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Introduction : Le linezolide est un médicament potentiellement efficace pour le traitement des patients atteints de tuberculose pharmaco-résistante. En dépit de son efficacité et sa bonne biodisponibilité, il présente des toxicités, dont celle hématologique demeure l'une des plus graves. Nous rapportons deux cas de toxicité hématologique du linézolide au cours du traitement de la tuberculose pharmacorésistante. Le premier cas concernait un patient de 65 ans traité pour une tuberculose multi-résistante avec un schéma thérapeutique contenant du linézolide. L'évolution fut marquée par la survenue d'une pancytopénie avec anémie sévère à 5,4 g et un tableau d'insuffisance rénale. L'issue fut favorable après arrêt du médicament et transfusion sanguine. Le second cas concernait un patient de 33 ans, pré XDR qui lutte contre la tuberculose depuis 10 ans avec cinq cures de chimiothérapie antituberculeuse qui se sont soldées par des échecs et résistances. Au cours de son suivi, il a présenté une bonne évolution clinique et bactériologique initiale mais rapidement était survenue une anémie sévère à 5g/dl, à cette anémie était associées des neuropathies périphériques. Le Linezolide avait été retiré du schéma thérapeutique, suivi de transfusions sanguines. La suite avait été favorable sous traitement antituberculeux et le patient fut guéri de sa tuberculose. Conclusion Le linézolide est efficace dans le traitement de la tuberculose pharmacorésistante mais présente une toxicité hématologique
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Transfusión Sanguínea , Guinea , Linezolid , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Tuberculosis Resistente a Múltiples Medicamentos/terapiaRESUMEN
BACKGROUND: Image-guided tumor ablation is a technique whereby needle-like applicators are placed directly into solid tumors under guidance typically with computed tomography or ultrasound. Changes in IgG and IgM antibody glycosylation were studied during ablation-induced immune response to cancer, and the use of glycosylation as a biomarker for diagnosis, prognosis and disease treatment was examined. METHODS: Plasma from 27 tumor patients was collected immediately before, after and for 6 months following ablation. IgG and IgM antibodies were isolated by use high-throughput chromatography, and analyzed by hydrophilic liquid chromatography. Thorough identification of glycan structures in each chromatography peak was performed by nano-liquid chromatography electrospray ionization mass spectrometry. RESULTS: Although antibody glycosylation was found to vary with cancer type, discernable patterns of change based on the successful treatment of tumors by ablation were not identified. One patient with renal clear cell carcinoma and poor disease outcome had unexpectedly high amount of oligomannose IgG glycans during the whole period of monitoring. In contrast, IgM antibodies did not follow the same pattern. CONCLUSIONS: These findings suggest that glycosylation patterns are indicative of an immune system that is unable to prevent different types of cancer, rather than products of the immunostimulatory response to the ablation of tumor itself. Analyses of the outcome effect suggested that IgG glycosylation and IgM glycosylation are not associated with tumor ablation. GENERAL SIGNIFICANCE: Present work opens a new way for parallel determination of glycosylation changes of both IgG and IgM antibodies by use of high-throughput methods, and their future use as biomarkers for disease diagnosis and prognosis. This article is part of a Special Issue entitled "Glycans in personalised medicine" Guest Editor: Professor Gordan Lauc.
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Anticuerpos Antineoplásicos/sangre , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Neoplasias , Anciano , Anciano de 80 o más Años , Femenino , Glicosilación , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/sangre , Neoplasias/patología , Neoplasias/terapia , Espectrometría de Masa de Ion SecundarioRESUMEN
Complex care pathways can result in detrimental treatment delay particularly in tuberculosis patients. The purpose of this retrospective study was to assess the care pathways followed by tuberculosis patients prior to diagnosis and to assess impact on the delay for initiation of treatment in Conakry, Guinea. A total of 112 patients were interviewed at the time of first admission for pulmonary tuberculosis with positive bacilloscopy. Based on interview data, pathways were classified as conventional (use of health care facilities only) and mixed (use of health care facilities, self-medication, and traditional medicine). The correlation between patient characteristics and type of pathway was assessed by univariate and multivariate analysis and the two groups, i.e., conventional vs. mixed, were compared with regard to delay for initiation of treatment. The care pathway was classified as mixed in two out of three patients. Multivariate analysis showed that this type of pathway was only correlated with schooling (p=0.02). The mean delay for treatment was similar, i.e., 13.4 and 12.8 weeks for conventional and mixed pathways respectively (p<0.68). The percentage of pathways including three consultations at health care facilities was significantly higher in the conventional than mixed group (72% vs. 30%, p<0.001). The main reasons given for delayed use of health care facilities were poor knowledge of tuberculosis symptoms (26%) and high cost of care (12%). The findings of this study indicate that tuberculosis patients follow a variety of care pathways that can lead to delayed treatment. An information campaign is needed to increase awareness among the population and care providers.
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Tuberculosis Pulmonar/terapia , Adolescente , Adulto , Femenino , Guinea , Conductas Relacionadas con la Salud , Costos de la Atención en Salud , Instituciones de Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Medicina Tradicional , Persona de Mediana Edad , Estudios Retrospectivos , Automedicación , Factores de Tiempo , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/tratamiento farmacológicoRESUMEN
Les parcours de soins sont souvent complexes et peuvent induire des retards de traitement; avec des effets particulierement deleteres en cas de tuberculose. Nous avons cherche a identifier de facon retrospective; les parcours de soins des patients avant le diagnostic de tuberculose et l'influence de ces parcours sur les delais de traitement a Conakry-Guinee.Nous avons interroge 112 nouveaux patients a leur enregistrement pour tuberculose pulmonaire a bacilloscopie positive. Ont ete distingues les parcours conventionnels (recours aux seules structures sanitaires) et mixtes (associant structures sanitaires; automedication et medecine traditionnelle). L'influence des caracteristiques des patients sur le type de parcours a ete testee en analyses uni et multivariees et les delais de mise sous traitement ont ete compares pour les deux types de parcours. Deux patients sur trois ont suivi un parcours mixte. Ce type de parcours n'etait lie; en analyse multivariee; qu'au niveau de scolarisation (p=0;02). Les delais moyens de traitement etaient similaires (respectivement 13;4 et 12;8 semaines pour les parcours conventionnels etmixtes; p=0;68). La proportion de parcours comportant plus de trois recours aux structures sanitaires etait significativement plus elevee pour les parcours conventionnels que pour les parcours mixtes (72vs 30; p0;001). Les principales raisons invoquees pour l'utilisation tardive des structures sanitaires etaient l'ignorance des signes de la tuberculose (26) et le cout eleve des soins (12). Les parcours des patients sont multiples et peuvent induire des retards a la mise sous traitement antituberculeux. Une sensibilisation de la population et des soignants est necessaire
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Antituberculosos , Tuberculosis/diagnóstico , Tuberculosis/terapiaRESUMEN
This study extends phenotypic and ecological knowledge of Coccidioides spp., by describing its recovery from soils of Ceará State (Northeast Brazil) and analyzing the in vitro features of the growth of its vegetative phase. Following a human coccidioidomycosis case, Coccidioides spp. strains were isolated from 3 of 14 soil samples collected in an armadillo's burrow. Mycological analysis showed colonies with glabrous, velvety or cottony texture and an increasing quantity of arthroconidia. The overall growth rates of the strains were slower in 8% NaCl medium, maximum growth rate was obtained at 30 degrees C, and their pH tolerance ranged from 4.0 to 11.0. Several carbohydrates and polyalcohol sources could be efficiently metabolized by Coccidioides spp. strains in the mycelial form. Total absence of growth was observed in media supplemented with either L-aspartic acid or L-histidine. Whereas intense growth was found when strains were incubated with any other aminoacid sources studied. Coccidioides spp. strains did not grow in the presence of Tween 60 and Tween 80, but exhibited intense growth in Tween 20. Nicotinic acid and the toxic compounds caffeic acid and phenol could not be metabolized by any strain. All of the strains were positive for urease production and displayed intense growth in media containing cycloheximide concentrations ranging from 0.01 and 0.05%, but did not grow at 0.1 and 0.2%. The present findings confirm the importance of armadillos burrows in the ecology of Coccidioides spp. in Northeast Brazil and indicate that the fungus is a very physiologically versatile organism.
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Coccidioides/aislamiento & purificación , Coccidioides/fisiología , Ecología , Microbiología del Suelo , Animales , Armadillos/microbiología , Brasil , Coccidioides/enzimología , Coccidioides/genética , Ecosistema , Ambiente , FenotipoRESUMEN
SETTING: Anti-tuberculosis centres in Conakry. OBJECTIVES: To determine the prevalence of diabetes mellitus in patients with tuberculosis (TB), identify the associated risk factors and describe the clinical signs of the association of TB and diabetes. METHOD: A total of 388 patients with TB selected by simple random sampling from the register of cases diagnosed in Conakry were examined and administered a capillary blood glycaemia test to detect diabetes. RESULTS: Thirteen cases of diabetes were identified, giving a prevalence rate of 3.35% (95%CI 1.35-5.35). Four (31%) had not been diagnosed before the survey. The diagnosis of diabetes preceded that of TB by an average of 5 years (range 1-9 years). The clinical characteristics of TB (frequent exposure to infection, site and proportion of new and retreated cases) did not differ from one group to another. Increased age (P < 0.0001), obesity (P < 0.005), sedentary lifestyle (P < 0.0004), and previous family history of diabetes (P = 0.04) or obesity (P = 0.04) were significantly associated with diabetes. CONCLUSION: The prevalence of diabetes among TB patients is higher than previously estimated for Guinea. Because of frequent co-morbidity, systematic testing for diabetes among TB patients may be recommended, particularly if risk factors are present.
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Complicaciones de la Diabetes/epidemiología , Tuberculosis/epidemiología , Adulto , Femenino , Guinea/epidemiología , Humanos , Masculino , Persona de Mediana Edad , PrevalenciaRESUMEN
SETTING: Seven selected out-patient clinics caring for asthma patients in Algeria, Guinea, Morocco, Syria, Turkey and Vietnam. DESIGN: Evaluation of treatment outcomes after one year of follow-up of a cohort of asthma patients consecutively enrolled in a prospective study evaluating routine practice. RESULTS: Among 310 asthma patients registered, the following outcomes were recorded after one year of follow-up: 95 (31%) successful, 61 (20%) under control, 35 (11%) failed, 116 (37%) defaulted and 3 (1%) transferred. Among the 167 (53.9%) patients still on treatment after one year there was a substantial increase in the proportion of patients classified as intermittent at the end of treatment (from 11% to 53%), with a decrease in all categories of persistent asthma (from 34% to 12% for mild, 45% to 28% for moderate and 10% to 8% for severe asthma). CONCLUSIONS: While patients' quality of life can be improved if they follow regular treatment, the key challenge in providing care is to ensure that patients adhere to their treatment.
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Atención Ambulatoria , Asma/tratamiento farmacológico , Broncodilatadores/uso terapéutico , Países en Desarrollo , Adolescente , Adulto , Albuterol/uso terapéutico , Argelia/epidemiología , Asma/mortalidad , Asma/fisiopatología , Niño , Preescolar , Femenino , Estudios de Seguimiento , Guinea/epidemiología , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Marruecos/epidemiología , Ápice del Flujo Espiratorio/efectos de los fármacos , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Análisis de Supervivencia , Siria/epidemiología , Resultado del Tratamiento , Turquía/epidemiología , Vietnam/epidemiologíaRESUMEN
Untreated smear-positive pulmonary tuberculosis constitutes a reservoir of infection which is highly contagious. The present study was conducted in Conakry, Guinea, to determine the different options which are available when seeking treatment or care, and to ascertain the average delay in diagnosis of pulmonary tuberculosis and the main factors linked to the delay in diagnosis after the initial onset of symptoms. Through a cross-sectional study, 113 consecutive patients with smear-positive pulmonary tuberculosis were interviewed through the use of a questionnaire. The median total delay from the onset of symptoms of pulmonary tuberculosis until the diagnosis was 11 weeks. This delay period exceeded 4 weeks for 90 of the patients (80%). The average delay linked to the conventional health care system was double that of the one at the fault of the patient (6 weeks versus 3 weeks, respectively). 54% of the patients had initially resorted to non-conventional care. To shorten this mean delay period, it is necessary to both strengthen the professional abilities and skills which train for one to better to detect tuberculosis and to sensitize the population to the subject matter and information on the illness and its symptoms.
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Tuberculosis Pulmonar/diagnóstico , Adolescente , Adulto , Intervalos de Confianza , Estudios Transversales , Interpretación Estadística de Datos , Femenino , Guinea , Humanos , Masculino , Factores Socioeconómicos , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
SETTING: Nine selected out-patient clinics caring for asthma patients in Algeria, Guinea, Ivory Coast, Kenya, Mali, Morocco, Syria, Turkey and Vietnam. DESIGN: Prospective enrolment of consecutive patients considered by the practitioner to have asthma with evaluation of adherence of the practitioner with recommended standard case management, including proportion of patients confirmed to have asthma, proportion in whom severity was correctly graded and proportion in whom treatment with inhaled corticosteroids corresponded to severity grade. RESULTS: Of 499 consecutive patients, 456 (91%) were enrolled and evaluated. The diagnosis was confirmed in 263 (58%). Agreement between the practitioner and the guidelines in assigning grade of severity was moderate overall (kappa = 0.42). It was higher for assignment of grade using symptoms (K = 0.51), but poor for assignment of grade using peak expiratory flow (PEF) rate (kappa = 0.29), with practitioners tending to underestimate the severity. Agreement between the practitioners' assessment of severity and treatment with inhaled corticosteroids was poor (kappa = 0.18), with underutilisation of inhaled corticosteroids. CONCLUSIONS: Practitioners caring for asthma patients in this study tended to underutilise the PEF rate in assessing their patients and underutilised treatment of patients with inhaled corticosteroids.
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Asma/diagnóstico , Países en Desarrollo , Adhesión a Directriz , Adolescente , Adulto , Asma/tratamiento farmacológico , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Ápice del Flujo Espiratorio , Guías de Práctica Clínica como AsuntoRESUMEN
Authors bring back their experience in surgery thyroïdienne patient sur192s admitted and operated in five years in tea service of General Surgery of him FALLEN Ignace Deen Conakry of. Thesis patients represented 3.13% of tea 6139 surgical interventions exercised during tea period of survey. It was about has retrospective survey of descriptive type going from January 1st, 1997 at 31 December 2001, structural one aspects epidemiological, clinic, therapeutic and histologique. Tea done operative gesture was 86 lefts loboisthmectomieseses (44.17%), 41 rights loboisthmectomieseses (21.35%), 58 thyroidectomies subtotales (30.21%), 7 thyroidectomieses total (3.65%). Tea gotten results were good in 99.48%. To slot of death has been recorded, representing 0.52%. Tea goalkeeper of tea survey was to appreciate results of surgery thyroidienne and to take out again elements of bad prognostication of this surgery in their service.
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Glándula Tiroides/cirugía , Tiroidectomía/estadística & datos numéricos , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Guinea , Humanos , Lactante , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Enfermedades de la Tiroides/cirugía , Adulto JovenRESUMEN
Foram atendidos no Centro Integrado de Diabetes e Hipertensão do Estado do Ceará, 141 pacientes diabéticos apresentando úlceras infectadas no período de 01/03/2001 a 30/11/2002 e submetidos a um estudo microbiológico no Laboratório de Microbiologia do Departamento de Medicina Legal da Universidade Federal do Ceará. Staphyloccocus aureus foi isolado de (43, 2)dos pacientes. Das cepas de Staphyloccocus aureus 07 (11,5...
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Diabetes Mellitus , Pie Diabético , Microbiología , Farmacorresistencia Microbiana , Staphylococcus aureusRESUMEN
This report describes 6 cases of Wilson's disease observed at the University Hospital Center in Conakry, Guinea. Presenting symptoms involved extrapyramidal syndrome in 4 cases, psychomotor epilepsy in 1, and confusional syndrome in 1 case. Diagnosis was based on neuropsychic manifestations, Kayser-Fleicher corneal ring, liver failure, and impaired copper metabolism. Brain CT-scan depicted normal features in 3 cases, symmetric hypodensity of the lenticular nucleus in one, discrete ventricular dilatation of in one a and cortico-subcoetical atrophy in one.
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Encéfalo/patología , Degeneración Hepatolenticular/patología , Adolescente , Adulto , Enfermedades de los Ganglios Basales/etiología , Niño , Confusión/etiología , Epilepsia/etiología , Femenino , Guinea , Degeneración Hepatolenticular/complicaciones , Degeneración Hepatolenticular/diagnóstico , Humanos , Masculino , Tomografía Computarizada por Rayos XRESUMEN
This rep o rt describes 6 cases of Wi l s o n 's disease observed at the Unive rsity Hospital Center in Conakry; Guinea. P resenting symptoms invo l ved ex t rapy ramidal syndrome in 4 cases; p s y chomotor ep i l epsy in 1; and confusional syndrome in 1 c a s e. Diagnosis was based on neuro p s y chic manife s t ations; Kayser- F l e i cher corneal ring; liver failure; and impaired copper metabolism. Brain CT-scan depicted normal fe at u res in 3 cases; s y m m e t ric hypodensity of the lenticular nu cleus in one; discrete ve nt ricular dilat ation of in one a and cortico-subcoetical atro p hy in one
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Cobre , Degeneración HepatolenticularRESUMEN
OBJECTIVE: Tuberculosis suspects with negative sputum smears for acid-fast bacilli (AFB) may have either pulmonary tuberculosis (PTB) or some other pulmonary disease (non-PTB). The aim of this study was to improve the differentiation between PTB and non-PTB. DESIGN: We enrolled 396 tuberculosis suspects 15 years of age or older who had cough of 21 days or longer and three negative AFB smears. Non-PTB was diagnosed by clinical and radiographic responses to amoxicillin; smear-negative PTB was diagnosed by positive culture for Mycobacterium tuberculosis or response to antituberculosis chemotherapy. RESULTS: Multivariate analysis, without X-ray variables, of 79 patients with a final diagnosis of non-PTB and 110 patients with smear-negative PTB indicated that age less than 37 years, family contact with TB, never having been married, loss of weight, lack of expectoration, human immunodeficiency virus (HIV) seropositivity, and tuberculin reactivity were significantly associated with PTB. When the initial X-ray findings were included, age younger than 37 years, lack of expectoration, HIV seropositivity, and tuberculin reactivity remained in the model, and cavitation and patchy densities were significantly associated. CONCLUSION: The response to 10 days of amoxicillin and certain demographic, clinical and radiographic characteristics are useful in separating non-PTB from PTB in tuberculosis suspects with negative AFB smears.
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Mycobacterium tuberculosis/aislamiento & purificación , Esputo/microbiología , Tuberculosis Pulmonar/diagnóstico , Adulto , Amoxicilina/uso terapéutico , Diagnóstico Diferencial , Reacciones Falso Negativas , Femenino , Guinea , Humanos , Masculino , Radiografía Torácica , Tuberculina , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/microbiologíaRESUMEN
Complement receptor type 1 (CR1) is a membrane glycoprotein that acts as a receptor for the C3b, iC3b and C4b fragments of complement. In primates, one function of erythrocytes is to promote safe clearance of immunocomplexes (IC) from the circulation through CR1. Theoretically, in diseases characterized by high levels of circulating IC, an erythrocyte CR1 (CR1/E) deficiency may favor IC deposition in tissues or facilitate inappropriate activation of leukocytes in the circulation. Depression of the cell immune response occurs in paracoccidioidomycosis (PCM), especially in the more severe cases, and is frequently associated with high serum IC levels. In the present study we quantified the number of CR1/E in patients with the acute and chronic forms of PCM before and after treatment and correlated it with serum IC levels and CD4+ and CD8+ T cell concentration in the peripheral blood of these patients. Patients with PCM, particularly those with active disease and who had received treatment for shorter periods of time, had low numbers of CR1/E. In addition, an increase in serum IC concentration and a reduction in the CD4+/CD8+ T cell ratio were observed. After treatment there was a significant increase in mean CR1/E number and a reduction in serum IC levels. In patients with the chronic form of the disease the CD4+/CD8+ T cell ratio tended to increase after treatment and was associated with increased CR1/E levels. These results suggest that the reduction in CR1/E observed in patients is a phenomenon acquired with the disease and that CR1 could play a role in the pathogenesis of PCM.
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Eritrocitos/inmunología , Paracoccidioides/inmunología , Paracoccidioidomicosis/inmunología , Receptores de Complemento/biosíntesis , Complejo Antígeno-Anticuerpo/biosíntesis , Complejo Antígeno-Anticuerpo/sangre , Proteína C-Reactiva/metabolismo , Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD8-positivos/inmunología , Proteínas del Sistema Complemento/metabolismo , Eritrocitos/metabolismo , Citometría de Flujo , Humanos , Inmunoglobulinas/sangre , Paracoccidioidomicosis/sangre , Receptores de Complemento/sangre , Receptores de Complemento/inmunologíaRESUMEN
SETTING: The cost and availability of the medications required for the treatment of asthma may represent potential barriers to effective management. METHOD: A survey of prices and policies for components of asthma treatment in 1998, in Algeria, Burkina Faso, Ivory Coast, Guinea, Mali, Syria, Turkey and Vietnam. RESULTS: Medications were consistently available in only four of the eight countries studied. The cost of essential medications for standard case management varied by over five times for beclomethasone and by over three times for inhaled salbutamol. In all but two countries, the cost of one year of drugs for treatment of a moderate, persistent case exceeded the monthly salary of a nurse in that country. The essential drugs list included inhaled salbutamol in five of eight countries and beclomethasone in three of eight. The costs of medications were lower where generic preparations were available and, to a lesser extent, where the medications are on the essential drugs list. CONCLUSIONS: The cost and availability of medications vary widely, and may represent an important barrier to effective management in some low and middle income countries.
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Albuterol/economía , Albuterol/uso terapéutico , Antiasmáticos/economía , Antiasmáticos/uso terapéutico , Asma/tratamiento farmacológico , Países en Desarrollo , Glucocorticoides/economía , Glucocorticoides/uso terapéutico , Beclometasona , HumanosAsunto(s)
Adhesinas de Escherichia coli/inmunología , Anticuerpos Antibacterianos/inmunología , Adhesión Bacteriana/efectos de los fármacos , Calostro , Escherichia coli/efectos de los fármacos , Inmunoglobulina A Secretora/inmunología , Anticuerpos Antibacterianos/aislamiento & purificación , Calostro/química , Calostro/inmunología , Escherichia coli/inmunología , Escherichia coli/patogenicidad , Escherichia coli/fisiología , Femenino , Células HeLa , Humanos , Inmunoglobulina A Secretora/aislamiento & purificación , Recién Nacido , Peso Molecular , Embarazo , VirulenciaRESUMEN
Human colostrum and a high molecular weight colostrum fraction (HMWF; > 14,000 D) prevented the adhesion of localized adherent (LA+) O111:H-enteropathogenic Escherichia coli (EPEC) to HeLa cells. This effect was abolished after absorption with an O111:H-LA + EPEC strain, but absorption with a LA- strain of same serotype had no effect on the process. A low molecular weight fraction (< 14,000 D), absorbed or not with LA+ or LA- bacterial strains, did not inhibit the adherence of E. coli to HeLa cells. IgA-depleted colostrum had no inhibitory effect on bacterial adhesion, demonstrating the critical role of this protein in the phenomenon. Heat inactivation of whole colostrum did not significantly modify the inhibition adherence levels. Immunoblots of O111:H-LA+ strain outer-membrane complex reacted with colostrum and HMWF showing that IgA antibodies were predominantly reactive with a 94-kD protein. These data confirm and extend observations about colostrum sIgA participation in adhesion inhibition of EPEC to HeLa cells and its response to a 94-kD outer-membrane protein.