RESUMEN
BACKGROUND: Little data is available on HIV-infected patients aged over 75years. METHODS: A descriptive study of HIV-infected patients aged over 75years was conducted in six hospitals of the Pays de la Loire region, France. Socio-demographic, immuno-virological, and therapeutic characteristics were collected via an electronic medical record software (Nadis®). To assess frailty, a simplified geriatric assessment was conducted during an HIV routine visit. RESULTS: Among the 3965 patients followed in the six centers, 65 (1.6%) were aged over 75years. From January to May 2016, 51 patients were included in the study: median age 78.7years, male patients 74.5%, homosexual transmission 41.2%, living at home 98% and single in 54.5% of cases, median duration of HIV infection 18.8years, median CD4 nadir 181 cells/mm3; CDC stage C 36.4%. All patients were on antiretroviral therapy and 98% of them had an HIV RNA<50c/mL; 82% of patients had at least one comorbidity and 58% at least two comorbidities. Eleven of 51 patients (21.6%) were diagnosed as at risk of frailty and 2/51 (3.9%) were considered frail. Cognitive disorders were diagnosed in 60.8%, depression in 35.3%, malnutrition in 25.5%, and vitamin D deficiency in 45.9%. CONCLUSIONS: HIV-infected patients aged above 75years are well-managed, but the prevalence of geriatric comorbidities is high.
Asunto(s)
Infecciones por VIH , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios Transversales , Estudios Epidemiológicos , Femenino , Francia/epidemiología , Evaluación Geriátrica , Infecciones por VIH/complicaciones , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , MasculinoRESUMEN
This cross-sectional study evaluates the prevalence and factors associated with sleep disturbances in French adult HIV-infected outpatients. Patients fullfilled a self-administered questionnaire on their health behavior, sleep attitudes (Pittsburgh sleep quality index, PSQI), quality of life and depression; 1354 patients were enrolled. Median sleeping time was 7 h. Poor sleep quality was observed in 47 % of the patients, and moderate to serious depressive symptoms in 19.7 %. Factors significantly associated with sleep disturbances were depression, male gender, active employment, living single, tobacco-smoking, duration of HIV infection, nevirapine or efavirenz-including regimen. Prevalence of poor sleepers is high in this HIV adult outpatient population. Associated factors seem poorly specific to HIV infection and more related to social and psychological status. Taking care of these disturbances may prove to be an effective health management strategy.
Asunto(s)
Depresión/epidemiología , Infecciones por VIH/complicaciones , Pacientes Ambulatorios/estadística & datos numéricos , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Trastornos del Sueño-Vigilia/epidemiología , Sueño , Adulto , Fármacos Anti-VIH/administración & dosificación , Estudios Transversales , Depresión/complicaciones , Femenino , Francia/epidemiología , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Calidad de Vida , Factores de Riesgo , Trastornos del Inicio y del Mantenimiento del Sueño/complicaciones , Trastornos del Sueño-Vigilia/diagnóstico , Encuestas y Cuestionarios , Adulto JovenRESUMEN
INTRODUCTION: Extramedullary plasmacytoma is an uncommon plasma cell malignancy mainly located to the upper aerodigestive tract. Primary pulmonary plasmacytoma is extremely rare. EXEGESIS: We report two new cases of primary pulmonary plasmacytoma and then proceed to a review of the literature concerning 35 similar cases previously described. CONCLUSION: Complete or partial responses were obtained in 24 cases (65%). Five patients (14%) have developed multiple myeloma within 3 years following plasmacytoma diagnostic. In spite of sustained responses with radiotherapy or chemotherapy, surgical resection while feasible remains the first therapeutic option.
Asunto(s)
Neoplasias Pulmonares/patología , Plasmacitoma/patología , Anciano , Anciano de 80 o más Años , Terapia Combinada , Femenino , Humanos , Neoplasias Pulmonares/terapia , Masculino , Plasmacitoma/terapia , Resultado del TratamientoRESUMEN
Mayotte is a little French island, located in the Indian ocean, between Madagascar and Mozambic. Officially there is a population of 150000 inhabitants, but in fact, there are probably about 200000 people, largely due to numerous illegal immigrants, especially coming from Anjouan the nearest Comorian island. There is only one hospital, with 252 beds. The malaria incidence reaches about 3000 cases per year; and treatments until august 2001 were generally haphazard. This is changing with the use of the Optimal rapid diagnostic test (DiaMed, Cressier Switzerland). More precise statistics should be available in the coming years. In 2000, 252 patients were hospitalised with malaria fever. Preventive measures were scarce. These have been reenforced this year, with the arrival of an entomologist, the use of reenforced pesticide pulverisation in high-risk areas, the distribution of impregnated bednets to pregnant women, and media based information campaigns. Common drugs resistance is becoming a real concern in Mayotte. First-line treatment was: chloroquine; second-line: sulfadoxine-pyrimethamine, and third-line: quinine. In vitro studies have shown high levels of resistance, therefore another antimalarial drug therapy will be introduced at the end of the year: first-line: artemether-lumefantrine, second-line: mefloquine or halofantrine, third-line: quinine. To conclude, solutions exist but a real policy from the decision makers is necessary to implement them. The eradication of malaria remains a dream, but we can expect "zero death" in Mayotte, considering that the fight against this disease may help to start a regional health program.
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Malaria Falciparum/epidemiología , Adolescente , Adulto , Anciano , Animales , Anopheles/parasitología , Antimaláricos/administración & dosificación , Antimaláricos/farmacología , Antimaláricos/uso terapéutico , Niño , Comoras/epidemiología , Resistencia a Medicamentos , Emigración e Inmigración , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Insectos Vectores/parasitología , Malaria Falciparum/diagnóstico , Malaria Falciparum/tratamiento farmacológico , Malaria Falciparum/prevención & control , Malaria Falciparum/transmisión , Masculino , Persona de Mediana Edad , Control de Mosquitos/organización & administración , Plasmodium falciparum/efectos de los fármacos , Embarazo , Complicaciones Infecciosas del Embarazo/parasitología , Complicaciones Infecciosas del Embarazo/prevención & control , Resultado del TratamientoRESUMEN
INTRODUCTION: It can be difficult to diagnose focal muscular disease. We report a case of crural biceps focal myositis after an insect bite. DISCUSSION: We then discuss diagnostics of one or a small number of muscle injury. Focal inflammatory myositis has been described. We emphasize the role of pathology. In our case, pathological examination rules out inflammatory or tumoral disease and access likely toxical etiology. Muscle injury can appear, most frequently around the bite of venomous animal. CONCLUSION: Hymenopters are often responsible for such stings in France. Venoms are toxic for muscle cells membrane.
Asunto(s)
Mordeduras y Picaduras de Insectos/complicaciones , Miositis/etiología , Miositis/patología , Adulto , Brazo/patología , Diagnóstico Diferencial , Femenino , Humanos , InflamaciónRESUMEN
The purpose of this open non-comparative retrospective study was to evaluate the efficacy and tolerance of Malarone for management of uncomplicated imported Plasmodium falciparum malaria. A total of 112 non-immune adult patients were included between 1999 and 2001. Excellent responses in terms of both clinical symptoms and parasite control were achieved within 4 days after the beginning of treatment in all cases. No recurrence was observed after 28 days of individual followup. Tolerance was satisfactory with no adverse events except for occasional, minor gastrointestinal upset. Based on our experience, Malarone appears to be effective, well-tolerated, and suitable for routine management of uncomplicated imported Plasmodium falciparum malaria.
Asunto(s)
Antimaláricos/farmacología , Malaria Falciparum/tratamiento farmacológico , Naftoquinonas/farmacología , Proguanil/farmacología , Adolescente , Adulto , Anciano , Antimaláricos/administración & dosificación , Antimaláricos/efectos adversos , Atovacuona , Quimioterapia Combinada , Femenino , Gastritis/inducido químicamente , Humanos , Masculino , Persona de Mediana Edad , Naftoquinonas/administración & dosificación , Naftoquinonas/efectos adversos , Proguanil/administración & dosificación , Proguanil/efectos adversos , Recurrencia , Estudios Retrospectivos , Resultado del TratamientoAsunto(s)
Aneurisma/diagnóstico por imagen , Angiografía , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Aneurisma Coronario/diagnóstico por imagen , Aneurisma Ilíaco/diagnóstico por imagen , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma/complicaciones , Aneurisma de la Aorta Abdominal/complicaciones , Enfermedades de las Arterias Carótidas/complicaciones , Angiografía Cerebral , Aneurisma Coronario/complicaciones , Angiografía Coronaria , Humanos , Hiperhomocisteinemia/complicaciones , Aneurisma Ilíaco/complicaciones , Aneurisma Intracraneal/complicaciones , Masculino , Persona de Mediana EdadAsunto(s)
Estramustina/uso terapéutico , Hipocalcemia/inducido químicamente , Anciano , Anciano de 80 o más Años , Estramustina/efectos adversos , Humanos , Hipocalcemia/terapia , Masculino , Isquemia Miocárdica/complicaciones , Isquemia Miocárdica/tratamiento farmacológico , Terapia por Inhalación de Oxígeno , Edema Pulmonar/complicaciones , Edema Pulmonar/tratamiento farmacológicoRESUMEN
INTRODUCTION: Hyper-reactive malarial splenomegaly (HMS) syndrome related to abnormal immunologic response to repeated malarial infections is unusual in European expatriates. EXEGESIS: We report the case of a 72-year-old white male patient who had been residing in the Congo and developed a typical clinical features of hyperactive malarial syndrome characterized by massive splenomegaly with hypersplenism, high titers of malarial IgM antibodies, IgM macroglobulinemia, liver and medullary lymphocytic proliferation, and a clinical and immunological response to long-term chloroquine therapy. CONCLUSION: Criteria for the diagnosis of hyper-reactive malarial splenomegaly are useful. However, making a distinction from malignant lymphoproliferative disorders is difficult, as a sustained response to chloroquine is required. Therefore, chloroquine appears to have a regulatory effect on the immune system.
Asunto(s)
Malaria/complicaciones , Esplenomegalia/parasitología , Anciano , Anticuerpos Antiprotozoarios/sangre , Congo , Francia/etnología , Humanos , Hipergammaglobulinemia/sangre , Hipergammaglobulinemia/inmunología , Hipergammaglobulinemia/parasitología , Inmunoglobulina M/sangre , Hígado/inmunología , Activación de Linfocitos , Malaria/inmunología , Masculino , Bazo/inmunología , Bazo/patología , Esplenomegalia/inmunologíaRESUMEN
Haemophagocytic syndrome (HM) is a severe disorder with characteristic clinical and biological features. The case of a patient with malignant lymphoma who experienced HM during Herpes virus I pulmonary infection is reported. Main clinical, biologial and pathological findings are described. The risk of underestimation of this disease in patients requiring intensive care as well as the absolute necessity of an early diagnosis are emphasised.