[How health care professionals perceive chronic disease: Changes in therapeutic patient education (TPE) assessment from 2011 to 2017 in a French university hospital]. / Perception du malade chronique chez les professionnels de santé : une évolution marquée par les indicateurs d'évaluation de programmes d'éducation thérapeutique du patient entre 2011 et 2017 au CHU de Clermont-Ferrand, France.

BACKGROUND: Since 2010, in France, Therapeutic Patient Education (TPE) programs have applied to the Regional Health Agency (RHA) for authorization. Every four years, these programs are mandatorily re-evaluated, and the assessment allows for change in the program management criteria. In our hospital, we studied the evolution of the Therapeutic Patient Education (TPE) appraisal benchmarks, otherwise known as "indicators", in the 17 programs having been authorized and renewed at least once by the RHA. METHOD: The TPE program appraisal benchmarks are classified in terms of structure, process and outcomes; program activity itself as well as pedagogic, psychosocial and bioclinical indicators are taken into consideration. We wished to determine the extent to which these indicators were addressed, applied and renewed or created during renewal of the TPE programs. Statistical tests were carried out in order to compare changes in the number of benchmarks in each category before and after the renewal process. RESULTS: During the first authorization, there existed 533 appraisal benchmarks, while they numbered 550 for the second. As for "before-and-after" changes, they consisted in a reduced number of outcome indicators (43.7% to 35.1%), whereas process indicators increased (36.8% to 43.1%) (P=0.0141). In comparison to the category pertaining to pedagogic, psychosocial and bioclinical indicators, the most widely registered indicator category (55.5%) and the most frequently collected indicator category involved the program activity itself (54.7%) (P<0.0001), which increased pronouncedly during renewal periods (67.6%) (P=0.0002). Conversely, the pedagogic and psychosocial indicators were little if at all collected. As regards the latter, there was nevertheless a considerable increase in indicators related to skills and changes favoring health-promoting behaviours. Strictly bioclinical indicators have been largely supplanted by those having to do with the disease evolution, its impact and risk management. CONCLUSION: The major role assigned to process and structure indicators reflects the fact that they are predominantly structured by RHA requests. Even if this initial study necessitates further research, it highlights a change in the design of educational and psychosocial assessments among caregivers, a change likely to reflect their interest in how patients go about managing their illnesses, (more or less healthy) lifestyles and daily lives.

[Sub-capsular renal hematoma during severe preeclampsia: clinical case and review of the literature]. / Hématome sous-capsulaire du rein compliquant une prééclampsie sévère: cas clinique et revue de la littérature.

Renal haematoma during severe preeclampsia is a rare uneventful event. It is usually associated with other organ injury such as cerebral or liver haematoma. Imaging (ultrasound or tomodensitometry examination) plays an important role in detecting this complication and following its evolution. In the current case report, we describe an isolated renal haematoma during a severe preeclampsia complicated by a HELLP syndrome. This patient was managed with a conservative treatment (control of arterial pressure and induction of delivery) and an imaging follow-up.

Aerosol spray treatment with bacteriophages and competitive exclusion reduces Salmonella enteritidis infection in chickens.

A combination of three different Salmonella-specific bacteriophages (BPs) and one competitive exclusion (CE) product were used to reduce Salmonella Enteritidis (SE) colonization in experimentally infected chickens. Equal numbers of 7-day-old chickens were used in each of three groups: a CE group (treated with CE), a BP group (treated with BP), and a CE-plus-BP group (treated with both products). The CE product was administered via coarse spray at 1 day of age and the cocktail of three BPs was given via spray at 6 days of age using a multiplicity of infection of 10(3) plaque-forming units. All the experimental groups, except a healthy control group, were challenged orally with 2.95 x 10(5) colony-forming units (CFU)/ml of an SE strain at 7 days of age. Seven days postchallenge, the chickens were euthanatized for individual SE detection, quantitative bacteriology, and phage isolation from ceca and an internal organ pool. The qualitative bacteriology demonstrated that the use of the CE product diminished the incidence of SE to 75.7% and the mixture of BPs reduced it to 80%; when CE plus BP were used, the incidence dropped significantly to 38.7% (P < 0.0001), as compared with the infection control group (100%). A significant difference in the incidence was observed between the CE and the CE-plus-BP groups, and the BP and the CE-plus-BP groups (P = 0.0027 and P = 0.0010, respectively). The mean SE cecal count diminished with the use of CE plus BP (1.6 x 10(2) CFU/g, P = 0.0003) compared with the control group (1.56 x 10(5) CFU/g), the CE group (4.23 x 10(3) CFU/g), and the BP group (9.48 x 10(3) CFU/g). On the basis of the present study, it may be concluded that the use of both types of biocontrollers can be an effective method for reducing SE colonization in commercial chickens, but further basic and applied research is needed.

Bacteriophage treatment reduces Salmonella colonization of infected chickens.

Three different lyric bacteriophages (BPs) were isolated from the sewage system of commercial chicken flocks and used to reduce Salmonella Enteritidis (SE) colonization from experimental chickens. Ten-day-old chickens were challenged with 9.6 x 10(5) colony-forming units (CFU)/ml of a SE strain and treated by coarse spray or drinking water with a cocktail of the three phages at a multiplicity of infection (MO1) of 10(3) plaque-forming units (PFU) 24 hr prior to SE challenge. Chickens were euthanatized at day 20 of age for individual SE detection, quantitative bacteriology, and phage isolation from the intestine and from a pool of organs. SE detection was performed by both bacteriologic culture and genome detection by polymerase chain reaction (PCR). Qualitative bacteriology showed that aerosol-spray delivery of BPs significantly reduced the incidence of SE infection in the chicken group (P = 0.0084) to 72.7% as compared with the control group (100%). In addition, SE counts showed that phage delivery both by coarse spray and drinking water reduced the intestinal SE colonization (P < 0.01; P < 0.05, respectively). BPs were isolated at 10 days postinfection from the intestine and from pools of organs from BP-treated chickens. We conclude that the phage treatment, either by aerosol spray or drinking water, may be a plausible alternative to antibiotics for the reduction of Salmonella infection in poultry.

Isolation and molecular characterization of quinolone resistant Salmonella spp. from poultry farms.

The antimicrobial susceptibility of 94 Salmonella strains isolated from different poultry farms in Chile (broiler and laggin hens) were analyzed by the dilution plates method. Thirty-nine of them were resistant to flumequine, nalidixic acid and oxolinic acid with MIC values higher than 64 microg/ml. These quinolone resistant strains were analyzed in order to determine the presence of mutations in the QRDR region of gyrA gene by AS-PCR-RFLP analysis. 51.3% of the strains showed mutations at codon Ser 83 and 41.0% showed mutations at codon Asp 87. No mutations were observed on codon Gly 81. These mutations were confirmed by sequenciation of one representative strain from different RFLP pattern. Likewise, no double mutations were observed. Over 90% of the quinolone resistant strains presented mutations at the QRDR region of the gyrA gene. Three phenotypically resistant strains did not show any mutations on the QRDR region of gyrA gene. However, other molecular resistant mechanism could be involve. This is the first study that demonstrate the emergency of quinolone and fluoroquinolone resistance in Chilean Salmonella strains isolated from poultry thus indicating the requirement of monitoring programmes in veterinary medicine.

Prenatal detection of a de novo terminal inverted duplication 4p in a fetus with the Wolf-Hirschhorn syndrome phenotype.

OBJECTIVES: To present the prenatal diagnosis of a de novo terminal inversion duplication of the short arm of chromosome 4 and a review of the literature. CASE: An amniocentesis for chromosome analysis was performed at 33 weeks' gestation because ultrasound examination showed a female fetus with multiple abnormalities consisting of severe intrauterine growth retardation, microcephaly, a cleft lip and renal hypoplasia. RESULTS: Cytogenetic analysis and FISH studies of the cultured amniocytes revealed a de novo terminal inversion duplication of the short arm of chromosome 4 characterized by a duplication of 4p14-p16.1 chromosome region concomitant with a terminal deletion 4p16.1-pter. The karyotype was thus: 46,XX, inv dup del (4)(:p14-->p16.1::p16.1-->qter). The parents opted to terminate the pregnancy. Fetopathological examination showed dysmorphic features and abnormalities consistent with a Wolf-Hirschhorn syndrome (WHS) diagnosis, clinical manifestations of partial 4p trisomy being mild. CONCLUSION: Although relatively rare, inverted duplications have been reported repeatedly in an increasing number of chromosomes. Only two previous cases with de novo inv dup del (4p) and one with tandem dup 4p have been reported, all of them associated with a 4pter deletion. We report the first case diagnosed prenatally. Breakpoints are variable, resulting in different abnormal phenotype. In our case, clinical manifestations resulted in a WHS phenotype.

Translocation (Y;22) resulting in the loss of SHOX and isolated short stature.

Chromosomal rearrangements involving both chromosome Y and chromosome 22 are rare, and may result in a number of different phenotypes. We report on a 4-year-old child with short stature and a dicentric chromosome with a deletion of the distal end of chromosome Yp. The pregnancy was uneventful, until intra-uterine growth retardation was noted. Prenatal karyotyping showed a (Y;22) translocation. No structural fetal abnormality was shown at ultrasound examination, and the pregnancy went to term. A growth-retarded boy with an otherwise normal physical examination was delivered at 39 weeks. At age 4, the child had short stature (-3 SD) without mental retardation. Radiological examination of the wrist was normal. A blood karyotype confirmed the chromosomal rearrangement previously seen on the amniotic fluid cells. C-banding showed a dicentric chromosome, and fluorescence in situ hybridization (FISH) with centromeric probes confirmed the presence of both chromosome Y and 22 centromeres on the derivative chromosome. The karyotype was thus 45,X,der(Y;22)(p11;q11)del(Y)(p11p11). Our patient's phenotype and chromosomal rearrangement prompted us to further investigate the distal Yp region. FISH using a subtelomeric probe showed a deletion of the distal Yp region. This technique also revealed that this chromosomal rearrangement resulted in the deletion of SHOX but not SRY. Although haploinsufficiency of SHOX may result in Léri-Weill Dyschondrosteosis, this diagnosis did not seem obvious in this young patient. This observation confirms the importance of FISH in the investigation of chromosomal abnormalities, and further delineates the phenotype of SHOX deleted patients.

[Sinusal penetration of amoxicillin-clavulanic acid. Formulation 1 g./125 mg., twice daily versus formulation 500 mg./125 mg., three times daily]. / Pénétration sinusienne de l'amoxicilline-acide clavulanique. Formulation 1 g/125 mg, 2 fois/jour, versus formulation 500 mg/125 mg, 3 fois/jour.

INTRODUCTION: In order to meet the evolution of pneumococcus resistance to beta-lactam antibiotics, a new formulation of amoxicillin (AMX) and clavulanic acid (CA), with twice as much AMX (1 g/125 mg vs. 500 mg/125 mg) was developed for the treatment of acute pneumonia in patients at risk. This formulation can also be used in the treatment of acute maxillary sinusitis using a 1 g/125 mg regimen twice-daily. OBJECTIVES: Compare the sinusal penetration of AMX and CA (1 g/125 mg twice-daily vs. 500 mg/125 mg three times a day) when administered at both regimens to demonstrate equivalent pharmacokinetic and pharmacodynamic behaviour of the former when compared to the latter. METHODS: Concentrations of AMX and CA were measured in the anterior ethmoid, maxillary, posterior ethmoid sinus and in the middle nasa concha in 62 patients undergoing surgery for nasosinusal polyps. Patients randomised in two groups corresponding to 2 oral regimens, received either 1 g/125 mg twice a day or 500 mg/125 mg three times a day for 4 days. The last dose in both groups was administered 1 h 30, 3, 5 or 8 hrs prior to surgery. Serum samples were taken simultaneously to tissue samples. AMX and CA were measured by high performance liquid chromatography. Exogenous and above all endogenous blood contamination were taken into account with the hematocrit as well as blood and tissue haemoglobin concentrations. Comparisons of tissue concentrations were made for each sampling time, according to values obtained for a specific tissue with both doses on one hand, and on the other to values obtained with a specific dose in different tissues. The calculated pharmacodynamic parameters, which are considered to be predictive for bacteriological and clinical efficacy, result directly from tissue concentrations of AMX. tissue inhibitory quotients (IQtissue = Tissue concentration/MIC). time above MICs for serum and tissue concentrations (T > MIC). RESULTS: As regards AMX, whatever the dose, at 1 h 30 and at 3 hrs, tissue concentrations did not differ significantly whatever the tissue studied (from 1.1 to 2.5 micrograms/g). Conversely, at 5 and 8 hrs, they were greater than after the 1 g/125 mg regimen given twice-daily (0.06-0.7 vs. 0.7-1.8 micrograms/g). If we consider a given dose, the comparison between the various tissues showed identical concentrations in the four tissues studied at each sampling time, except in two cases with the dose of 500 mg/125 mg 3 times a day. T > MIC for serum and tissue showed higher values than those required for AMX/pneumococcus association (40-50%) with, nevertheless, greater tissue values for the 1 g/125 mg dose given twice-daily when MIC was of 1 microgram/ml (40-52% vs. 50-66%). The maximum tissue inhibitory quotients were also greater with the twice-daily 1 g/125 mg dose, when calculated with MIC 50 or 90 of S. Pneumoniae, H. influenzae, M. catarrhalis or S. pyogenes. As for CA, concentrations were equivalent for both doses at each sampling time and greater than those required in vitro during respectively 4 and 5 hours for beta-lactamases H. influenzae and M. catarrhalis. DISCUSSION-CONCLUSION: A least an equivalence between both dose regimens was observed, with occasionally a superiority of the twice-daily 1 g/125 mg dose, in terms of pharmacokinetics, tissue penetration and pharmacodynamics for both AMX and CA. This new regimen therefore appears more appropriate for the treatment of acute maxillary sinusitis in adults.

Characterization of a novel HLA-Cw*04 variant in a Laotian family: HLA-Cw*0406.

The sequence of a new HLA-Cw*04 allele has been identified in a Laotian family. This allele, designated Cw*0406, differs from Cw*0403 by a single nucleotide substitution at codon 156 (CGG-->CTG) in the alpha2 domain, leading to an amino acid change from Arginine to Leucine. Further screening by specific amplification of two ethnically different populations, i.e. French (n=150) and Lebanese (n=100), provided no case of Cw*406, suggesting that the distribution of this allele may be restricted.

Clonal diversity of Chilean isolates of enterohemorrhagic Escherichia coli from patients with hemolytic-uremic syndrome, asymptomatic subjects, animal reservoirs, and food products.

To determine clonal relationship among Chilean enterohemorrhagic Escherichia coli (EHEC) strains from different sources (clinical infections, animal reservoirs, and food), 54 EHEC isolates (44 of E. coli O157, 5 of E. coli O111, and 5 of E. coli O26) were characterized for virulence genes by colony blot hybridization and by pulsed-field gel electrophoresis (PFGE). By colony blotting, 12 different genotypes were identified among the 44 E. coli O157 isolates analyzed, of which the genetic profile stx1+ stx2+ hly+ eae+ was the most prevalent. All human O157 strains that were associated with sporadic cases of hemolytic-uremic syndrome (HUS) carried both the stx1 and stx2 toxin-encoding genes and were eaeA positive. Only 9 of 13 isolates from human controls were stx1+ stx2+, and 8 carried the eaeA gene. Comparison of profiles obtained by PFGE of XbaI-digested genomic DNA showed a great diversity among the E. coli O157 isolates, with 37 different profiles among 39 isolates analyzed. Cluster analysis of PFGE profiles showed a wide distribution of clinical isolates obtained from HUS cases and asymptomatic individuals and a clonal relationship among O157 isolates obtained from HUS cases and pigs. Analysis of virulence genes showed that a correlation exists among strains with the genotype stx1+ stx2+ eae+ and pathogenic potential. A larger difference in the PFGE restriction patterns was observed among the EHEC strains of serogroups O26 and O111. These results indicate that several different EHEC clones circulate in Chile and suggest that pigs are an important animal reservoir for human infections by EHEC. Guidelines have been proposed for better practices in the slaughter of animals in Chile.

Health status of free-living pigeons in the city of Santiago.

A total of 100 free-living urban pigeons (Columba livia) were captured in the city of Santiago, Chile, in order to evaluate, for the first time, their health status. Negligible antibody titres (1 to 3 log2) were detected in 22% of the birds against a strain of the paramyxovirus (PMV) serotype 1. No pigeons had antibodies against PMV serotype 7 and avian influenza. Salmonella sp. belonging to serogroups B and D were isolated from the intestinal tract of three pigeons (3%). The protozoa Haemoproteus columbae, Plasmodium sp., and Leucocytozoon sp. were not detected in any pigeons. Trichomonas gallinae was detected in 11%, without observation of either clinical signs or gross pathological changes at necropsy. Sixty-seven percent of the birds showed the presence of the chewing lice Columbicola columbae and Campanulotes bidentatus compar, and 1% harboured the mite Laminosioptes cysticola. Seven species of nematodes were identified. The frequency at which each species was detected was; Tetrameres sp. (14%), Capillaria annulata (1%), Capillaria columbae (11%), Capillaria obsignata (1%), Ascaridia columbae (5%), Dispharynx spiralis (2%), and Gongylonema ingluvicola (2%). The class Cestoda, found in one pigeon, was represented by the species Aporina delafondi. No trematodes were detected in the sampled birds.

[Isolation and characterization of Yersinia enterocolitica from pigs and bovines in Chile]. / Aislamiento y caracterización de Yersinia enterocolitica de cerdos y bovinos en Chile.

The occurrence of Yersinia enterocolitica in tonsils and rectal swabs from 100 healthy pigs and the rectal swabs of 100 healthy cattle slaughtered at Santiago-Chile were analysed. Yersinia enterocolitica was isolated from 48 (48%) pigs but not from cattle. 98.2% of strains were of 4/O3 bioserogroup, considered to be pathogenic for humans. All of the strains were resistant to penicillin producing beta-lactamase. Most of them were resistant to neomicin and tetracycline. The pYV marker was used to demonstrate pathogenicity in all strains by four different assays: 65.5% of the strains were pYV positive by their plasmid profile; 73.3% by crystal violet binding; 84.5% by calcium dependency and 87.9% by hybridization with probe associated with cytotoxicity to Hep-2 cells in vitro. All of the Yersinia enterocolitica strains were pYV positive with at least one of the four tests analysed, 46/58 strains were positive by three tests simultaneously. The similarities between associated cytotoxic genes of porcine and human strains is discussed. The phenotypic and genotypic characteristics demonstrated by the isolates strains suggest that the pigs in Chile are reservoir of potential pathogenic Yersinia enterocolitica for humans.

Detection and characterization of enterohaemorrhagic Escherichia coli in slaughtered cattle.

Fecal samples from slaughtered cattle were studied for enterohaemorrhagic Escherichia coli (EHEC) by DNA hybridization with biotin-labelled DNA probes specific for the EHEC virulence plasmid, Shiga-like toxin I (SLT I), Shiga-like toxin II (SLT II) and eae gene. Among 136 animals analysed, 47 (34.5%) were found to carry EHEC. The cytotoxic genotypes observed for EHEC strains were: 60.4% SLT I, 12.5% SLT II and 10.4% SLT I + SLT II; 16.7% resulted SLT I and SLT II negative. A total of 14 out of 48EHEC strains (29.2%) hybridized with a fimbrial probe and 14 of 48 strains with an sas probe. An important number of strains (18 out of 48) belonged to serogroups O157, O26 and O111, serogroups also commonly isolated from haemolytic uremic syndrome cases in Chile. While EHEC isolates from the same animal were usually of the same serogroup, one animal was found to carry two EHEC strains of different serogroups. A total of 50% of EHEC strains were sorbitol negative, irrespective of the O serogroup or EHEC genotypic profile. Results obtained in this study strongly suggest that cattle in Chile are a reservoir of EHEC associated with disease in humans.

Analysis of the nucleic acid annealing activities of nucleocapsid protein from HIV-1.

Retroviral nucleocapsid (NC) protein is an integral part of the virion nucleocapsid where it is in tight association with genomic RNA and the tRNA primer. NC protein is necessary for the dimerization and encapsidation of genomic RNA, the annealing of the tRNA primer to the primer binding site (PBS) and the initial strand transfer event. Due to the general nature of NC protein-promoted annealing, its use to improve nucleic acid interactions in various reactions can be envisioned. Parameters affecting NC-promoted nucleic acid annealing of NCp7 from HIV-1 have been analyzed. The promotion of RNA:RNA and RNA:DNA annealing by NCp7 is more sensitive to the concentration of MgCl2 than the promotion of DNA:DNA hybridization. Stimulation of complex formation for all three complexes was efficient at 0-90 mM NaCl, between 23 and 55 degrees C and at pH values between 6.5 and 9.5, inclusive. Parameters affecting NCp7-promoted hybridization of tRNA(Lys,3) to the PBS, which appears to be specific for NC protein, will be discussed. Results implicate the basic regions of NCp7, but not the zinc fingers, in promoting the annealing of complementary nucleic acid sequences. Finally, NCp7 strand transfer activity aids the formation of the most stable nucleic acid complex.

[A family outbreak of acute hepatic fascioliasis]. / Brote familiar de fascioliasis hepática aguda.

The diagnosis of human fascioliasis was established in an 11 year old boy with prolonged fever by complement fixation and ELISA tests. Good clinical response followed the treatment with emetine. Four other family members were also affected with the disease and their treatment was equally effective. The origin of the infection was traced to the ingestion of infected watercress at a site 15 km away from Santiago.