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Schrage N.F.,Klinik fur Augenheilkunde | Struck H.G.,Universitatsklinik Und Poliklinik For Augenheilkunde | Gerard M.,Center Hospitalier University Of Fort Of France
Ophthalmologe | Year: 2011

With these recommendations the authors want to improve the acute therapy of eye burns based on the literature and clinical experience. Due to the lack of studies with high evidential value we base these recommendations on the results of experimental work and reports of successfully treated eye burns. A development of this document by systematic research is necessary. Despite the limited knowledge, the collated facts are the current state of the art of treatment according to the knowledge and research of the authors. The most important clinical recommendation is to rinse a chemically or thermally burnt eye as soon and as extensively as possible. Any delay worsens the prognosis. Substances on the market for first aid have different levels of clinical evidence. Thus saline and amphoteric diphoterine ® have been evaluated in a prospective clinical study showing an advantage for the amphoter. Water, borate buffer, phosphate buffers and derivatives have never been proven to work in clinical applications. Nevertheless, they are recommended. Within experimental work in vitro we could show the value of polyvalent decontamination. Side-effects of phosphate buffers have been demonstrated in retrospective clinical and prospective experimental studies so that even in cases of beneficial effects on pH we cannot recommend these substances which propagate corneal calcification. Special types of burns, such as hydrofluoric acid need special treatment but as clinical studies are lacking only experimental data can offer suitable recommendations. © 2011 Springer-Verlag.

Wingerchuk D.M.,Mayo Medical School | Banwell B.,Childrens Hospital of PhiladelphiaPA | Bennett J.L.,University of Colorado at Denver | Cabre P.,Center Hospitalier University Of Fort Of France | And 15 more authors.
Neurology | Year: 2015

Neuromyelitis optica (NMO) is an inflammatory CNS syndrome distinct from multiple sclerosis (MS) that is associated with serum aquaporin-4 immunoglobulin G antibodies (AQP4-IgG). Prior NMO diagnostic criteria required optic nerve and spinal cord involvement but more restricted or more extensive CNS involvement may occur. The International Panel for NMO Diagnosis (IPND) was convened to develop revised diagnostic criteria using systematic literature reviews and electronic surveys to facilitate consensus. The new nomenclature defines the unifying term NMO spectrum disorders (NMOSD), which is stratified further by serologic testing (NMOSD with or without AQP4-IgG). The core clinical characteristics required for patients with NMOSD with AQP4-IgG include clinical syndromes or MRI findings related to optic nerve, spinal cord, area postrema, other brainstem, diencephalic, or cerebral presentations. More stringent clinical criteria, with additional neuroimaging findings, are required for diagnosis of NMOSD without AQP4-IgG or when serologic testing is unavailable. The IPND also proposed validation strategies and achieved consensus on pediatric NMOSD diagnosis and the concepts of monophasic NMOSD and opticospinal MS. © 2015 American Academy of Neurology.

Afonso P.V.,Institute Pasteur Paris | Mekaouche M.,French National Center for Scientific Research | Mortreux F.,French National Center for Scientific Research | Toulza F.,Imperial College London | And 10 more authors.
Blood | Year: 2010

Approximately 3% of all human T-lymphotropic virus type 1 (HTLV-1)-infected persons will develop a disabling inflammatory disease of the central nervous system known as HTLV-1-associated myelopathy/tropical spastic paraparesis, against which there is currently no efficient treatment. As correlation exists between the proviral load (PVL) and the clinical status of the carrier, it is thought that diminishing the PVL could prevent later occurrence of the disease. We have conducted a study combining valproate, an inhibitor of histone deacetylases, and azidothymidine, an inhibitor of reverse transcriptase, in a series of baboons naturally infected with simian T-lymphotropic virus type 1 (STLV-1), whose PVL was equivalent to that of HTLV-1 asymptomatic carriers. We show that the combination of drugs caused a strong decrease in the PVL and prevented the transient rise in PVL that is seen after treatment with histone deacetylases alone. We then demonstrate that the PVL decline was associated with an increase in the STLV-1-specific cytotoxic T-cell population. We conclude that combined treatment with valproate to induce viral expression and azidothymidine to prevent viral propagation is a safe and effective means to decrease PVL in vivo. Such treatments may be useful to reduce the risk of HAM/TSP in asymptomatic carriers with a high PVL. © 2010 by The American Society of Hematology.

Flandre P.,French Institute of Health and Medical Research | Flandre P.,Laboratoire Of Virologie | Pugliese P.,Nice University Hospital Center | Bagnis C.I.,Service de Nephrologie | And 7 more authors.
Clinical Journal of the American Society of Nephrology | Year: 2011

Background and objectives The main aim of this study was determining the risk factors of chronic kidney disease (CKD) in HIV-1-infected patients. Design, setting, participants, & measurements Patients were followed from seven large HIV reference centers in France that maintain prospective databases on HIV-1-infected patients. The main outcome was the time to CKD defined as two consecutive measures of estimated GFR ≤60 ml/min per 1.73 m2 over ≥3 months. A Cox's model with delayed entry was used to search predictive factors of time to CKD. Results From 1993 to 2006, 349 out of 7378 patients were found to have CKD. Of these, 166 had hypertension, 33 had diabetes, and 26 were antiretroviral therapy-naïve. Occurrence of acute kidney injury (hazard ratio [HR] = 2.40) and hypertension (HR = 2.39) were strongly associated with an increased risk of CKD. Patients with a durable level of CD4 count >200 cells/mm3 had a lower risk of CKD (HR = 0.63). Recent exposure to indinavir (HR = 2.03), totenofovir (HR = 1.55), and abacavir (HR = 1.37) were associated with an increased risk of CKD. Past exposure to tenofovir was also associated with an increased risk of CKD (HR = 2.23), and a trend toward significance was observed for past exposure to indinavir (HR = 1.28). Conclusions CKD was not rare in HIV-infected patients and occurs preferentially in HIV-infected patients exposed to certain ARVs, specifically abacavir, indinavir and tenofovir. This requires closer monitoring of renal function in patients exposed to one of these drugs. © 2011 by the American Society of Nephrology.

Hochedez P.,Center Hospitalier University Of Fort Of France | Rosine J.,Cellule Of Linstitut Of Veille Sanitaire En Region | Theodose R.,Center Hospitalier University Of Fort Of France | Abel S.,Cellule Of Linstitut Of Veille Sanitaire En Region | And 4 more authors.
American Journal of Tropical Medicine and Hygiene | Year: 2011

Three athletes who participated in a race in the tropical forest of the Caribbean island of Martinique were subsequently diagnosed with leptospirosis using polymerase chain reaction (PCR). We investigated an outbreak to evaluate possible risk factors, and to determine the appropriate public health recommendations. Of 230 athletes, we contacted 148 (64%) and 20 (13.5%) met our case definition. Five were hospitalized and none were fatal. Ten (91%) of the 11 ill athletes who were tested were confirmed by PCR or serology. Serogroup Pyrogenes was commonly found. Cutaneous cuts, reported by 14 (73.7%), was the only potential risk factor using univariate analysis. Sporting event participants in tropical areas should be made aware of specific warnings and recommendations concerning the risk of leptospirosis, especially after periods of heavy rainfall or flooding. Rapid diagnostic assays such as PCR are particularly appropriate in this setting for early diagnosis and for formulating public health recommendations. Copyright © 2011 by The American Society of Tropical Medicine and Hygiene.

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