2011
Purpose of Review: To review the role of varicocele repair in the treatment of male infertility. Recent Findings: Since the advent of technologies bypassing boundaries of natural selection, this question may seem outdated. Over the past 20 years, fertility has decreased, and testicular damage (cryptorchidism, tumors) has increased. Thus the exploration of the infertile male is still unavoidable. However, what should be done and assigned to the discovery of a varicocele?The issue raised is whether varicocele found during the review of the infertile couple should be treated or 'ignored'.This study will update significant findings with regards to the pathophysiology of varicocele-induced infertility, such as oxidative stress and role of varicocele in bilaterality of testicular damage. Benefits of varicocele repair in semen analysis and simplifications of assisted reproductive techniques are reported. But reviews of randomized clinical trials have raised doubts about the benefit of varicocele treatment in infertile men. Summary: We conclude that varicocele repair may be effective in men with subnormal semen analysis, a clinical varicocele and otherwise unexplained infertility. Deleterious cofactors, like obesity or smoking, could also be reduced for the benefit of general health and fertility. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Pean P.,Institute Pasteur in Cambodia |
Nerrienet E.,Institute Pasteur in Cambodia |
Madec Y.,Institute Pasteur Paris |
Borand L.,Institute Pasteur in Cambodia |
And 11 more authors.
Blood | Year: 2012
Immune reconstitution inflammatory syndrome (IRIS) is a common and potentially serious complication occurring in HIV-infected patients being treated for tuberculosis (TB) using combined antiretroviral treatment. A role of adaptive immunity has been suggested in the onset of IRIS, whereas the role of natural killer (NK) cells has not yet been explored. The present study sought to examine the involvement of NK cells in the onset of IRIS in HIV-infected patients with TB and to identify predictive markers of IRIS. A total of 128 HIV-infected patients with TB from the Cambodian Early versus Late Introduction of Antiretroviral Drugs (CAMELIA) trial were enrolled in Cambodia. Thirty-seven of the 128 patients developed IRIS. At inclusion, patients had low CD4 cell counts (27 cells/mm 3) and high plasma viral load (5.76 and 5.50 log/mL in IRIS and non-IRIS patients, respectively). At baseline, NK-cell degranulation capacity was significantly higher in IRIS patients than in non-IRIS patients (9.6% vs 6.38%, P < .005). At IRIS onset, degranulation capacity did not differ between patients, whereas activating receptor expression was lower in IRIS patients. Patients with degranulation levels > 10.84% had a higher risk of IRIS (P = .002 by log-rank test). Degranulation level at baseline was the most important IRIS predictor (hazard ratio = 4.41; 95% confidence interval, 1.60-12.16). We conclude that NK-degranulation levels identify higher IRIS risk in HIV-infected patients with TB. © 2012 by The American Society of Hematology.