Measles in vulnerable populations: An outbreak in Roma settlements of Loire-Atlantique, France, 2019.

In May 2019, a measles outbreak occurred in the French subregion of Loire-Atlantique, particularly affecting Roma settlements. Various obstacles hindered the implementation of postexposure measures among Roma population, resulting in the spread of the cases to other settlements. Suspected cases of measles were immediately investigated and concerned settlements were visited for measles-mumps-rubella (MMR) vaccination. From July 1 to September 3, 2019, a first and then a second Health Reserve team helped for vaccination on the affected and then also the measles-free settlements. Vaccination uptake was monitored with the use of the department's vaccination center immunization registry. Genotyping of selected samples was performed for comparison with viruses circulating at the same time in France and Romania. As of September 16 2019, 109 cases of measles were confirmed among Roma population, including 99 (91%) children under 15 years. Of the 85 people eligible for vaccination, 60 (71%) had not been vaccinated and 23 (27%) had an unknown vaccination status. Sequence comparison revealed that 28/29 sequenced D8 strains were 100% identical to the strain responsible for a large number of cases throughout France in 2019, and to two sequences reported in Romania among sporadic cases. The vaccination campaign resulted in 1136 people on 35 settlements receiving at least one dose of MMR vaccine and in the increase of one-dose MMR vaccine coverage at 24 months from 43% (23/53) to 91% (48/53). With measles transmission continuing in Europe, efforts must be made to meet immunization coverage targets, particularly in hard-to-reach communities where outbreaks may be difficult to control.

Psittacosis outbreak after participation in a bird fair, Western France, December 2008.

In December 2008, three hospitalized cases of suspected psittacosis infection were notified by respiratory disease clinicians from a local hospital to the Regional Epidemiology Unit of Pays de la Loire, France. They all had attended a bird fair. A retrospective cohort study was conducted among exhibitors and organizers to identify potential risk factors in relation to this fair. Environmental and veterinary investigations were implemented to trace potential sources of infection. We identified two confirmed, two probable and 44 possible cases among participants. The attack rate in exhibitors and organizers was 38% (33/86). The median incubation period was 11 days (range 6-22 days). Individuals located in two particular sectors of the showroom were found to be at double the risk of developing psittacosis (relative rate 2·1, 95% confidence interval 1·03-4·18) than those in other sectors. Pooled faecal samples of birds belonging to a possible case exhibitor tested positive for Chlamydiaceae by PCR. Ventilation conditions in the showroom were inadequate. This investigation allowed the formulation of recommendations to prevent psittacosis in bird exhibitions which are held weekly in France.

Early and late cardiac ventricular reverse remodeling after catheter ablation for lone paroxysmal atrial fibrillation.

AIM: We sought to explore ventricular function in patients with lone paroxysmal atrial fibrillation (AF) and determine the mid- and long-term impact of pulmonary vein isolation on cardiac remodeling. BACKGROUND: The relationship between tachyarrhythmia and ventricular dysfunction is still a matter of debate. Tachycardia-induced cardiomyopathy is defined as reversible myocardial dysfunction following treatment for tachyarrhythmia. METHOD: We prospectively studied 31 patients (56.4 ± 10 years) presenting with paroxysmal-AF who were treated successfully by catheter ablation and 15 age-matched controls. Left and right ventricular functions were assessed by echocardiography at baseline and at 3-month and 1-year follow-up. RESULTS: In AF-patients, LV-function was slightly lower at baseline than controls (LV-ejection fraction was 60% versus 64%; P = 0.06). More impressive, systolic peak velocity on Doppler tissue imaging was 9 cm/s in AF patients (versus 12 cm/s; P = 0.0004). LV global longitudinal strain was also significantly different between the two groups (patients: -16% versus controls: -19%; P = 0.005). At 1-year follow-up, most functional parameters significantly improved in the AF-patients and no longer differed from the controls. Right ventricular (RV) function was also depressed in AF patients at baseline. At 1-year follow-up, tissue Doppler showed improvement in RV-S' (+27%, P = 0.007) and RV peak systolic strain (+36%, P<0.0001) and became comparable to controls. CONCLUSION: We demonstrate that some degree of arrhythmic cardiomyopathy exists in patients presenting with lone paroxysmal-AF. Catheter ablation improved RV and LV functions. Longitudinal function is the most sensitive component of ventricular systole to monitor when looking for this cardiac reverse remodeling.

Contribution of cardiac MRI in the comprehension of peripartum cardiomyopathy pathogenesis.

Pathogenesis of peripartum cardiomyopathy (PPC) is still discussed. We report one case of PPC in which a cardiac magnetic resonance imaging analysis allowed to exclude some "classical" pathogenesis hypotheses. We would like to emphasize the benefits of cardiac MRI in the comprehension of the mechanism(s) involved in the genesis of PPC.

[Beta-blocker prescription and chronic obstructive pulmonary disease]. / Prescription des bêtabloquants et bronchopneumopathie chronique obstructive.

The beta-blocker (BB) prescription remains insufficient despite guidelines, especially, for chronic heart failure. Patients suffering chronic obstructive pulmonary disease (COPD) are particularly less treated by BB. The level of evidence for BB prescription is however especially high and as we will focus on, the level of evidence for the safety of BB in the COPD context is convincing enough. We, thus, propose to review the existing literature in regard to this prescription of BB in the chronic heart failure, in the coronary artery disease and for high blood pressure in COPD patients. We then propose our approach to improve the level of prescription of BB in COPD patient really justifying this prescription in cardiology.

Colonic metastasis of breast carcinoma.

Metastasis of breast carcinoma to the colon is a rare occurrence. We report here the case of a 65-year-old patient who presented a stenosing tumor of breast origin, located in the right colon. Some of the regional lymph nodes were infiltrated but no distant metastasis were detected. The primary breast lesion was a 4-cm infiltrating adenocarcinoma, operated 4 years earlier. Surgical removal of the lesion was followed by Endoxan-Epirubicin and 5-Fluororacil chemotherapy and the patient remained disease-free during the 3 years of follow-up. We could find only 2 similar cases reported in the world literature until now. Profound anemia in a patient with a past history of breast carcinoma may indicate colonic metastasis; treatment should be surgery followed by chemotherapy.

Structural requirements of 5-hydroxytryptamine-moduline analogues to interact with the 5-hydroxytryptamine1B receptor.

5-Hydroxytryptamine-moduline is an endogenous cerebral tetrapeptide that regulates the activity of 5-hydroxytryptamine1B receptors. Direct binding of 5-[3H]hydroxytryptamine-moduline on rat brain homogenate evidenced the existence of two interacting sites for the peptide, very likely corresponding to different conformations of the 5-hydroxytryptamine1B receptor: The peptide first binds to a low-affinity state of the receptor (pIC50 = 7.68+/-0.14) and then induces (or stabilizes) a high-affinity complex (pIC50 = 11.62+/-0.18). This work focuses on the ability of 5-hydroxytryptamine-moduline analogues to recognize the high- and low-affinity sites for 5-hydroxytryptamine-moduline. The results obtained show that the two conformers of the 5-hydroxytryptamine1B receptor have similar but not identical binding pockets for 5-hydroxytryptamine-moduline. These two sites proved to be stereoselective and selective for tetrapeptides and favored the binding of peptides with hydrophobic amino acids in positions 1 and 4, serine in position 2, and a short amino acid in position 3. However, the serine in position 2 seems to be more important for the interaction of the peptide with the low-affinity site than the high-affinity one, which only needs a short hydrophobic amino acid in position 2.

Pharmacokinetics, metabolism and bioavailability of the new anti-allergic drug BM 113. Part III: Pharmacokinetics, metabolism, dose dependency and gender effect after single or repeated administration to human healthy volunteers.

A new anti-allergic drug, BM 113 (1-(benzhydryloxyethyl)piperidino-4- ethylacetate, CAS 115313-90-1; BM 113 maleate: CAS 115313-91-2), with a piperidinic structure, showing anti-histaminic properties was studied after administration to healthy human volunteers. The focus was on the pharmacokinetics, the metabolism, the dose dependency and gender differences of the pharmacokinetic parameters of BM 113 and its main desacetylated metabolite, BM 212. Unchanged BM 113 was not recovered in plasma or in urine. The elimination of the radioactivity was essentially urinary with about 81% recovered within 24 h. The elimination was completed with 97% of the administered dose recovered after 120 h. HPLC dosage of BM 212, using a specific method, showed that BM 212 represented 62% of the urine radioactivity. The plasma profile of radioactivity was characterized by two decreasing phases with respective half-lives of 3.71 +/- 0.66 h and 24.67 +/- 25.01 h. A dose dependency study realised with 20, 40, 60 and 80 mg oral doses administered to 8 healthy volunteers has proven the linearity of the pharmacokinetics of BM 212 in the studied range. BM 212 disposition after single and repeated BM 113 oral doses in a 14-day study did not vary and permitted to conclude that no auto-induction or auto-inhibition phenomenon was involved. No significant difference between men and women was observed. The concentration profile was mono or biexponential, depending on the subject but whatever the gender. An inter-individual variability appeared for both sexes and caused some variations in the pharmacokinetic parameters.

Pharmacokinetics, metabolism and bioavailability of the new anti-allergic drug BM 113. Part II: Pharmacokinetics in primates after repeated oral or single intravenous administration.

The pharmacokinetics of BM 113 (1-(benzhydryloxyethyl)piperidino-4-ethylacetate, CAS 115313-90-1; BM 113 maleate: CAS 115313-91-2) was studied using 3H-BM 113 in the Cynomolgus primate. Oral repeated administration of 0.75 mg/kg was performed on 8 days. 40 days after the oral treatment, a single intravenous administration of 0.4 mg/kg was done. Whatever the administration route, the radioactivity excretion was essentially urinary (about 60%) and most of the radioactivity was excreted within the first 24 h. The faecal elimination was low, about 10% of the administered dose. 40 days after the treatment, some radioactivity was already present in the urine. For this reason, the excretion balance ranged from 70 to 83% of the dose. The elimination half-life of 3H-BM 113 was long, about 80 h.

Pharmacokinetics, metabolism and bioavailability of the new anti-allergic drug BM 113. Part I: Pharmacokinetics and tissular distribution in Sprague-Dawley rats.

A new anti-allergic drug, BM 113 (1-(benzhydryloxyethyl)piperidino-4-ethylacetate, CAS 115313-90-1; BM 113 maleate: CAS 115313-91-2) with a piperidinic structure, showing antihistaminic properties was studied in male and female Sprague-Dawley rats after i.v. or p.o. administrations of 0.750 mg/kg 3H-BM 113. This product presented a rapid faecal elimination after i.v. and oral administration. The total recovery of the dose was obtained after 144 h. Biliary elimination was very fast: 54% of the intravenous dose were biliarily eliminated within 2 h, essentially as a conjugated form. For both i.v. and p.o. routes, the blood kinetics were biexponential. Intravenous administration led to elimination half-lives of 1.36 h and 0.75 h for the first phase and 38.6 h and 56.5 h for the second one for males and females, respectively. After oral administration, rebounds corresponding to the presence of enterohepatic cycle or metabolites were observed. Thus, the determination of half-lives was not possible. Slight but significant differences of some pharmacokinetic parameters were observed between genders. The results obtained during the protein binding study corresponded to the BM 113 metabolite known as BM 212. The free fraction corresponded to 55.5%. Tissular concentrations showed a rapid distribution of 3H-BM 113 followed by a slow elimination. In most of the tissues, the decrease was biexponential. The organs containing most of the radioactivity were those of the intestinal tract and the liver. Other tissues presented concentrations close to those of plasma. Lipidic tissues, showing low BM 113 concentrations, presented a slower elimination, probably related to the high lipophilicity of molecule.

New benzocycloalkylpiperazines, potent and selective 5-HT1A receptor ligands.

A series of 1-(benzocycloalkyl)-4-(benzamidolkyl)piperazine derivatives was prepared in order to obtain compounds with a high affinity and selectivity for 5-HT1A receptors. The modifications of aromatic substituents, the length of the alkyl chain, and the size of the ring were explored. Most of N-(1,2,3,4-tetrahydronaphthyl)-N'-(benzamidoethyl)piperazines (32-37) were bound to 5-HT1A receptors in a nanomolar range and presented a high degree of selectivity. After resolution, levorotatory enantiomers showed affinity and selectivity higher than those of dextrorotory ones for 5-HT1A sites. The agonist type activity of selected derivatives was also confirmed in vitro on the inhibition of the activation of adenylate cyclase induced by forskolin and, in vivo, on the induction of the lower lip retraction in rats.