Rockstroh J.K.,University of Bonn |
Gatell J.,University of Barcelona |
Landman R.,Bichat Claude Bernard Hospital
Antiviral Therapy | Year: 2010
Managing patients who present late with HIV infection is challenging. All late-presenting patients should have an individual treatment plan that encompasses both antiretroviral therapy and, where necessary, treatment for opportunistic diseases. Timely initiation of treatment in late presenters is crucial but the optimal time to start therapy depends on many individual factors, including the presence of opportunistic infection and potential drug-drug interactions. Primary drug resistance is an important contributor to poor clinical outcomes in HIV; resistance profiling before treatment initiation is therefore recommended. The choice of initial HIV treatment should reflect patient characteristics, the results of resistance testing and the complexity of concomitant disease. ©2010 International Medical Press.
Haustein T.,University of Geneva |
Gastmeier P.,Charité - Medical University of Berlin |
Holmes A.,Imperial College London |
Lucet J.-C.,Bichat Claude Bernard Hospital |
And 4 more authors.
The Lancet Infectious Diseases | Year: 2011
Benchmarking of surveillance data for health-care-associated infection (HCAI) has been used for more than three decades to inform prevention strategies and improve patients' safety. In recent years, public reporting of HCAI indicators has been mandated in several countries because of an increasing demand for transparency, although many methodological issues surrounding benchmarking remain unresolved and are highly debated. In this Review, we describe developments in benchmarking and public reporting of HCAI indicators in England, France, Germany, and the USA. Although benchmarking networks in these countries are derived from a common model and use similar methods, approaches to public reporting have been more diverse. The USA and England have predominantly focused on reporting of infection rates, whereas France has put emphasis on process and structure indicators. In Germany, HCAI indicators of individual institutions are treated confidentially and are not disseminated publicly. Although evidence for a direct effect of public reporting of indicators alone on incidence of HCAIs is weak at present, it has been associated with substantial organisational change. An opportunity now exists to learn from the different strategies that have been adopted. © 2011 Elsevier Ltd.
Eltchaninoff H.,University of Rouen |
Prat A.,University Hospital |
Gilard M.,Brest University Hospital Center |
Leguerrier A.,University Hospital |
And 8 more authors.
European Heart Journal | Year: 2011
AimsTranscatheter aortic valve implantation is a therapeutic alternative for high-surgical-risk patients with severe symptomatic aortic stenosis. Two models of prosthesis are currently commercialized in France, which can be implanted either via a transarterial or a transapical approach. The aim of the study was to evaluate in a national French registry the early safety and efficacy of transcatheter aortic valve replacement (AVR) using either the Edwards SAPIEN™ or CoreValve™ in high-surgical-risk patients with severe aortic stenosis.Methods and resultsThe multicentre national registry was conducted in 16 centres between February 2009 and June 2009, under the authority of the French Societies of Cardiology and Thoracic and Cardio-Vascular Surgery. The primary endpoint was mortality at 1 month. Two hundred and forty-four high-surgical-risk patients (logistic EuroSCORE <20, STS <10, or contra-indication to AVR) were enrolled. Mean age was 82 ± 7 years and 43.9 were female. Edwards SAPIEN and CoreValve were implanted in 68 and 32 of patients, respectively. The approaches used were transarterial (transfemoral: 66; subclavian: 5) or transapical in 29. Device success rate was 98.3 and 30-day mortality was 12.7. Severe complications included stroke (3.6), tamponade (2), acute coronary occlusion (1.2), and vascular complications (7.3). Pacemaker was required in 11.8. At 1 month, 88 of patients were in NYHA class II or less.ConclusionThis prospective registry reflects the real-life experience of transcatheter aortic valve implantation in high-risk elderly patients in France. The early results are satisfactory in terms of feasibility, short-term haemodynamic and functional improvement, and safety. Longer term follow-up will be further assessed. © 2011 The Author.
Page A.-L.,Epidemiology and Population Health |
De Rekeneire N.,Epidemiology and Population Health |
Sayadi S.,Epidemiology and Population Health |
Aberrane S.,Center Hospitalier Intercommunal |
And 3 more authors.
Pediatrics | Year: 2014
BACKGROUND: Early recognition of bacterial infections is crucial for their proper management, but is particularly difficult in children with severe acute malnutrition (SAM). The objectives of this study were to evaluate the accuracy of C-reactive protein (CRP) and procalcitonin (PCT) for diagnosing bacterial infections and assessing the prognosis of hospitalized children with SAM, and to determine the reliability of CRP and PCT rapid tests suitable for remote settings. METHODS: From November 2007 to July 2008, we prospectively recruited 311 children aged 6 to 59 months hospitalized with SAM plus a medical complication in Maradi, Niger. Blood, urine, and stool cultures and chest radiography were performed systematically on admission. CRP and PCT were measured by rapid tests and by reference quantitative methods using frozen serum sent to a reference laboratory. RESULTS: Median CRP and PCT levels were higher in children with bacteremia or pneumonia than in those with no proven bacterial infection (P < .002). However, both markers performed poorly in identifying invasive bacterial infection, with areas under the curve of 0.64 and 0.67 before and after excluding children with malaria, respectively. At a threshold of 40 mg/L, CRP was the best predictor of death (81% sensitivity, 58% specificity). Rapid test results were consistent with those from reference methods. CONCLUSIONS: CRP and PCT are not sufficiently accurate for diagnosing invasive bacterial infections in this population of hospitalized children with complicated SAM. However, a rapid CRP test could be useful in these settings to identify children most at risk for dying. Copyright © 2014 by the American Academy of Pediatrics.
Hayem F.,Necker Enfants Malades Hospital |
Hayem G.,Bichat Claude Bernard Hospital
Medical Hypotheses | Year: 2012
Although Still's disease has been first described more than one century ago, it still appears as an orphan entity, which should be separated from the other auto-inflammatory diseases (AID). The main reason to individualize Still's disease among the AID is the absence of any genetic predisposition. Recently, the human mitochondria have been clearly implicated in the systemic inflammation that is observed during the innate immune response. After various types of cellular injuries, including infections, the release of "Damage-Associated Molecular Patterns" (DAMPs) from mitochondria can recruit circulating polymorphonuclear neutrophils (PMNs), monocytes and macrophages, along with the activation of NLRP3 inflammasome. Flares of Still's disease usually mimic systemic bacterial infections, with high levels of PMNs, but no evidence of circulating bacteria. Ubiquitous and usually benign viruses, such as human herpes virus 6 (HHV-6), appear capable of inducing mitochondrial damages. Such a phenomenon could in turn initiate the flares of Still's disease, thereafter persisting as an inappropriate and self-perpetuating reaction to an endogenous bacterial vestige, the mitochondrion itself. © 2012 Elsevier Ltd.
Urena M.,Bichat Claude Bernard Hospital |
Rodes-Cabau J.,Laval University
EuroIntervention | Year: 2015
The introduction of the so-called newer-generation transcatheter aortic valve implantation (TAVI) devices has led to a dramatic reduction in the incidence of complications associated with the procedure. However, preliminary data suggest that conduction abnormalities (particularly new-onset atrioventricular block and left bundle branch block) remain a frequent complication post TAVI. Although inconsistencies across studies are apparent, new-onset conduction abnormalities post TAVI may be associated with higher incidences of mortality, sudden cardiac death and left ventricular dysfunction. Strategies intended both to reduce the risk and to improve the management of such complications are clearly warranted. In fact, the indication and timing of permanent pacemaker implantation are frequently individualised according to centre and/or operator preference. Currently, studies assessing the impact of these complications and the optimal indications for permanent cardiac pacing are underway. In this article, we review the data available on the incidence and impact of conduction disturbances following TAVI, and propose a strategy for the management of such complications. © Europa Digital & Publishing 2015. All rights reserved.
Arjona Ferreira J.C.,Sharp Corporation |
Marre M.,French Institute of Health and Medical Research |
Marre M.,University Paris Diderot |
Marre M.,Bichat Claude Bernard Hospital |
And 6 more authors.
Diabetes Care | Year: 2013
OBJECTIVE-Patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease have an increased risk ofmicro- and macrovascular disease, but limited options for antihyperglycemic therapy. We compared the efficacy and safety of sitagliptin with glipizide in patients with T2DM and moderate-to-severe chronic renal insufficiency and inadequate glycemic control. RESEARCH DESIGN AND METHODS-Patients (n = 426) were randomized 1:1 to sitagliptin (50 mg every day [q.d.] for moderate renal insufficiency and 25 mg q.d. for severe renal insufficiency) or glipizide (2.5 mg q.d., adjusted based on glycemic control to a 10-mg twice a day maximumdose). Randomization was stratified by: 1) renal status (moderate or severe renal insufficiency); 2) history of cardiovascular disease; and 3) history of heart failure. RESULTS-At week 54, treatment with sitagliptin was noninferior to treatment with glipizide in A1C change from baseline (20.8 vs. 20.6%; between-group difference 20.11%; 95% CI 20.29 to 0.06) because the upper bound of the 95% CI was less than the prespecified noninferiority margin of 0.4%. There was a lower incidence of symptomatic hypoglycemia adverse events (AEs) with sitagliptin versus glipizide (6.2 and 17.0%, respectively; P = 0.001) and a decrease in body weight with sitagliptin (20.6 kg) versus an increase (1.2 kg) with glipizide (difference, 21.8 kg; P < 0.001). The incidence of gastrointestinal AEs was low with both treatments. CONCLUSIONS-In patients with T2DM and chronic renal insufficiency, sitagliptin and glipizide provided similar A1C-lowering efficacy. Sitagliptin was generally well-tolerated, with a lower risk of hypoglycemia and weight loss versus weight gain, relative to glipizide. © 2013 by the American Diabetes Association.
Fernandez-Gerlinger M.P.,Bichat Claude Bernard Hospital |
Bernard E.,University of Versailles |
Saint-Lary O.,University of Versailles
BMC Public Health | Year: 2013
Background: Since 2009, HIV mass screening of the 15-70-year-old general population in low-risk situations has been recommended in France. This, not yet implemented, untargeted screening would be cost-effective with a positive impact on public health. No previous studies had interrogated primary care patients about it. This study aimed at exploring perceptions of patients attending general practitioner's on HIV mass screening and at identifying barriers to its implementation. Methods. We conducted a qualitative study through semi-structured individual interviews. Participants were recruited according to age, gender and location of their physician's practice. Data analysis was based on triangulation by two researchers. Results: Twenty-four interviews were necessary to obtain data saturation. HIV transmission was mostly associated with sexual intercourse; main barriers stemming from the screening were related to sexuality, often seen as questioning spouse's faithfulness. It could interfere with religiosity, implying an upsetting perception of sexuality among the elderly. Patients' beliefs and perceptions regarding HIV/AIDS, the fear to be screened and difficulties to talk about sexuality were other barriers. Conclusion: To our knowledge, no studies had previously interrogated primary care patients about barriers to HIV mass screening in France. Although relevance of this untargeted screening is debated in France, our results could be helpful to a better understanding of patients' attitudes toward this and to an outstanding contribution to reduce the number of new cases of HIV contamination. © 2013 Fernandez-Gerlinger et al.; licensee BioMed Central Ltd.
Himbert D.,Bichat Claude Bernard Hospital |
Vahanian A.,Bichat Claude Bernard Hospital
Heart Failure Clinics | Year: 2015
Older patients suffering severe heart failure related to aortic stenosis (AS) undergo transcatheter aortic valve replacement (TAVR), owing to their high surgical risk. The diagnosis is made based on echocardiographic examination, but may require a multimodality imaging approach in patients with low gradients. In severely decompensated heart failure or cardiogenic shock, rescue percutaneous balloon aortic valvuloplasty as a bridge to TAVR seems reasonable. Emergent TAVR has been reported. Efforts should be made to avoid late diagnosis or referring patients with severe AS to offer them timely interventions, reduce the risk of TAVR, and predict whether left ventricular function will improve. © 2015 Elsevier Inc.
Duroy D.,Bichat Claude Bernard Hospital |
Gorse P.,Bichat Claude Bernard Hospital |
Lejoyeux M.,Bichat Claude Bernard Hospital
Addictive Behaviors | Year: 2014
Background: Online compulsive buying is a little-studied behavioral disorder. Aims: To better understand its clinical aspects by focusing on (i) prevalence rate, (ii) correlation with other addictions, (iii) influence of means of access, (iv) motivations to shop to the internet and (v) financial and time-consuming consequences. Design: Cross-sectional study. Setting and participants: 200 students in two different centers of Paris Diderot University - Paris VII. Measurements: Brief self-questionnaires, to screen online compulsive buying, internet addiction, alcohol and tobacco use disorders, to rate frequency of online purchase by private-sale websites, by advertising banners, by mobile phone or to avoid stores, to rate motivations like "more discreet", "lonelier", "larger variety of products", "more immediate positive feelings", and "cheaper" and to assess the largest amount of online purchasing and the average proportion of monthly earnings, and time spent, both day and night. Findings: Prevalence of online compulsive buying was 16.0%, while prevalence of internet addiction was 26.0%. We found no significant relationship with cyberdependence, alcohol or tobacco use disorders. Online compulsive buyers accessed more often shopping online by private-sale websites (56.2% vs 30.5%, p. < 0.0001) or by mobile phone (22.5% vs 7.9%, p = 0.005) and preferred online shopping because of exhaustive offer (p. < 0.0001) and immediate positive feelings (p. < 0.0001). Online compulsive buyers spent significantly more money and more time in online shopping. Conclusion: Online compulsive buying seems to be a distinctive behavioral disorder with specific factors of loss of control and motivations, and overall financial and time-consuming impacts. More research is needed to better characterize it. © 2014 Elsevier Ltd.