[Is the bacterial vaginosis risk factor of prematurity? Study of a cohort of 1336 patients in the hospital of Arras]. / La vaginose bactérienne est-elle facteur de risque de prématurité ? Étude d'une cohorte de 1336 patientes au centre hospitalier d'Arras.

BACKGROUND: Among risk factors of prematurity, bacterial vaginosis (BV) could play an important role, but few studies took place in our country. AIM: In a French population of women booking in a hospital maternity, to search a link between prematurity and BV in the first trimester of pregnancy. METHODS: A hospital cohort study was carried out between May 2006 and September 1(st), 2009. Pregnant women were screening for BV before 13+6 weeks' gestation. BV was determined by a Gram-Stained Vaginal score greater or equal to 7. RESULTS: One thousand three hundred and thirty-six patients were included in the study among whom 203 patients had BV and 1133 patients did not have. The presence of BV was significantly associated with preterm delivery (OR: 1.6; 95% IC: 1.1-2.7). But this increase concerned only the spontaneous prematurity (ORa: 1.8, 95% IC: 1.0-3.2) and the statistical association disappeared after taking into account maternal tobacco addiction and socio-economic weak level (ORa: 1.6; 95% IC: 0.9-2.9). At the patient with BV, moreover, the risk of miscarriage before 16SA was significantly augmented at the patient with BV (OR: 3.4; 95% IC: 1.1-10.4), but this risk disappeared after taking into account tobacco addiction and maternal level of studies (ORa: 1.9; 95% IC: 0.5-7.2). CONCLUSION: The presence of BV in the first trimester of pregnancy seems to be associated with increased risks of preterm delivery and early spontaneous miscarriage. However, this relation seems to be partly linked to a level of weaker study and a more frequent tobacco addiction among the women with BV.

[Evaluation of the performances of the iQ(®)200 ELITE automated urine microscopy analyser and comparison with manual microscopy method]. / Évaluation des performances de l'automate de cytologie urinaire Iris iQ(®)200 ELITE et comparaison avec la méthode manuelle microscopique.

Microscopy urinalysis is one of the last manual analyses in laboratories and it is difficult to control. The automation of this analysis permits our laboratory to standardise this test. We performed an evaluation of the iQ(®)200 ELITE's performances and compare the data to the manual microscopy method which is considered as "the gold standard". The repeatability achieved at different levels of leukocytes and erythrocytes showed CVs below 10% for pathological values. Inter-run repeatability is 5,57% and carry-over is negligible if we take into consideration the linearity of the formed particles. Compared to the manual method, sensitivity (Se) of the analyser for leukocytes and erythrocytes are respectively 94.85 and 100%, the negative predictive value (NPV) are 92.91 and 100%, respectively. The weaknesses of the specificity (Sp) and positive predictive value (PPV) of erythrocytes (24.22 and 41.92%) are due to the lack of sensibility of the manual method. Also, the weak PPV of yeasts, casts and crystals are due to the better detection of those particles with the iQ(®)200's image recognition system than with manual method. NPV for all the urine formed particles are excellent, they are between 98 and 100%. The iQ(®)200 ELITE permits us to standardise and control this test for a future accreditation of the laboratory. We also significantly increase the turn around time.

[Comparison of the pharmacokinetics of tobramycin administered in a single daily dose or in 3 doses in cystic fibrosis]. / Comparaison de la pharmacocinétique de la tobramycine administrée en dose unique journalière ou en trois doses dans la mucoviscidose.

An aminoglycoside in association with beta-lactam antibiotic are usually the most efficient treatment for Pseudomonas aeruginosa infections in cystic fibrosis patients. Tobramycin has the lower MICs than the other aminoglycosides to Pseudomonas aeruginosa. The aim of the work was to compare pharmacokinetics of tobramycin after once daily (15 mg/kg/day; 11 patients) or thrice daily dose (5 mg/kg/day; 9 patients) in combination ceftazidime (CAZ 200 mg/day in 3 inj. IVD) in sputum and sera for two weeks. No statistical difference in the serum concentration obtained in each group of patients was observed between the first and the 14th day. Serum concentrations were three fold higher when tobramycin was administered in once daily dose. Low through concentrations were quickly obtained, but they were slightly higher after thrice daily doses. Bronchial concentrations were 2 to 2.5 superior and near the critical concentration of tobramycin. The clinical efficacy were comparable in the two regimens.

[Evaluation of bactericidal activity of cefpirome-aminoglycoside combination against Pseudomonas aeruginosa strains with intermediate sensitivity to cefpirome and in various phenotypes of beta-lactam resistance]. / Evaluation de l'activité bactéricide de l'association cefpirome-aminoglycosides sur des souches de Pseudomonas aeruginosa de sensibilité intermédiaire au cefpirome et appartenant à différents phénotypes de résistance aux bêta-lactamines.

The bactericidal activity of cefpirome (CPO)-aminoglycoside (AG) combination was assessed by a kinetic time-kill method against 8 strains of Pseudomonas aeruginosa showing intermediate susceptibility to cefpirome (MICS: 8-32 mg/l). Six strains had an acquired beta-lactam resistance mechanism (moderate cephalosporinase hyperproduction, OXA-2 or PSE-1 enzyme production, non enzymatic resistance) and one strain was resistant to tobramycin (TOB). Antibiotic concentrations used for time-kill curves were 1/2, 1 and 2x MIC for cefpirome, 8 mg/l for tobramycin and 16 mg/l for amikacin (AKN). Bactericidal activity was defined as a (4 log10 reduction of the initial inoculum. At the concentrations used in this study, CPO was not bactericidal; AG were bactericidal in 3 to 24 hours. CPO-AG combination was bactericidal against all the strains with no secondary regrowth. For 7/8 strains, the combination of CPO with TOB and/or AKN was more rapidly bactericidal than the AG alone. In conclusion, despite an intermediate susceptibility against numerous strains of P. aeruginosa, the CPO-AG combination is bactericidal at concentrations achievable with standard dosing regimens in man.

Pharmacokinetics and bronchial diffusion of single daily dose amikacin in cystic fibrosis patients.

A single daily dose of amikacin 35 mg/kg by i.v. infusion over 30 min in 18 cystic fibrosis patients achieved mean serum peak and trough concentrations of 121.4 mg/L (+/- 37.3) and 0.88 mg/L (+/- 0.62), respectively. Pharmacokinetic parameters and bronchial diffusion of amikacin showed marked inter-patient variability. The highest concentrations in sputum were obtained at 2 h (10.95 +/- 7.55 mg/L) and decreased slowly to reach a mean concentration of 2.14 mg/L (range 0.2-3.8 mg/L) just before the following infusion. An increase in the body clearance of amikacin and a decrease in the volume of distribution according to age were observed.

[Bacteriological monitoring of the treatment of Pseudomonas aeruginosa infections with amikacin administrated at once-daily dosis in patients with cystic fibrosis]. / Surveillance bactériologique du traitement par amikacine en dose unique journalière des infections à Pseudomonas aeruginosa au cours de la mucoviscidose.

The interest of the treatment with a single daily dose of amikacin (AMK) in cystic fibrosis (CF) patients with P. aeruginosa infections has been much debated. The aim of work was to study the efficiency of this treatment on (CF) patients with chronic bronchopulmonary P. aeruginosa infections previously treated for two weeks with the combination ceftazidime (CAZ 200 mg/day in 3 inj. IVD) and AMK (35 mg/day in one IV perf. of 30 minutes). The bacteriological supervision of this treatment was performed 1: by the determination of MICs before and after treatment, 2: by the decrease of P. aeruginosa colonization immediately after this treatment and during 11 months, 3: by the identification of P. aeruginosa strains with phenotypic methods (serotyping and antibiotyping) and with genotypic method (pulsed field gel electrophoresis). The use of AMK in a single daily dose in order to treat chronic lung infections colonized with P. aeruginosa susceptible to this antibiotic shows encouraging results as far as bacteriology is concerned: this treatment has given means to reduce colonization for a month in 15 of 18 patients. For 9 of the 18 patients, no P. aeruginosa strains were isolated for nine months. The serotyping and antibiotyping systems do not enable us to study the P. aeruginosa epidemiology. Genome macrorestriction fingerprinting of P. aeruginosa in pulsed field gel electrophoresis confirms that patient with CF were colonized with one or several clones. In our study no variation of these clones was noticed for the first eleven months. Genome macrorestriction fingerprinting appears to be one of the most effective methods for delineate strains of P. aeruginosa colonizing CF patients.

Significance of circulating plasma cells in multiple myeloma.

The number of circulating plasma cells (CPC) was determined on mononuclear cell preparations after Giemsa (morphology) and light chain staining (immunocytochemistry). Both methods gave reproducible and identical results when CPC were 1% or more. Using this limit, no CPC were observed in MGUS (0/11) and primary amyloidosis (0/2), whereas 45/98 (45.9%) multiple myeloma (MM) pts had > or = 1% CPC. 3/14 pts (21.4%) in stage I, 5/13 pts (38.5%) in stage II, 20/28 pts (71.4%) in stage III, 4/25 pts (16%) at plateau phase, and 13/18 pts (72.2%) at relapse had > or = 1% CPC (p < 0.001). Mean beta-2 microglobulin was 3.77 mg/l and 6.08 mg/l for pts without or with > or = 1% CPC, respectively p = 0.0001). Presence of CPC was also correlated with an higher percentage of bone marrow PC, but not with the number of Ki-67 positive BM-PC, and not with CRP or LDH levels. K/L and Gamma/Alpha CPC isotype ratio showed these cells as monotypic in nearly all pts. The prognostic value could not really be assessed in this study, as only the initial response to therapy was investigated, and the latter failed to give any difference between pts with and without CPC. So, presence of CPC is not an infrequent finding, but is highly related to tumor mass and active disease; in most if not all patients they are monotypic and certainly belong to the malignant clone. Their prognostic value is unclear but under current investigation; CPC are correlated with B-2M level.