Claessens Y.-E.,Center Hospitalier Princesse Grace |
Tubach F.,University Paris Diderot |
Hausfater P.,Paris-Sorbonne University |
Carette M.-F.,Hopital Tenon |
And 3 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2015
Rationale: Clinical decision making relative to community-acquired pneumonia (CAP) diagnosis is difficult. Chest radiograph is key in establishing parenchymal lung involvement. However, radiologic performance may lead to misdiagnosis, rendering questionable the use of chest computed tomography (CT) scan in patients with clinically suspected CAP. Objectives: To assess whether early multidetector chest CT scan affects diagnosis and management of patients visiting the emergency department with suspected CAP. Methods: A total of 319 prospectively enrolled patients with clinically suspected CAP underwent multidetector chest CT scan within 4 hours. CAP diagnosis probability (definite, probable, possible, or excluded) and therapeutic plans (antibiotic initiation/discontinuation, hospitalization/discharge) were established by emergency physicians before and after CT scan results. The adjudication committee established the final CAP classification on Day 28. Measurements and Main Results: Chest radiograph revealed a parenchymal infiltrate in 188 patients.CAPwas initially classified as definite in 143 patients (44.8%), probable or possible in 172 (53.8%), and excluded in 4 (1.2%).CTscan revealed a parenchymal infiltrate in 40 (33%) of the patients without infiltrate on chest radiograph and excludedCAPin 56 (29.8%) of the 188 with parenchymal infiltrate on radiograph. CT scan modified classification in 187 (58.6%; 95% confidence interval, 53.2-64.0), leading to 50.8% definite CAP and 28.8% excluded CAP, and 80% of modifications were in accordance with adjudication committee classification. Because of CT scan, antibiotics were initiated in 51 (16%) and discontinued in 29 (9%), and hospitalization was decided in 22 and discharge in 23. Conclusions: In CAP-suspected patients visiting the emergency unit, early CT scan findings complementary to chest radiograph markedly affect both diagnosis and clinical management. © 2015 by the American Thoracic Socie.
Maisonobe T.,Laboratoire Of Neuropathologie |
Chapelon-Abric C.,Service de Medecine Interne 2 |
Lidove O.,Groupe Hospitalier Bichat Claude Bernard |
Papo T.,Groupe Hospitalier Bichat Claude Bernard |
Dubourg O.,Laboratoire Of Neuropathologie
Journal of Neurology, Neurosurgery and Psychiatry | Year: 2011
The authors report on four patients aged over 50 with chronic myopathy suggestive of sporadic inclusion body myositis. They present progressive and selective weakness of the quadriceps femoris muscles. Asymmetrical and selective atrophy of the forearm muscles were noted in all, with more severe involvement of the flexors than the extensors. Biopsy revealed granulomatous myositis. Histological features of sporadic inclusion body myositis were lacking. Evidence for systemic sarcoidosis was found in one patient. Corticosteroid treatment was associated with a partial but significant improvement in two patients. Granulomatous myositis may mimic inclusion body myositis and may be steroid-responsive.
Leoz M.,CNR Institute of Neuroscience |
Leoz M.,University of Rouen |
Feyertag F.,University of Manchester |
Charpentier C.,Groupe Hospitalier Bichat Claude Bernard |
And 5 more authors.
AIDS | Year: 2013
Several B/CRF02-AG Unique Recombinant Forms (URFs) have previously been identified in France. Here we show that one of them (URF5-B/ 02/G) is emerging in MSM, a high-risk population where HIV incidence and number of superinfections are increasing.We describe this new Circulating Recombinant Form, CRF56-cpx, estimate the time to its most recent common ancestor, investigate its origins and show that it probably shares common ancestors with strains from the East Mediterranean. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Shrinking lung syndrome associated with systemic lupus erythematosus: A multicenter collaborative study of 15 new cases and a review of the 155 cases in the literature focusing on treatment response and long-term outcomes
PubMed | University of Rouen, Service de Medecine Interne, University Pierre and Marie Curie, Service de Medecine Interne B and 3 more.
Type: Journal Article | Journal: Autoimmunity reviews | Year: 2016
Shrinking lung syndrome (SLS) is a rare respiratory manifestation of systemic lupus erythematosus (SLE), characterized by dyspnea, chest pain, elevated hemidiaphragm and a restrictive pattern on pulmonary function tests. Here, we report 15 new observations of SLS during SLE and provide a systematic literature review. We studied the clinical, biological, functional and morphologic characteristics, the treatments used and their efficacy.The inclusion criteria were all patients with SLE defined by the American College of Rheumatology criteria Hochberg (1997) , associated with a restrictive pattern on pulmonary function tests. The exclusion criteria were all differential diagnoses of restrictive patterns, including obesity and pulmonary fibrosis. The patients were recruited from local databases through chest physicians, rheumatologists and internists. The data for the literature review were extracted from the Medline database using shrinking lung syndrome and lupus as key words.All 15 new cases were women with a median age at SLS onset of 27years old (range 17-67years). All of them complained of dyspnea and all but one of chest pain. The antibodies were similar to those found in SLE, although the anti-SS-A was positive in 10 of 13 cases. Thoracic imaging showed elevated hemidiaphragm (12/15) and/or basal atelectasia (8/15). All of the patients had an isolated restrictive pattern on PFT, with a median decrease >50% of lung volume. All of the patients were treated, using corticosteroids (11/15), immunosuppressive drugs (8/15), beta-mimetics (2/15), physiotherapy (3/15) and/or colchicine (1/15). Improvement was described in 9 of 12 patients and stability in 3 of 12. We extracted 155 cases of SLE-associated SLS from the Medline database. The clinical, biological and functional parameters were similar to our cases. Clinical improvement was described in 48 of 52 cases (94%) and PFT improvement in 36 of 47 cases. Worsening occurred in 4 cases.SLS is a rare SLE manifestation. Pain and parietal inflammation seem to play important pathogenic roles. Steroids and antalgics are the most commonly used therapies with good responses. There is no proof of efficacy with immunosuppressive drugs for this entity. Rituximab can be discussed after failure of corticosteroids, as well as antalgics, theophylline and beta-mimetics.
Bouvet P.,Institute Pasteur Paris |
Ruimy R.,Center Hospitalier University |
Bouchier C.,Institute Pasteur Paris |
Faucher N.,Groupe Hospitalier Bichat Claude Bernard |
And 2 more authors.
Journal of Clinical Microbiology | Year: 2014
A nontoxigenic strain isolated from a fatal human case of bacterial sepsis was identified as a Clostridium strain from Clostridium botulinum group III, based on the phenotypic characters and 16S rRNA gene sequence, and was found to be related to the mosaic C. botulinum D/C strain according to a multilocus sequence analysis of 5 housekeeping genes. Copyright © 2014, American Society for Microbiology.
PubMed | Center hospitalier and groupe hospitalier Bichat Claude Bernard
Type: Journal Article | Journal: Annales de cardiologie et d'angeiologie | Year: 2016
Gender influences the clinical presentation and the management of some acquired cardiovascular diseases, such as coronary artery disease, resulting in different outcomes. Differences between women and men are also noticed in congenital heart disease. They are mainly related to the prevalence and severity of some congenital heart defects at birth, and in adulthood to the prognosis, incidence of Eisenmenger syndrome and risks of pregnancy. The role of gender on the risk of operative mortality of congenital heart surgery remains debated.
Visseaux B.,University Paris Diderot |
Charpentier C.,University Paris Diderot |
Hurtado-Nedelec M.,Groupe Hospitalier Bichat Claude Bernard |
Storto A.,University Paris Diderot |
And 6 more authors.
Antimicrobial Agents and Chemotherapy | Year: 2012
HIV-2 is naturally resistant to nonnucleoside reverse transcriptase inhibitors, to a fusion inhibitor, and to some of the protease inhibitors. Maraviroc is the first drug of the new anti-CCR5 drug class and is effective only on CCR5-tropic (R5) HIV-1. No previous studies concerning HIV-2 susceptibility to maraviroc have been reported yet. We developed a phenotypic maraviroc susceptibility test using a peripheral blood mononuclear cell (PBMC) model. We analyzed the maraviroc susceptibility of 13 R5 HIV-2, 2 X4R5 (dual) HIV-2, and 2 CXCR4-tropic (X4) HIV-2 clinical isolates. We also tested, with the same protocol, 1 X4 HIV-1 and 4 R5 HIV-1 clinical isolates. For the R5 HIV-2 clinical isolates, the 50% effective concentration (EC 50) for maraviroc was 0.80 nM (interquartile range [IQR], 0.48 to 1.39 nM), similar to that observed for the R5 HIV-1 isolates. The median maximum percentage of inhibition in the R5 HIV-2 isolates was 93% (IQR, 84 to 98%), similar to that observed in the R5 HIV-1 isolates. As expected, both X4 HIV-1 and HIV-2 were highly resistant to maraviroc. Our study showed for the first time that maraviroc is active in vitro against R5 HIV-2. The new tools we developed will allow identification of HIV-2-infected patients eligible for CCR5 inhibitor use and management of virological failure when receiving a maraviroc-based regimen. Copyright © 2012, American Society for Microbiology. All Rights Reserved.
de Tymowski C.,Groupe Hospitalier Bichat Claude Bernard
ASAIO Journal | Year: 2016
Metabolic disorders and fluid overload are indications of continuous renal replacement therapy (CRRT) including continuous venovenous hemofiltration in patients on ECMO.Direct connection of CRRT machine to the ECMO circuit provides many advantages. Nevertheless, because pressures in CRRT lines relate to ECMO blood flow, high ECMO blood flow may be associated with high pressures in CRRT lines. Thus, management of CRRT pressure lines becomes challenging. We evaluated a protocol for managing high CRRT pressures.Connections were performed according to a standardized protocol to maintain CRRT lines in the correct pressure ranges without modifying ECMO settings or inhibiting pressure alarms. To achieve this goal, the way of connecting of CRRT lines was adapted following a standardized protocol.Connection was first attempted between pump and oxygenator in the 12 patients. In 5 cases, high pressures in CRRT lines were successfully managed by changing the connection segment. CRRT parameters were within target levels and reduction of serum creatinine was 37%.In conclusion, management of high pressures in CRRT lines induced by ECMO could be achieved without modifying ECMO blood flow or inhibiting CRRT alarms. Iterative stops were avoided allowing efficient procedures. Copyright © 2016 by the American Society for Artificial Internal Organs
Berdah C.,Groupe hospitalier Bichat Claude Bernard
Annales Medico-Psychologiques | Year: 2010
Obesity is defined as being overweight from an excess of fat with harmful effects on health. It is a chronic disorder of complex etiology, a serious risk factor, which compromises psychosocial functioning and the patient's quality of life. However, it is not a part of DSM-IV. Nevertheless, a link seems to be established between eating disorders, problems with one's body image, self-esteem, stigmatisation and psychopathological disorders. Physical corporal satisfaction and dissatisfaction with regard to one's body are two distinct aspects of the concept of bodily image. The major characteristic of dissatisfaction of social origin is the sensation of not being attractive; therefore, it is not an isolated cognition but truly one that reasons in reference to others, bringing avoidance behaviours as well as explaining a high probability of social phobia and agoraphobia in obese subjects. It would be tempting to think that social pressure could be a motivation to lose weight; however, this is not the case: dissatisfaction must be moderate in order to be stimulating. The dissatisfaction of an obese subject regarding his/her body seems to depend on several factors. Indeed, this disorder seems to be more frequent in female subjects suffering from bulimia and searching for help to lose weight, but the studies remain contradictory. However, differences according to sex seem well established and seem to have a neurobiological substratum. In effect, a recent study in functional RMI shows that when looking at their oversized deformed bodies, men and women do not activate the same networks. Women activate perception and emotional regulation circuits, men activate dorsal vision which analyses the body as an object in space. There are also ethnical differences, overweight black women seem less dissatisfied with their bodies than white women. The age at which obesity starts does not seem to influence the vision of one's body, but the earlier obesity starts the longer dissatisfaction will continue after weight loss. Bodily image seems to improve with weight. Nevertheless, it seems to equally improve with cognitive and behavioural therapy such as low self-esteem and binge eating and this independently from weight loss. Negative images of one's body could have major psychopathological and psychosocial consequences. They can start or aggravate eating problems, social anxiety, depressions, sexual problems and low self-esteem. Women maintain some dissatisfaction and anxious concerns with their bodies. The severity of a negative bodily image seems to be linked to the amount of stigmatisation suffered. Discrimination starts at a very young age, six-year-old children described obese subjects as stupid, lazy, dirty, liars and cheaters and adults as incompetent and emotionally unstable. Negative attitudes towards obese subjects are widespread throughout the medical profession. Obesity is also the subject of professional discrimination. Massive obesity also seems to be an obstacle to marriage and a source of conjugal and sexual dysfunction, especially if it started recently. However the quality of life, social and professional activities, relations with others, body image and sexuality seem to improve with weight loss. Subjects who adopt positive strategies for coping with stigmatisation show more self-esteem and a lesser degree of dissatisfaction towards their bodies. Stigmatising experiences in female subjects seems to start or reinforce low self-esteem, dissatisfaction with their life style, social anxiety, depressions and eating disorders. Indeed, three population groups seem particularly at risk of psychiatric problems: female obese subjects. They are more at risk from changes to bodily perception, discrimination and negative psychosocial consequences. They suffer 10 times more than men from eating disorders. They are at risk from social behaviour problems and even personality problems; the obese suffering from a binge eating disorder represents about 5% of the obese population. They incur the largest risk of a psychopathology of axe 1 (including substance abuse and dependency) with more serious depressions. They are also at risk from bodily image disorders with low self-esteem and more important psychopathological consequences; the morbidly obese cover about 5% of obese subjects. They also are at great risk from psychopathological disorders. A larger prevalence of subjects suffering from binge eating disorders, behavioural problems, anxiety problems, bulimia, addiction to tobacco and personality problems are found here. Obesity and depression share many common points, from a clinical behavioural and emotional point of view but also from a neurobiological one. In women obesity and major depressive syndromes, atypical depressive syndromes, suicidal thoughts and attempted suicides are positively correlated. A young obese woman with a bad bodily image is at a high risk from depression. Males incur a high risk of depression, suicidal thoughts and suicide attempts for a BMI less than 20.8. One of the key symptoms of depression is anhedonia. The link between obesity and anhedonia has been studied in reports through behavioural studies on sensibility to rewards of which the neurobiological bases rest on the dopaminergic mesolimbic transmission. A significant decrease in the number of dopamenergic D2 receivers was observed in obese subjects in line with the decrease in sensitivity towards reward. The neurobiological profile of obesity in men decreases, it is inversely proportional to the BMI and associated with prefrontal cortex anomalies. This invalidating disease shows neurobiological, behavioural and emotional peculiarities, which remain to be investigated. © 2009 Elsevier Masson SAS.
PubMed | Groupe Hospitalier Bichat Claude Bernard
Type: Journal Article | Journal: ASAIO journal (American Society for Artificial Internal Organs : 1992) | Year: 2016
Metabolic disorders and fluid overload are indications of continuous renal replacement therapy (CRRT) including continuous venovenous hemofiltration in patients on extracorporeal membrane oxygenation (ECMO). Direct connection of CRRT machine to the ECMO circuit provides many advantages. Nevertheless, because pressures in CRRT lines relate to ECMO blood flow, high ECMO blood flow may be associated with high pressures in CRRT lines. Thus, management of CRRT pressure lines becomes challenging. We evaluated a protocol for managing high CRRT pressures. Connections were performed according to a standardized protocol to maintain CRRT lines in the correct pressure ranges without modifying ECMO settings or inhibiting pressure alarms. To achieve this goal, the way of connecting of CRRT lines was adapted following a standardized protocol. Connection was first attempted between pump and oxygenator in the 12 patients. In five cases, high pressures in CRRT lines were successfully managed by changing the connection segment. Continuous renal replacement therapy parameters were within target levels and reduction of serum creatinine was 37%. In conclusion, management of high pressures in CRRT lines induced by ECMO could be achieved without modifying ECMO blood flow or inhibiting CRRT alarms. Iterative stops were avoided allowing efficient procedures.