Identification of a new reovirus causing substantial losses in broiler production in France, despite routine vaccination of breeders.

Numerous cases of tenosynovitis appeared in France causing high morbidity in free-range and standard broilers. The main clinical findings were lameness, stunting and non-uniform bodyweights. Although the natural mortality was low, the economic losses due to birds that had to be removed from the flock prematurely, downgrading of carcases and lower average weights at slaughter were substantial. Postmortem examinations, bacteriological, virological and serological examination confirmed the aetiology of avian orthoreovirus (ARV)-induced tenosynovitis. The isolated ARVs were analysed serologically and genetically. Sequencing of σC RT-PCR products and phylogenetic analysis revealed a new type of ARV. The virus was not neutralised in serum neutralisation test using monovalent sera from vaccinated chickens. Together with the flock data, epidemiology of these recent reovirus outbreaks in France was reconstructed. It is concluded that these reovirus isolates differ serologically and genetically from the well described reovirus isolates used in commercial vaccines which were not capable of preventing the disease. The outbreaks resulted in substantial losses in broilers from vaccinated breeders.

[Therapeutic adherence to oral cancer therapy and interdisciplinary management]. / Adhésion thérapeutique aux traitements oncologiques oraux et prise en charge interdisciplinaire.

Medication adherence is a well-known risk factor in internal medicine. However in oncology this dimension is emerging due to the increasing number of oral formulations. First results in the oral oncology literature suggest that patients' ability to cope with medical prescription decreases with time. This might preclude patients from reaching clinical outcomes. Factors impacting on medication adherence to oral oncology treatments have not been yet extensively described neither strategies to address them and support patient's needs. Oncologists and pharmacists in our University outpatient settings performed a pilot study which aimed at measuring and facilitating adherence to oral oncology treatments and at understanding determinants of patient's adherence. The ultimate purpose of such a patient-centered and interdisciplinary collaboration would be to promote patient self-management and complement the standard medical follow-up.

Clinical implications of HIV seroprevalence in childbearing women: the Louisiana experience.

An epidemiologic analysis of the HIV Seroprevalence Survey of Childbearing Women in Louisiana and the Louisiana AIDS Surveillance Report was conducted to inform health care practitioners of the trends in HIV infection and AIDS cases in women and children. HIV seropositivity in childbearing women has increased by 64% from 1988 to 1991 with an overall rate of 0.15% (202,178 tested). The rate in Orleans Parish is 0.53% (22,833 tested). Louisiana pediatric AIDS cases have increased yearly with 85% due to perinatal transmission. Assuming a 30% perinatal transmission rate, approximately 93 children are expected to develop AIDS in Louisiana within the next few years. Because of anticipated larger numbers of pediatric AIDS cases, health care providers for women and children need to identify their HIV infected patients so that early intervention can begin.

Spectrum of disease in persons with human immunodeficiency virus infection in the United States.

OBJECTIVE: To describe the spectrum of disease in persons with human immunodeficiency virus (HIV) infection. DESIGN: Retrospective survey of medical records. SETTING: More than 50 clinics, hospitals, and private medical practices in nine US cities. PATIENTS: A total of 626 women and 7008 men 13 years of age or older with HIV infection who received medical care from January 1990 through March 1991 were consecutively enrolled. MAIN OUTCOME MEASURES: Any history of diseases in the 1987 case definition for the acquired immunodeficiency syndrome (AIDS), and during the 12-month period preceding enrollment (baseline period), the occurrence of other major diseases, hospitalizations, and results of CD4+ lymphocyte counts. RESULTS: Thirty-two percent of persons met the 1987 case definition for AIDS. The occurrence of an AIDS-indicator disease during the baseline period ranged from 3% (33/1011) to 46% (1254/2748) among persons with CD4+ lymphocyte counts of 0.50 x 10(9)/L or greater and fewer than 0.20 x 10(9)/L (greater than or equal to 500 and less than 200 CD4+ lymphocytes per microliter), respectively, and, at comparable CD4+ lymphocyte levels, was similar among women compared with men, and among persons who reported intravenous drug use compared with men who reported male-to-male sex. The frequency of one or more other major infectious diseases (eg, other pneumonias, bacterial sepsis, pulmonary tuberculosis) ranged from 6% to 16% among persons with CD4+ lymphocyte counts of 0.50 x 10(9)/L or greater and fewer than 0.20 x 10(9)/L, respectively; these illnesses were also associated with a history of intravenous drug use. Among persons who did not meet the 1987 AIDS case definition, 30% of those with an available CD4+ lymphocyte count had fewer CD4+ cells than 0.20 x 10(9)/L, 8% had one or more major infectious diseases, and 14% had one or more hospital admissions. CONCLUSIONS: For every person with AIDS at these sites, two additional persons with HIV infection were receiving medical care, many of whom had severe immunosuppression and a broad spectrum of serious HIV-related disease.