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1.
J Med Virol ; 83(3): 437-44, 2011 Mar.
Article in English | MEDLINE | ID: mdl-21264864

ABSTRACT

New factors that influence the viral response in HCV non-genotype 2/3 patients must be identified in order to optimize anti-HCV treatment. This multicenter prospective study evaluates the influence of HCV variability and pharmacological parameters on the virological response of these patients to pegylated interferon α2a (peg-IFN-α2a: 180 µg/week) and ribavirin (RBV; 800-1,200 mg/day) for 48 weeks. HCV subtypes were identified by sequencing the NS5B region. Serum RBV and peg-IFN-α2a concentrations were measured at weeks 4 and 12. The 115 patients (67 men; median age = 49, range 31-76) included 64 who had never been treated and 27 co-infected with HIV. The mean baseline HCV RNA was 6.30 ± 0.06 log IU/ml and the HCV genotypes were: G1 (n = 93) with 1a (n = 37) and 1b (n = 50), G4 (n = 20) and G5 (n = 2). Most patients (79/108; 73%) had an early virological response. Independent predictors of an early virological response were interferon naive patients (OR= 2.98, 95% CI: 1.15-7.72) and RBV of >2,200 ng/ml at week 12 (OR = 3.41, 95% CI: 1.31-8.90). Forty of 104 patients (38%) had a sustained virological response. The only independent predictors of a sustained virological response were subtype 1b (OR = 6.82, 95% CI: 1.7-26.8), and HCV RNA <15 IU/ml at week 12 (OR = 25, 95% CI: 6.4-97.6). Thus a serum RBV concentration of >2,200 ng/ml was associated with an early virological response and patients infected with HCV subtype 1b had a better chance of a sustained virological response than did those infected with subtype 1a.


Subject(s)
Hepacivirus/drug effects , Hepacivirus/genetics , Hepatitis C, Chronic/drug therapy , Hepatitis C, Chronic/virology , Interferon-alpha/therapeutic use , Polyethylene Glycols/therapeutic use , Ribavirin/pharmacology , Ribavirin/therapeutic use , Adult , Aged , Antiviral Agents/blood , Antiviral Agents/therapeutic use , Drug Therapy, Combination , Female , Genotype , HIV Infections/complications , HIV Infections/virology , Humans , Interferon-alpha/blood , Male , Middle Aged , Prospective Studies , Recombinant Proteins/blood , Recombinant Proteins/therapeutic use , Ribavirin/blood , Treatment Outcome , Viral Load
2.
Rev Med Interne ; 31(6): 445-8, 2010 Jun.
Article in French | MEDLINE | ID: mdl-20395022

ABSTRACT

INTRODUCTION: Chronic meningococcemia is an unusual clinical presentation within the spectrum of infections due to Neisseria meningitidis. CASE REPORT: We report a 32-year-old man who presented with a 15-day history of fever and maculopapular skin rash, in the absence of meningeal irritation or severe sepsis manifestation. Blood culture identified N. meningitidis. Clinical course was uneventful after antibiotic treatment was initiated. CONCLUSION: Early diagnosis of chronic meningococcemia is crucial for optimal management of the patient and his/her contacts. Such a diagnosis should be suspected in the presence of the characteristic clinical triad (recurrent fever, skin rash and arthralgia), and this clinical presentation should be distinguished from systemic vasculitis as inadequate prescription of corticosteroids may be deleterious.


Subject(s)
Exanthema/microbiology , Fever/microbiology , Meningococcal Infections/diagnosis , Neisseria meningitidis/isolation & purification , Adult , Anti-Bacterial Agents/therapeutic use , Arthralgia/microbiology , Chronic Disease , Diagnosis, Differential , Early Diagnosis , Humans , Male , Meningococcal Infections/complications , Meningococcal Infections/drug therapy , Treatment Outcome
5.
Dermatology ; 205(4): 394-7, 2002.
Article in English | MEDLINE | ID: mdl-12444338

ABSTRACT

We report the case of a 56-year-old HIV-seropositive man who presented a facial Demodex infection developed 2 months after initiation of highly active antiretroviral therapy. The Demodex infection was confirmed by scrapings and histopathologic examination and by the dramatic response to antiparasitic treatment with oral ivermectin associated with 5% permethrin cream.


Subject(s)
AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/drug therapy , Ivermectin/therapeutic use , Mite Infestations/diagnosis , Mite Infestations/drug therapy , Administration, Oral , Antiretroviral Therapy, Highly Active , Diagnosis, Differential , Drug Administration Schedule , Follow-Up Studies , HIV Seropositivity , Humans , Male , Middle Aged , Risk Assessment , Rosacea/diagnosis , Treatment Outcome
6.
Scand Cardiovasc J ; 34(3): 254-60, 2000 Jun.
Article in English | MEDLINE | ID: mdl-10935771

ABSTRACT

Coronary heart disease and beta-blocker treatment can increase the use of the Frank-Starling mechanism during exercise. The aim of the study was to assess whether this could be influenced by physical training. Male patients on beta-blocker treatment after myocardial infarction were randomised to four weeks of training (ET, n = 19) or to a control group (Ctr, n = 18). Cardiac output (CO) at rest and at identical submaximal exercise levels in each patient were determined by radionuclide ventriculography at baseline and after the intervention period. CO was calculated as end diastolic volume (EDV) x ejection fraction x heart rate, and deltaCO and deltaEDV as change in parameter from rest to exercise. The mean (SD) deltaCO decreased from 6.5 (2.1) L/min(-1) to 5.1 (2.4) in ET patients and increased from 5.0 (1.7) to 5.8 (2.7) in Ctr, p = 0.004. deltaEDV decreased from 30 (30) mL to 12 (35) in ET and increased from 11 (20) to 36 (33) in Ctr, p = 0.005. When adjusting for baseline dissimilarities between the groups in a multivariate linear regression analysis, these differences were still statistically significant, p = 0.018 and p = 0.044, respectively. Physical training reduces the CO increase needed to perform identical submaximal exercise, and this is accompanied by less left ventricular dilatation, with a potential for reducing exercise-induced ischaemia.


Subject(s)
Exercise/physiology , Myocardial Infarction/rehabilitation , Ventricular Dysfunction, Left/rehabilitation , Adrenergic beta-Antagonists/administration & dosage , Adrenergic beta-Antagonists/adverse effects , Adult , Aged , Hemodynamics/drug effects , Hemodynamics/physiology , Humans , Male , Middle Aged , Myocardial Infarction/physiopathology , Ventricular Dysfunction, Left/physiopathology , Ventricular Function, Left/drug effects , Ventricular Function, Left/physiology
7.
Scand Cardiovasc J ; 34(1): 59-64, 2000.
Article in English | MEDLINE | ID: mdl-10816062

ABSTRACT

In this study we assessed the short- and long-term effects of 4-weeks of exercise training (MI) soon after myocardial infarction in patients on beta-blocker treatment. Thirty-seven male patients < or = 65 years of age were included in the study, 19 of them randomized to exercise training (ET) and 18 to a control group (Ctr). Cumulated work (CW), calculated in kiloJoules (kJ), was recorded before immediately after the intervention period and again six months after the MI. In the short term the mean (SD) CW increased by 22% (from 65(20) to 79(25) kJ) in the ET group, compared with no change in the Ctr patients (65(24) vs 65(21) kJ) (p = 0.009). At late follow-up CW was 14% above baseline in the ET patients (65(20) vs 74(20) kJ) p = 0.036, compared with only 6% in the 15 Ctr patients who were still available for follow-up (68(24) vs 72(29) kJ), but without a significant between-group difference. In post-MI patients on beta-blocker treatment, and with a high baseline exercise capacity, physical training improved exercise capacity in the short term, but there was no significant between-group difference at long-term follow-up.


Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Exercise Therapy , Myocardial Infarction/rehabilitation , Aged , Atenolol/therapeutic use , Electrocardiography , Exercise Test , Female , Follow-Up Studies , Heart Rate , Humans , Male , Metoprolol/therapeutic use , Middle Aged , Myocardial Infarction/drug therapy , Myocardial Infarction/physiopathology , Time Factors , Timolol/therapeutic use , Treatment Outcome
8.
Microbes Infect ; 1(10): 771-6, 1999 Aug.
Article in English | MEDLINE | ID: mdl-10816082

ABSTRACT

In a retrospective study, an increase in double-negative (CD3+ CD4- CD8-) (DN) T lymphocytes has been shown to be an independent predictor of disseminated Mycobacterium avium complex (D.MAC) infection in patients with less than 100 CD4+ T cells per mm3. To better characterize this cell expansion, a prospective study was designed. From July 1995 to April 1997, 206 HIV-infected patients with less than 100 CD4+ T cells per mm3 were prospectively followed up and immunophenotyped. The median followup was 1.1 year (+/-0.5 year), and 14 new D.MAC infections were diagnosed among 84 first AIDS-defining events. In univariate and multivariate analyses, D.MAC infections were the only opportunistic infection with a significant increase in DN T-cell percentage (median = 6.6; range = 1.7 to 24.5, P = 0.004) compared with patients without any opportunistic infection. This alteration in T-lymphocyte count could constitute a predictor for D.MAC infection in clinical practice.


Subject(s)
AIDS-Related Opportunistic Infections/immunology , Acquired Immunodeficiency Syndrome/immunology , CD3 Complex/immunology , CD4-Positive T-Lymphocytes/immunology , Mycobacterium avium-intracellulare Infection/immunology , T-Lymphocyte Subsets/immunology , AIDS-Related Opportunistic Infections/microbiology , AIDS-Related Opportunistic Infections/pathology , Acquired Immunodeficiency Syndrome/complications , Adult , Aged , Cohort Studies , Female , Flow Cytometry , Humans , Male , Middle Aged , Multivariate Analysis , Mycobacterium avium-intracellulare Infection/complications , Prospective Studies
9.
Tidsskr Nor Laegeforen ; 118(27): 4217-21, 1998 Nov 10.
Article in Norwegian | MEDLINE | ID: mdl-9857805

ABSTRACT

Constrictive pericarditis is an uncommon condition. Previously, tuberculosis or other bacterial infections were prevalent causes, often with prominent pericardial calcification. Presently, many patients with constrictive pericarditis of other aetiologies have lesser degrees of structural changes in the pericardium. We report on a case with severe symptoms where the correct diagnosis was elusive because of absent or minimal preoperative pericardial pathology. The clinical, echocardiographic and haemodynamic features of constrictive pericarditis are reviewed. We recommend thorough echocardiographic evaluation of central haemodynamics in patients with symptoms of heart failure when the aetiology is not readily apparent (e.g. previous myocardial infarction dilated cardiomyopathy or valvular disease.


Subject(s)
Pericarditis, Constrictive , Aged , Diagnosis, Differential , Hemodynamics , Humans , Male , Pericarditis, Constrictive/diagnosis , Pericarditis, Constrictive/diagnostic imaging , Pericarditis, Constrictive/physiopathology , Pericarditis, Constrictive/surgery , Prognosis , Ultrasonography
10.
J Heart Valve Dis ; 6(2): 115-22, 1997 Mar.
Article in English | MEDLINE | ID: mdl-9130117

ABSTRACT

BACKGROUND AND AIMS OF THE STUDY: The hemodynamic function of the CarboMedics bileaflet mitral valve prosthesis was evaluated by Doppler echocardiography and by heart catheterization. The clinical state of the invasively examined patients was evaluated before and after surgery. METHODS: Doppler echocardiography was performed in 54 patients at six months after surgery. Further, combined right and left heart catheterization was performed in 22 of these patients before surgery and at six months thereafter. RESULTS: The Doppler mean gradients were small (3.6 +/- 1.2 mmHg), and corresponded well with Doppler mean gradients in the subgroup examined with both methods (3.5 +/- 1.1 mmHg) and with the invasive gradients (3.4 +/- 1.9 mmHg); there was also no difference between the different valve sizes. Clinically, pressure recovery distal to the valve is probably so small that no systematic difference between the two techniques of measurement is present. Only physiological regurgitation was found, and no case of valve dysfunction. The patients improved from functional NYHA class 3.1 +/- 0.4 to 1.4 +/- 0.6, regardless of preoperative diagnosis, with most pronounced improvement in those with mitral stenosis. Pulmonary artery pressure was normalized. Pulmonary vascular resistance and cardiac index improved slightly. CONCLUSIONS: In conclusion, the valvular prostheses demonstrated excellent hemodynamic function. There was striking agreement between the small invasive and non-invasive gradients. Finally, the functional status of the patients improved considerably, most distinctly in those patients with prior mitral stenosis.


Subject(s)
Bioprosthesis , Heart Valve Diseases/physiopathology , Heart Valve Diseases/surgery , Heart Valve Prosthesis/instrumentation , Mitral Valve/surgery , Postoperative Complications/diagnostic imaging , Adult , Aged , Blood Flow Velocity , Cardiac Catheterization , Echocardiography, Doppler , Equipment Safety , Evaluation Studies as Topic , Female , Follow-Up Studies , Heart Valve Diseases/diagnosis , Heart Valve Prosthesis/methods , Hemodynamics/physiology , Humans , Linear Models , Male , Middle Aged , Postoperative Complications/physiopathology , Treatment Outcome
13.
Rev Med Interne ; 18(8): 642-5, 1997.
Article in French | MEDLINE | ID: mdl-9365739

ABSTRACT

Cardiac-related death of HIV-positive patients is not rare. The etiology of AIDS-associated dilated cardiomyopathies often remains unknown, even at autopsy. We report an observation associated to a severe deficit in selenium. The patient had been diagnosed as HIV-positive 2 years before. He presented Pneumocystis carinii pneumonia then Cryptococcus meningitis. Two months later he was hospitalized for pancreatitis and cachexia. He presented global heart failure that lead to death. No microorganism was found in myocardium at autopsy but plasma selenium was dramatically decreased (24 micrograms/L). The deficit in selenium has been associated to a dilated cardiomyopathy in non-AIDS patients. HIV-positive patients have an early decrease in plasma selenium, this concentration is dramatically decreased in malnourished patients. Selenium deficit might be the cause of some of the AIDS-related dilated cardiomyopathies and selenium supplementation might be useful in these patients.


Subject(s)
Acquired Immunodeficiency Syndrome/complications , Cardiomyopathy, Dilated/etiology , Selenium/deficiency , Acquired Immunodeficiency Syndrome/blood , Acquired Immunodeficiency Syndrome/physiopathology , Adult , Electrocardiography , Humans , Male
14.
Eur Heart J ; 17(12): 1821-7, 1996 Dec.
Article in English | MEDLINE | ID: mdl-8960423

ABSTRACT

OBJECTIVES: The aim of the present study was to determine whether simple clinical variables can predict the effect of intensive exercise training in an unselected population early after myocardial infarction. METHODS: Starting 5 weeks after the qualifying myocardial infarction, 105 patients, 68 years old or younger, completed a 4 week period of intensive exercise training. The training effect was defined as an absolute increase in cumulative work at bicycle ergometry. Using univariate and multivariate analysis, 28 variables were tested against the training effect. RESULTS: The mean exercise capacity increased from 46.7 +/- 22.7 kJ to 69.5 +/- 31.1 kJ (P = 0.0001). Multivariate analysis identified five independent predictors of the training effect. Myocardial infarct size was associated with a better training effect (P = 0.0018), as was male gender (P = 0.0042) and ability to exercise to exhaustion at the baseline exercise test (P = 0.0124). Older age (P = 0.0017) and treatment with beta-adrenergic blocking agents (P = 0.0241) were associated with a lower effect from training. These five variables explained 33% of the variations in effect from training. Patients suffering in-hospital cardiac complications or congestive heart failure achieved a training effect at least as great as patients without cardiac complications. CONCLUSIONS: Five simple clinical variables, including infarct size, can assist in the selection of patients for exercise training after myocardial infarction.


Subject(s)
Exercise Tolerance/physiology , Exercise , Myocardial Infarction/rehabilitation , Aged , Analysis of Variance , Female , Humans , Male , Multivariate Analysis , Myocardial Infarction/physiopathology , Predictive Value of Tests , Treatment Outcome
16.
Rev Med Interne ; 17(10): 842-5, 1996.
Article in French | MEDLINE | ID: mdl-8976979

ABSTRACT

The Kikuchi-Fujimoto's syndrome is an histiocytic necrotizing lymphadenitis which is observed at any ages but preferentially among young adults. The sex ratio is about 4:1 in favour of women. It is clinically characterized by cervical lymph nodes in a context of fever and asthenia. Sometimes, there is transitory leucopenia and an increase of the erythrocyte sedimentation rate. The course of the disease is spontaneously favourable in 1 or 3 months but recurrence is possible. The histology of the lymph node could mimic a malignant lymphoma and the immunohistochemical findings are of a great importance (Ki-M1P or KP1 antibody). The etiology remains unknown but some infectious diseases have been suspected (toxoplamosis, Epstein-Barr virus). Its association with a systemic lupus erythematous had been described and this set the problem of its physiopathology. We report two new cases of Kikuchi-Fujimoto's syndrome which one was attributed to Epstein-Barr virus primo-infection and the other associated with a systemic lupus erythematous.


Subject(s)
Lymphadenitis/pathology , Adult , Female , Histiocytes , Humans , Lymphadenitis/etiology , Lymphadenitis/physiopathology , Male , Necrosis
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