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Simon F.,Laveran Military Teaching Hospital | Gautret P.,Laveran Military Teaching Hospital | Nicolas X.,Clermont Tonnerre Military Teaching Hospital | Ausset P.,Laveran Military Teaching Hospital | And 2 more authors.
Travel Medicine and Infectious Disease

Skin and soft tissue infections were observed in migrants from Somalia who crossed the Gulf of Aden, crowded on a drifting boat for 14 days. Thirty-three percent of survivors of this hazardous journey had skin infections. Seven were hospitalized for severe Staphylococcus aureus cutaneous infections associated with intracellular dehydration. Migrants face infectious risks during their precarious travel, including severe cutaneous infections that require specific medical and surgical treatment by the emergency services. © 2013 Elsevier Ltd. All rights reserved. Source

Weiss E.,University Paris Diderot | Zahar J.-R.,University of Angers | Lesprit P.,Laboratory of Biology | Ruppe E.,University Paris Diderot | And 26 more authors.
Clinical Microbiology and Infection

Empirical broad spectrum antimicrobial therapy prescribed in life-threatening situations should be de-escalated to mitigate the risk of resistance emergence. Definitions of de-escalation (DE) vary among studies, thereby biasing their results. The aim of this study was to provide a consensus definition of DE and to establish a ranking of β-lactam according to both their spectra and their ecological consequences. Twenty-eight experts from intensive care, infectious disease and clinical microbiology were consulted using the Delphi method (four successive questionnaires) from July to November 2013. More than 70% of similar answers to a question were necessary to reach a consensus. According to our consensus definition, DE purpose was to reduce both the spectrum of antimicrobial therapy and the selective pressure on microbiota. DE included switching from combination to monotherapy. A six-rank consensual classification of β-lactams allowing gradation of DE was established. The group was unable to differentiate ecological consequences of molecules included in group 4, i.e. piperacillin/tazobactam, ticarcillin/clavulanic acid, fourth-generation cephalosporin and antipseudomonal third-generation cephalosporin. Furthermore, no consensus was reached on the delay within which DE should be performed and on whether or not the shortening of antibiotic therapy duration should be included in DE definition. This study provides a consensual ranking of β-lactams according to their global ecological consequences that may be helpful in future studies on DE. However, this work also underlines the difficulties of reaching a consensus on the relative ecological impact of each individual drug and on the timing of DE. © 2015 European Society of Clinical Microbiology and Infectious Diseases. Source

Fadhlaoui-Zid K.,Tunis el Manar University | Rodriguez-Botigue L.,University Pompeu Fabra | Naoui N.,Laboratory of Medical Biology | Benammar-Elgaaied A.,Tunis el Manar University | And 4 more authors.
American Journal of Physical Anthropology

Human population movements in North Africa have been mostly restricted to an east-west direction due to the geographical barriers imposed by the Sahara Desert and the Mediterranean Sea. Although these barriers have not completely impeded human migrations, genetic studies have shown that an east-west genetic gradient exists. However, the lack of genetic information of certain geographical areas and the focus of some studies in parts of the North African landscape have limited the global view of the genetic pool of North African populations. To provide a global view of the North African genetic landscape and population structure, we have analyzed ∼2,300 North African mitochondrial DNA lineages (including 269 new sequences from Libya, in the first mtDNA study of the general Libyan population). Our results show a clinal distribution of certain haplogroups, some of them more frequent in Western (H, HV0, L1b, L3b, U6) or Eastern populations (L0a, R0a, N1b, I, J) that might be the result of human migrations from the Middle East, sub-Saharan Africa, and Europe. Despite this clinal pattern, a genetic discontinuity is found in the Libyan/Egyptian border, suggesting a differential gene flow in the Nile River Valley. Finally, frequency of the post-LGM subclades H1 and H3 is predominant in Libya within the H sequences, highlighting the magnitude of the LGM expansion in North Africa. © 2011 Wiley-Liss, Inc. Source

Vasilev V.,University of Liege | Daly A.F.,University of Liege | Thiry A.,University of Liege | Petrossians P.,University of Liege | And 6 more authors.
Journal of Clinical Endocrinology and Metabolism

Context: McCune Albright syndrome (MAS) is a clinical association of endocrine and nonendocrine anomalies caused by postzygotic mutation of the GNAS1 gene, leading to somatic activation of the stimulatory α-subunit of G protein (Gsα). Important advances have been made recently in describing pathological characteristics of many MAS-affected tissues, particularly pituitary, testicular, and adrenal disease. Other rarer disease related features are emerging.Objective: The objective of the investigation was to study the pathological and genetic findings of MAS on a tissue-by-tissue basis in classically and nonclassically affected tissues.Design: This was a comprehensive autopsy and genetic analysis.Setting: The study was conducted at a tertiary referral university hospital.Patients: An adult male patient with MAS and severe disease burden including gigantism was the subject of the study.Intervention(s): Interventions included clinical, hormonal, and radiographic studies and gross and microscopic pathology analyses, conventional PCR, and droplet digital PCR analyses of affected and nonaffected tissues.Main Outcome Measure: Pathological findings and the presence of GNAS1 mutations were measured.Results: The patient was diagnosed with MAS syndrome at 6 years of age based on the association of café-au-lait spots and radiological signs of polyostotic fibrous dysplasia. Gigantism developed and hyperprolactinemia, hypogonadotropic hypogonadism, and hyperparathyroidism were diagnosed throughout the adult period. The patient died at the age of 39 years from a pulmonary embolism. A detailed study revealed mosaiscism for the p.R201C GNAS1 mutation distributed across many endocrine and nonendocrine tissues. These genetically implicated tissues included rare or previously undescribed disease associations including primary hyperparathyroidism and hyperplasia of the thymus and endocrine pancreas.Conclusions: This comprehensive pathological study of a single patient highlights the complex clinical profile of MAS and illustrates important advances in understanding the characteristics of somatic GNAS1-related pathology across a wide range of affected organs. Copyright © 2014 by the Endocrine Society. Source

De Laval F.,French Army Center for Epidemiology and Public Health | Simon F.,Laveran Military Teaching Hospital | Bogreau H.,French Army Institute for Biomedical Research | Rapp C.,Begin Military Teaching Hospital | And 7 more authors.
Clinical Infectious Diseases

Background. French military surveillance identified an increase in Plasmodium ovale attacks among soldiers in Ivory Coast. This emergence and the low sensitivity of biological tests raise the question of a possible role of P. ovale variant species.Methods. Epidemiological data about P. ovale attacks from 1993 to 2012 were studied; the species diagnosis was based on a thin blood smear and/or a quick diagnostic test. Clinical and biological features in soldiers hospitalized in 2 French military hospitals were also reviewed. Malaria polymerase chain reaction followed by genotyping was performed when available.Results. French military physicians declared 328 P. ovale attacks over the 20-year study. A peak of incidence occurred in 2005. Among patients with positive blood smears, the quick diagnostic test was positive in 33 of 101 tests performed. The hospital study showed that symptoms and biological changes were not specific, which made diagnosis challenging: fever, anemia, and thrombocytopenia were not present in 20%, 71%, and 23% of the 45 confirmed cases, respectively. It was possible to perform molecular investigations on 19 clinical isolates: 18 were classic haplotypes with additional polymorphism and 1 was variant.Conclusions. This emergence of P. ovale malaria enabled a good description to be made in nonimmune patients. The lack of sensitivity of both clinical features and quick diagnostic tests suggests an underestimation. Reasons for this outbreak are especially intense exposure to the vectors and the insufficient efficacy of doxycycline against P. ovale. The polymorphism of classic haplotypes of P. ovale rather than variant forms could be involved. © 2014 The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. Source

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