Knowledge of HIV and hepatitis B and C status among people living in extreme poverty in France, in 2012.

OBJECTIVE: "Médecins du Monde" healthcare centers receive individuals living in extremely precarious conditions for primary health care; 94% of these are foreigners. These medical consultations are an opportunity to discuss their serological status and to offer them screening tests. PATIENTS AND METHOD: Two standardized questionnaires were implemented in all healthcare centers in 2000. The medical record covers knowledge of HIV and hepatitis B and C status. RESULTS: 41,033 consultations were given in 2012 in the 20 healthcare centers, for 23,181 patients. Only 29% of the patients knew their hepatitis status and 35% their HIV status. 42% of French patients were unaware of their HIV status compared to 67% of foreign patients. The lack of knowledge of foreign patients' HIV status was more frequent among men and in age classes<20 and>60 years of age. Patients from non-EU Europe, the Middle East, and Asia were significantly more likely to be unaware of their HIV status compared to people from Sub-Saharan Africa and Oceania/America. The rate of foreigners not having undergone screening remained stable, regardless of the duration of residence in France. CONCLUSION: These results highlight the need to develop specific prevention projects among immigrant populations in precarious situations.

[Development of actions for the prevention of HIV, hepatitis and sexually transmitted infections among immigrants consulting in the doctors of the world "Missions France"]. / Développement d'actions de prévention du VIH, des hépatites et des infections sexuellement transmissibles chez les immigrants consultant dans les missions France de Médecins du monde.

The mission France of Doctors of the World has for objective to facilitate the access to care and to rights in the common law system for vulnerable populations and to bring testimonies out. The objective of the project is to ensure daily actions of prevention: to bring people to screen for HIV and hepatitis as well as obtaining full access to treatment for populations consulting in the Reception centers for Care and Orientation (RCCO). The screening is proposed systematically to all new patients (90% of them are immigrants) after a medical consultation or a special prevention consultation. The prevalence of HIV, hepatitis B and C was respectively 15, 10.5, and 7 times higher than the national average among patients screened in 2007, The centers of Doctors of the World are privileged places to inform, prevent, offer screening, and bring healthcare to this population particularly exposed to risks.

[Development of prevention programmes for HIV, hepatitis and sexually transmitted infections among migrants consulting in the doctors of the World French centers]. / Développement d'actions de prévention du VIH, des hépatites et des infections sexuellement transmissibles chez les migrants consultant dans les missions France de médecins du monde.

The French Doctors of the World centers have as objective to facilitate access to care and to rights in the law system for vulnerable populations and to keep the global population informed. The objective of the project was to ensure daily actions of prevention: to bring people to HIV and hepatitis screening as well as to offer full access to treatment for the populations consulting in Reception centers of care and orientation (Caso). The screening is proposed systematically to all new patients (90% of them are migrants) after a medical consultation or a special prevention consultation. Among the patients screened in 2007, the prevalence of HIV, hepatitis B and C was respectively 15, 10,5 and seven times greater than the national average. The centers of Doctors of the World are privileged places to inform, prevent, offer screening and bring to healthcare these people particularly exposed to risks.

[Massive poisoning by African bee stings]. / Envenimation massive après piqûres d'abeilles africaines.

BACKGROUND: Bee stings can cause severe toxic effects when envenomation is massive. CASE REPORT: While touring in Casamance (Southern Senegal) a white male was severely stung by a swarm of African bees. The massive envenomation caused rhabdomyolysis, hemolysis and acute renal failure. Pathology examination of kidney and bladder specimens showed vasculitis affecting both arteries and veins. The patient was treated with several hemodialysis sessions and renal function returned to normal three months after the incident. DISCUSSION: Bees in Africa, known as "killer bees", are particularly aggressive. They have recently been imported from tropical zones in America where a large number of deaths have been reported. Most cases of massive envenomation have shown acute tubular necrosis or renal involvement with myoglobinuria or hemoglobinuria. The renal pathology observed in our case is not usually described.

Activation of renin synthesis is dependent on intact nitric oxide production.

The present study investigated whether or not nitric oxide (NO) synthesis mediates mechanisms regulating activation of renin formation. Studies were performed on afferent arterioles freshly isolated from the rat kidney. We have shown previously that this preparation is a useful model to study regulation of renin synthesis and secretion. The expression of renin mRNA was assessed by ribonuclease protection assay, and total renin content and renin secretion by radioimmunoassay. In afferent arterioles isolated from rats treated with the angiotensin-converting enzyme inhibitor ramipril, renin mRNA levels, total renin content and renin secretion were increased threefold compared to untreated controls. Inhibition of NO-synthase by NG-nitro-L-arginine methyl ester (L-NAME) in the ramipril-treated rats, abolished the increase in renin mRNA levels, total renin content and renin secretion. In other animals furosemide, a diuretic acting on macula densa cells, activated renin synthesis to a level similar to that found in the ramipril-treated group. Addition of L-NAME to the furosemide-treated rats suppressed the increases in renin mRNA levels, total renin content and renin secretion, suggesting that NO acts on renin activation by a mechanism independent of angiotensin II. In separate experiments, the inhibitory effect of L-NAME on the activation of renin secretion was abolished when afferent arterioles were treated with nicardipine, an L-type Ca2+ channel blocker, suggesting that the suppression of renin activation during NO inhibition is due to increased Ca2+ entry. Since endothelin is a potent mediator of Ca2+ influx and an inhibitor of renin release, we tested whether or not endothelin could be involved in the inhibitory effect of L-NAME on renin secretion. Application of the endothelin receptor antagonist, bosentan, in vitro mimicked the effect of nicardipine. In addition, bosentan coadministered with L-NAME in vivo blunted the inhibitory effect of L-NAME and restored the increases in renin mRNA level, synthesis and secretion. These data indicate that the physiological mechanism(s) regulating activation of renin synthesis and secretion are impaired during NO inhibition, probably because of increased Ca2+ influx. This increase in calcium flux is mediated at least partially by the action of endothelin.

Regulation of renin release is impaired after nitric oxide inhibition.

The aim of the present study was dual: first to establish that a preparation of afferent arterioles freshly isolated from the rat kidney is a suitable model to study renin release and synthesis, and second to investigate the effect(s) of nitric oxide (NO) inhibition on renin release in this model. Purification of renal microvessels was based on iron oxide infusion into the kidneys and separation of the afferent arterioles from glomeruli and connective tissue with a magnet. These microvessels express preprorenin mRNA, contain renin granules and release renin as evidenced by RT-PCR, immunocytochemistry and measurement of renin activity, respectively. Renin secretion was increased in isolated afferent arterioles after in vivo treatment with the diuretic furosemide (+300%) or in vitro treatment with the adenylyl cyclase activator forskolin (+50%), indicating that this vascular preparation responds appropriately to regulators of the renin-angiotensin system. Furthermore, in afferent arterioles isolated from control rats, renin release was positively correlated with total renin content (r = 0.85). In afferent arterioles isolated from rats chronically treated with the NO-synthase inhibitor NG-nitro-L-arginine methyl ester (L-NAME), forskolin was ineffective in modifying renin release despite stimulation of cAMP levels. In addition, the correlation between renin release and tissue renin content was disrupted. Similar results were obtained when cortical slices were used instead of afferent arterioles, suggesting that this defect in the regulation of renin release is independent of the presence of macula densa cells. To verify that the lack of regulation of renin release after L-NAME treatment was due to NO inhibition, the NO donor 3-morpholino-syndonimin-hydrochloride (SIN-1) was administered in afferent arterioles or cortical slices from kidneys of L-NAME-treated rats. In both preparations, SIN-1 reversed the L-NAME effect and re-established the responsiveness of renin release to forskolin and the relationship between renin release and renin content. These data indicate that the adenylyl cyclase-mediated mechanism regulating renin release is impaired when NO synthesis is inhibited.