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1.
Prim Health Care Res Dev ; 22: e20, 2021 05 27.
Artigo em Inglês | MEDLINE | ID: mdl-34039463

RESUMO

AIM: We aimed to understand practice nurses' perceptions about how they engage with parents during consultations concerning the measles, mumps and rubella (MMR) vaccine. BACKGROUND: The incidence of measles is increasing globally. Immunisation is recognised as the most significant intervention to influence global health in modern times, although many factors are known to adversely affect immunisation uptake. Practice nurses are a key member of the primary care team responsible for delivering immunisation. However, little is known how practice nurses perceive this role. METHODS: Semi-structured interviews were undertaken with 15 practice nurses in England using a qualitative descriptive approach. Diversity in terms of years of experience and range of geographical practice settings were sought. These interviews were recorded, transcribed verbatim and open-coded using qualitative content analysis to manage, analyse and identify themes. FINDINGS: Three themes were derived from the data: engaging with parents, the informed practice nurse and dealing with parental concerns: strategies to promote MMR uptake. During their consultations, practice nurses encountered parents who held strong opinions about the MMR vaccine and perceived this to be related to the parents' socio-demographic background. Practice nurses sought to provide parents with tailored and accurate sources of information to apprise their immunisation decision-making about the MMR vaccine.


Assuntos
Caxumba , Enfermeiras e Enfermeiros , Pesquisa Qualitativa , Rubéola (Sarampo Alemão) , Inglaterra , Humanos , Vacina contra Sarampo-Caxumba-Rubéola , Pais , Encaminhamento e Consulta
2.
Clin Exp Immunol ; 204(1): 107-124, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33314121

RESUMO

Natural killer (NK) cell functions are regulated by diverse inhibitory and activating receptors, including killer cell immunoglobulin-like receptors (KIR), which interact with human leukocyte antigen (HLA) class I molecules. Some KIR/HLA genetic combinations were reported associated with spontaneous clearance (SC) of hepatitis C virus (HCV) but with discordant results, possibly reflecting KIR and/or HLA gene polymorphism according to populations. KIR/HLA genetic combinations associated with both an exhaustive NK and T cell repertoire were investigated in a cohort of HIV-HCV co-infected individuals with either SC (n = 68) or chronic infection (CI, n = 163) compared to uninfected blood donors [controls (Ctrl), n = 100]. Multivariate analysis showed that the HLA C2C2 environment was associated with SC only in European HIV-HCV co-infected individuals [odds ratio (OR) = 4·30, 95% confidence interval = 1·57-12·25, P = 0·005]. KIR2D+ NK cell repertoire and potential of degranulation of KIR2DL1/S1+ NK cells were similar in the SC European cohort compared to uninfected individuals. In contrast, decreased frequencies of KIR2DS1+ and KIR2DL2+ NK cells were detected in the CI group of Europeans compared to SC and a decreased frequency of KIR2DL1/S1+ NK cells compared to controls. Regarding T cells, higher frequencies of DNAX accessory molecule-1 (DNAM-1)+ and CD57+ T cells were observed in SC in comparison to controls. Interestingly, SC subjects emphasized increased frequencies of KIR2DL2/L3/S2+ T cells compared to CI subjects. Our study underlines that the C2 environment may activate efficient KIR2DL1+ NK cells in a viral context and maintain a KIR2DL2/L3/S2+ mature T cell response in the absence of KIR2DL2 engagement with its cognate ligands in SC group of HCV-HIV co-infected European patients.


Assuntos
Coinfecção/imunologia , Infecções por HIV/imunologia , Antígenos HLA-C/imunologia , Hepatite C/imunologia , Adulto , Células Cultivadas , Feminino , Citometria de Fluxo/métodos , França , Genótipo , Antígenos HLA-C/genética , Humanos , Células Matadoras Naturais/imunologia , Células Matadoras Naturais/metabolismo , Masculino , Pessoa de Meia-Idade , Receptores KIR/genética , Receptores KIR/imunologia , Receptores KIR2DL1/genética , Receptores KIR2DL1/imunologia , Receptores KIR2DL2/genética , Receptores KIR2DL2/imunologia , Receptores KIR2DL3/genética , Receptores KIR2DL3/imunologia , Remissão Espontânea , Subpopulações de Linfócitos T/imunologia , Subpopulações de Linfócitos T/metabolismo
3.
Public Health ; 187: 84-88, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32932131

RESUMO

OBJECTIVES: Female genital mutilation (FGM) is a worldwide problem associated with severe health risks. In the UK, preventative public health campaigns have been developed to eradicate FGM. The aim of the present study was to elicit the views about FGM public health campaigns from the perspective of a UK Somali community. STUDY DESIGN: Three focus groups and one interview were conducted with 16 community members. METHODS: Using posters and leaflets focused on UK FGM prevention, photo-elicitation was used to encourage participants to discuss the usefulness and implications for national public health messages aimed at eradicating FGM. Data were subjected to inductive thematic analysis. RESULTS: Participants were positive about the aims of the campaigns presented within the research, believing such campaigns were necessary and increased awareness of FGM. However, participants felt the campaigns also carried risks of enhancing stereotypes in terms of ethnicity, gender and religion. For example, some images were perceived to suggest that FGM was only relevant to Sub-Saharan women, although it is also prevalent in other populations. Some fathers reported feeling unfairly targeted in campaigns that focused on the role of mothers in protecting daughters from FGM. Participants were also concerned that some poster images may suggest that FGM was associated with Islam and perceived as a religious issue, rather than a cultural one. Fears were identified that this could lead to stigmatisation and hostility towards those affected. CONCLUSIONS: The research findings suggested that actively working with affected communities to develop messaging that counters negative stereotyping and associated hostility should be a priority.


Assuntos
Circuncisão Feminina/efeitos adversos , Promoção da Saúde/métodos , Mães/psicologia , Adulto , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Saúde Pública , Pesquisa Qualitativa , Religião , Estigma Social , Somália/etnologia , Reino Unido/epidemiologia
4.
Med Mal Infect ; 50(7): 567-574, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32284220

RESUMO

OBJECTIVES: One-stage replacement arthroplasty for treatment of periprosthetic joint infection (PJI) results in similar cure rate than two-stage (around 85-92%), but antibiotic therapy duration is not well established. The aim of this study was to evaluate the efficacy of a short six-week antibiotic course in periprosthetic joint infections after onstage exchange. PATIENTS AND METHODS: Retrospective, observational study conducted at Orthopaedic Department of Cochin Hospital, Paris, between 1st January 2010 and 31 December 2015. Patients with a microbiologically proven PJI, treated with one-stage replacement and 6 weeks (+/1week) of antimicrobial therapy were included. Pearson's-χ2 and Wilcoxon tests were used to compare categorical and continuous variables. RESULTS: Fifty patients with periprosthetic joint infections (42 hip, 8 knee PJI) treated with one-stage replacement arthroplasty were included. Median age was 69.3 years (IQR 24.5-97.4). Infections occurred after a mean of 36 months (IQR 1-216). Bone biopsy cultures were positive for Staphylococcus spp. in 29 patients (58%), Cutibacterium acnes in 19 (38%), Gram-negative bacilli in 6 (12%). Polymicrobial infections occurred in 12 (24%). Intravenous antibiotics were administered for a median of 11 days (IQR 4-45) and 46 patients (92%) were switched to an oral therapy. Medium follow-up was of 32 months (IQR 12-101). Overall remission rate was 90%. CONCLUSIONS: A six-week course of antibiotics in knee and hip PJIs treated with one-stage RA has a satisfactory remission rate in this open study.


Assuntos
Antibacterianos/administração & dosagem , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/cirurgia , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Bacterianas/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/etiologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
5.
Med Mal Infect ; 50(4): 323-331, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31326299

RESUMO

Antibiotic prescription in chronic kidney disease patients poses a twofold problem. The appropriate use of antibacterial agents is essential to ensure efficacy and to prevent the emergence of resistance, and dosages should be adapted to the renal function to prevent adverse effects. SiteGPR is a French website for health professionals to help with prescriptions to chronic kidney disease patients. A working group of infectious disease specialists and nephrology pharmacists reviewed the indications, dosing regimens, administration modalities, and dose adjustments of antibiotics marketed in France for patients with renal failure. Data available on the SiteGPR website and detailed in the present article aims to provide an evidence-based update of infectious disease recommendations to health professionals managing patients with chronic kidney disease.


Assuntos
Antibacterianos/administração & dosagem , Infectologia/métodos , Insuficiência Renal Crônica/metabolismo , Antibacterianos/efeitos adversos , Antibacterianos/farmacocinética , Biotransformação , Relação Dose-Resposta a Droga , Monitoramento de Medicamentos , Medicina Baseada em Evidências , Humanos , Hospedeiro Imunocomprometido , Rim/efeitos dos fármacos , Rim/metabolismo , Guias de Prática Clínica como Assunto , Medicamentos sob Prescrição
6.
Vaccine ; 37(19): 2532-2536, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30962093

RESUMO

A prenatal care provider's recommendation for maternal vaccines is one of the strongest predictors of vaccine acceptance during pregnancy. Aside from basic talking points, few resources exist to help obstetric care providers effectively navigate conversations with vaccine hesitant patients. This paper describes the development and acceptability of "VaxChat," an hour-long, evidence-based video tutorial aimed at improving obstetric care providers' ability to promote maternal vaccines. Between June and November 2017, 62 obstetric care providers registered to receive continuing medical education credit for viewing VaxChat. Of the post-tutorial responses received, over 90% said VaxChat increased their knowledge of what to say to vaccine hesitant patients, increased their confidence in addressing vaccinations with their pregnant patients, and will help them improve their practice culture regarding maternal vaccine promotion. Eighty percent intend to change how they approach vaccine conversations. These data suggest VaxChat may be a welcome complement to existing provider-to-patient talking points.


Assuntos
Pessoal de Saúde , Programas de Imunização/métodos , Serviços de Saúde Materna , Aceitação pelo Paciente de Cuidados de Saúde , Mídias Sociais , Feminino , Humanos , Masculino , Modelos Teóricos
7.
Phys Ther Sport ; 37: 105-112, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30928840

RESUMO

OBJECTIVES: The objective of this study is to explore the effect of concussion history on head control during front on rugby tackles in non-professional male and female Rugby Union players. DESIGN: An observational cross-sectional design. SETTING: A laboratory-based study of simulated front on rugby tackles with a dynamic relatively-weighted (∼50% body-mass) tackle bag. PARTICIPANTS: 27 club Rugby Union players were recruited; 10 (7female) with no-concussion history, 10 (3female) within 12-months of concussion and 7 (3female) with 24 + months since last concussion. MAIN OUTCOME MEASURES: Linear and rotational head acceleration measured with a skin mounted CSx® triaxial accelerometer. Normalized Surface EMG amplitude of the bilateral sternocleidomastoid (Scm), upper trapezius (Trap) and splenius capitis (Spl). All outcome measures were synchronised with moment of impact with the tackle bag. RESULTS: A mixed-model analysis showed that players with 12-Month concussion history had the highest head acceleration (females = 48.6g, males = 68.3g, p < 0.05) with lower Trap (6.9-11.7%, p < 0.05) and Spl (3-12%, p < 0.05) amplitudes compared to athletes with No-concussion. CONCLUSIONS: These findings suggest probable disruption to neuromuscular control of the head in athletes with concussion history as a potential mechanism for recurrent concussion incidence.


Assuntos
Aceleração , Concussão Encefálica/fisiopatologia , Cabeça/fisiopatologia , Músculos do Pescoço/fisiopatologia , Músculos Superficiais do Dorso/fisiopatologia , Adulto , Estudos Transversais , Eletromiografia , Feminino , Futebol Americano/fisiologia , Humanos , Masculino , Adulto Jovem
8.
Diabetes Metab ; 45(6): 573-581, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-30862472

RESUMO

AIM: Ageing HIV-infected patients controlled by antiretroviral therapy (ART) frequently present age-related comorbidities, such as cardiovascular (CV) events, diabetes, dyslipidaemia, hypertension and chronic kidney disease (CKD). The prevalence of these comorbidities was evaluated in a cohort of long-term-monitored ART-controlled HIV-infected patients, then followed by a search into whether oxidative stress, like inflammation, might be associated with metabolic parameters and/or comorbidities. METHODS: Included were 352 long-term ART patients who started with protease inhibitors (PIs) in 1997-1999. They were evaluated at their final visit, 11 years later, for previous CV events, prevalence of diabetes, LDL-related and atherogenic (high TG/HDL) dyslipidaemias, hypertension and CKD. Also measured were circulating biomarkers to explore oxidative stress (Lp-PLA2, oxLDL, oxLDL/LDL ratio, paraoxonase and arylesterase activities), inflammation/immune activation (hsCRP, hsIL-6, D dimer, soluble CD14, ß2 microglobulin, cystatin C), adipokines and insulin resistance. Levels were compared in patients with and without each comorbidity or condition using non-parametric correlation tests and multivariate adjusted analyses. RESULTS: At the final visit, 81.5% of patients were male and were aged (median, IQR) 49 years (45-56); BMI was 23.0 kg/m2 (21.1-25.4), CD4+ lymphocytes were 620 cells/mm3 (453-790) and 91.5% had undetectable HIV-1 viral loads. The prevalence of diabetes was 11%, and LDL-related dyslipidaemia 28%, atherogenic dyslipidaemia 9%, hypertension 28%, CKD 9% and previous CV events 9%. Diabetes and atherogenic dyslipidaemia were associated with increased oxidative stress and independently with inflammation. LDL-related dyslipidaemia and impaired fasting glucose were associated with increased oxidative stress. No association of these biomarkers was detected with hypertension, CKD and previous CV events. CONCLUSION: In long-term-treated HIV-infected patients with frequent comorbid conditions, oxidative stress could be contributing to diabetes and LDL-related and atherogenic dyslipidaemias independently of inflammation.


Assuntos
Antirretrovirais/uso terapêutico , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Infecções por HIV , Inflamação/epidemiologia , Estresse Oxidativo/fisiologia , Aterosclerose/sangue , Aterosclerose/epidemiologia , Biomarcadores/sangue , LDL-Colesterol/sangue , Estudos de Coortes , Comorbidade , Complicações do Diabetes/sangue , Complicações do Diabetes/epidemiologia , Diabetes Mellitus/sangue , Dislipidemias/sangue , Dislipidemias/complicações , Feminino , HIV , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Sobreviventes de Longo Prazo ao HIV/estatística & dados numéricos , Humanos , Hipertensão/sangue , Hipertensão/epidemiologia , Inflamação/sangue , Inflamação/complicações , Lipoproteínas LDL/sangue , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores de Tempo
9.
HIV Med ; 20(3): 222-229, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30693646

RESUMO

OBJECTIVES: We examined trends in the incidence rates of invasive cervical cancer (ICC) and in the rate of survival after ICC among women living with HIV (WLHIV) in France and compared them to those of the general population. METHODS: Histologically validated incident cases of ICC in the period 1992-2009 from the French Hospital Database on HIV (FHDH-ANRS CO4) were included in the study. Age-standardized incidence rates were estimated for FHDH and the general population in France for 1992-1996 [pre-combination antiretroviral therapy (cART) period], 1997-2000 (early cART period), 2001-2004 (intermediate cART period), and 2005-2009 (late cART period). Age-standardized incidence ratios (SIRs) were calculated. Five-year survival was compared with that of the general population for ICC diagnosed in 2005-2009 after standardization for age. RESULTS: Among 28 977 WLHIV, 60 incident ICCs were histologically validated. There was a nonsignificant decreasing trend for the incidence across the cART periods (P = 0.07), from 60 to 36/100 000 person-years. The risk of ICC was consistently significantly higher in WLHIV than in the general population; the SIR was 5.4 [95% confidence interval (CI) 3.0-8.9] during the pre-cART period and 3.3 (95% CI 2.2-4.7) in 2005-2009. Survival after ICC did not improve across periods (log-rank P = 0.14), with overall estimated 5-year survival of 78% (95% CI 0.67-0.89%). Five-year survival was similar for WLHIV and the general population for women diagnosed with ICC in 2005-2009, after standardization (P = 0.45). CONCLUSIONS: ICC risk is still more than three times higher in WLHIV than in the general population. Survival after ICC did not improve over time and was similar to that of the general population during the most recent period. Such results call for promotion of the uptake of screening in WLHIV.


Assuntos
Antirretrovirais/administração & dosagem , Infecções por HIV/tratamento farmacológico , Neoplasias do Colo do Útero/epidemiologia , Adulto , Antirretrovirais/uso terapêutico , Estudos de Coortes , Feminino , França/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/mortalidade , Humanos , Incidência , Pessoa de Meia-Idade , Medição de Risco , Análise de Sobrevida , Neoplasias do Colo do Útero/etiologia , Neoplasias do Colo do Útero/mortalidade
10.
Animal ; 13(7): 1440-1447, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30442216

RESUMO

Sow environment during gestation can generate maternal stress which could alter foetal development. The effects of two group-housing systems for gestating sows on piglet morphological and physiological traits at birth were investigated. During gestation, sows were reared in a conventional system on a slatted floor (C, 18 sows), demonstrated as being stressful for sows or in an enriched system in larger pens and on deep straw bedding (E, 19 sows). On gestation day 105, sows were transferred into identical individual farrowing crates on a slatted floor. Farrowing was supervised to allow sampling from piglets at birth. In each litter, one male piglet of average birth weight was euthanized immediately after birth to study organ development and tissue traits. Blood samples were collected from 6 or 7 piglets per litter at birth and 2 piglets per litter at 4 days of lactation (DL4). At birth, mean piglet BW did not differ between groups (P > 0.10); however, the percentage of light ( 0.10) between C and E piglets, but the insulin to glucose ratio was greater (P = 0.02) in C than in E piglets. Compared with E piglets, C piglets had a lighter gut at birth (P = 0.01) and their glycogen content in longissimus muscle was lower (P < 0.01). In this muscle, messenger RNA levels of PAX7, a marker of satellite cells and of PPARGC1A, a transcriptional coactivator involved in mitochondriogenesis and mitochondrial energy metabolism, were greater (P < 0.05), whereas the expression level of PRDX6, a gene playing a role in antioxidant pathway, was lower (P = 0.03) in C than in E piglets. Other studied genes involved in myogenesis did not differ between C and E piglets. No system effect was observed on target genes in liver and subcutaneous adipose tissue. On DL4, C piglets exhibited a lower plasma antioxidant capacity than E piglets (P = 0.002). In conclusion, exposure of sows to a stressful environment during gestation had mild negative effects on the maturity of piglets at birth.


Assuntos
Animais Recém-Nascidos/fisiologia , Tamanho do Órgão/fisiologia , Prenhez/fisiologia , Sus scrofa/fisiologia , Animais , Animais Recém-Nascidos/crescimento & desenvolvimento , Feminino , Masculino , Parto , Gravidez , Sus scrofa/crescimento & desenvolvimento
11.
Animal ; 13(7): 1432-1439, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30468144

RESUMO

In pig husbandry, pregnant females are often exposed to stressful conditions, and their outcomes on maternal and offspring health have not been well evaluated. The present study aimed at testing whether improving the welfare of gestating sows could be associated with a better maternal health during gestation, changes in the composition of lacteal secretions and improvement in piglet survival. Two contrasted group-housing systems for gestating sows were used, that is, a French conventional system on slatted floor (C, 49 sows) and an enriched system using larger pens on deep straw (E, 57 sows). On the 105th days of gestation (DG105), sows were transferred into identical farrowing crates on slatted floor. Saliva was collected from all sows on DG35, DG105 and DG107. Blood samples were collected on DG105 from all sows and on the 1st day of lactation (DL1) from a subset of them (C, n=18; E, n=19). Colostrum and milk samples were collected from this subset of sows at farrowing (DL0) and DL4. Saliva concentration of cortisol was greater in C than in E sows at DG35 and DG105, and dropped to concentrations comparable to E sows after transfer into farrowing crates (DG107). On DG105, plasma concentrations of haptoglobin, immunoglobulins G (IgG) and A (IgA), blood lymphocyte counts and plasma antioxidant potential did not differ between groups (P > 0.10), whereas blood granulocyte count, and plasma hydroperoxide concentration were lower in E than in C sows (P < 0.05). Concentrations of IgG and IgA in colostrum and milk did not differ between the two groups. The number of cells did not differ in colostrum but was greater in milk from E than C sows (P < 0.05). Pre-weaning mortality rates were lower in E than C piglets (16.7% v. 25.8%, P < 0.001), and especially between 12 and 72 h postpartum (P < 0.001). Plasma concentration of IgG was similar in E and C piglets on DL4. In conclusion, differences in salivary cortisol, blood granulocyte count and oxidative stress markers between groups suggested improved welfare and reduced immune solicitation during late gestation in sows of the E compared with the C system. However, the better survival observed for neonates in the E environment could not be explained by variations in colostrum composition.


Assuntos
Ração Animal/análise , Lactação/efeitos dos fármacos , Suínos/fisiologia , Animais , Animais Recém-Nascidos , Antioxidantes , Colostro , Dieta/veterinária , Suplementos Nutricionais , Feminino , Granulócitos , Abrigo para Animais , Hidrocortisona/sangue , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Lactação/fisiologia , Leite/imunologia , Estresse Oxidativo , Gravidez , Estresse Fisiológico , Análise de Sobrevida , Suínos/sangue
12.
Phys Rev Lett ; 120(13): 134301, 2018 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-29694200

RESUMO

A Hamiltonian system is said to have nontrivial monodromy if its fundamental action-angle loops do not return to their initial topological state at the end of a closed circuit in angular momentum-energy space. This process has been predicted to have consequences which can be seen in dynamical systems, called dynamical monodromy. Using an apparatus consisting of a spherical pendulum subject to magnetic potentials and torques, we observe nontrivial monodromy by the associated topological change in the evolution of a loop of trajectories.

13.
Rev Epidemiol Sante Publique ; 66(1): 7-17, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29233572

RESUMO

BACKGROUND: In a context of the evolution of severe morbidities in patients living with HIV (PLWH), the aim of this study was to describe reasons for hospitalization and the mode of care for the patients requiring hospitalization. METHODS: All admissions (≥24h) of PLWH to 10 hospitals in the south of Paris (COREVIH Ile-de-France Sud) between 1/1/2011 and 12/31/2011 were identified. The hospital database and the file of patients followed in the HIV referral department of each hospital were matched. Detailed clinical and biological data were collected, by returning to the individual medical records, for a random sample (65% of hospitalized patients). RESULTS: A total of 3013 hospitalizations (1489 patients) were recorded in 2011. The estimated rate of hospitalized patients was about 8% among the 10105 PLWH routinely managed in COREVIH Ile-de-France Sud in 2011. The majority (58.5%) of these hospitalizations occurred in a unit other than the HIV referral unit. Non-AIDS-defining infections were the main reason for admission (16.4%), followed by HIV-related diseases (15.6%), hepatic/gastrointestinal diseases (12.0%), and cardiovascular diseases (10.3%). The median length of stay was 5 days overall (IQR: 2-11), it was longer among patients admitted to a referral HIV care unit than to another ward. HIV infection had been diagnosed >10 years previously in 61.4% of these hospitalized patients. They often had associated comorbidities (coinfection HCV/HVB 40.5%, smoking 45.8%; hypertension 33.4%, dyslipidemia 28.8%, diabetes 14.8%). Subjects over 60 years old accounted for 15% of hospitalized patients, most of them were virologically controlled under HIV treatment, and cardiovascular diseases were their leading reason for admission. CONCLUSION: Needs for hospitalization among PLWH remain important, with a wide variety in causes of admission, involving all hospital departments. It is essential to prevent comorbidities to reduce these hospitalizations, and to maintain a link between the management of PLWH, that becomes rightly, increasing ambulatory, and recourse to specialized inpatient services.


Assuntos
Atenção à Saúde/estatística & dados numéricos , Infecções por HIV/epidemiologia , Necessidades e Demandas de Serviços de Saúde , Hospitalização/estatística & dados numéricos , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adulto , Comorbidade , Atenção à Saúde/normas , Feminino , Infecções por HIV/complicações , HIV-1 , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/tendências , Departamentos Hospitalares/estatística & dados numéricos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Paris/epidemiologia , Adulto Jovem
14.
J Viral Hepat ; 25(4): 320-328, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29112304

RESUMO

To examine mid-term benefits on hepatic complications, extrahepatic clinical syndromes and quality of life associated with HCV cure; to review the few safety issues linked to oral direct-acting antivirals (DAAs); and to discuss the potential population benefits of reducing the burden of HCV infection. DAAs cure HCV infection in more than 95% of patients. The halting of liver inflammation and fibrosis progression translates into both hepatic and extrahepatic benefits and reduces the need for liver transplantation. A reduction in the frequency of extrahepatic manifestations such as mixed cryoglobulinaemia and vasculitis and improvements in quality of life and fatigue have also been described. A few safety issues linked to DAAs such as the potential recurrence of aggressive HCC, the flares of hepatitis B virus in patients with overt or occult HBV infection are been discussed. Curing HCV infection also has a high potential to reduce the burden of HCV infection at the population level. With widespread scaling up of HCV treatment, several modeling studies suggest that major reductions in HCV prevalence and incidence are possible, and that elimination of viral hepatitis is an achievable target by 2030.


Assuntos
Antivirais/efeitos adversos , Antivirais/uso terapêutico , Hepatite B/patologia , Hepatite C Crônica/complicações , Hepatite C Crônica/tratamento farmacológico , Exacerbação dos Sintomas , Vírus da Hepatite B , Humanos , Recidiva
17.
Eur J Pharm Biopharm ; 116: 51-60, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27702687

RESUMO

One of the main goals in the galenic development of innovative topical treatment options for inflammatory skin diseases such as psoriasis and atopic dermatitis is to selectively deliver the drug at the inflammation site. Recent studies have highlighted the beneficial use of polymeric nanoparticles for anti-inflammatory therapy and topical anti-inflammatory drug delivery due to their ability to form a drug reservoir retaining the drug locally at the site of action. Our approach consisted in designing innovative topical semi-solid formulations of poly(lactic acid) (PLA) nanoparticles as anti-inflammatory drug vehicles for local treatment of inflammatory skin diseases. In the course of this work, five topical formulations containing fluorescent PLA nanoparticles were initially developed, and then screened depending on their physico-chemical properties, toxicity and delivery efficacy. The penetration and permeation of a fluorophore vectorized by PLA nanoparticles into healthy and inflammatory skin were assessed using an alternative device to classical Franz cells: VitroPharma. All these investigations led to the selection of two satisfactory formulations out of five initial candidates.


Assuntos
Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/química , Inflamação/tratamento farmacológico , Nanopartículas/química , Poliésteres/química , Polímeros/química , Dermatopatias/tratamento farmacológico , Administração Tópica , Animais , Química Farmacêutica/métodos , Sistemas de Liberação de Medicamentos/métodos , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Nanopartículas/administração & dosagem , Poliésteres/administração & dosagem , Polímeros/administração & dosagem , Pele/efeitos dos fármacos , Absorção Cutânea/efeitos dos fármacos
18.
Arch Pediatr ; 23(8): 798-805, 2016 Aug.
Artigo em Francês | MEDLINE | ID: mdl-27345556

RESUMO

INTRODUCTION: The therapeutic management of hemophilia is based on replacement therapy by clotting factor concentrates and may require several injections per week. In teenagers, non-compliance with treatment may be responsible for major orthopedic complications. The aim of this study was to develop and assess an educational intervention for children with hemophilia and their parents, thus illustrating the complex phenomena related to treatment and its adhesion. METHODS: The construction of the educational workshop and tools was based on the concrete, visual, and playful representation of the following concepts: pathophysiology, the replacement therapy's mechanism of action, drug elimination requiring repeated administrations, and inhibitor development. The procedure was then assessed by a sample of children and parents using a questionnaire. RESULTS: A 60- to 90-min workshop was developed. The different tools used to illustrate the severity of the disease, the effect of the injected drug, drug elimination, and the inhibitor effect were: a blue-to-transparent colorimetric scale in bottles, a weekly timeline, Muppets, and a slow redox reaction. Five children and eight parents assessed this educational intervention with a rating of 3.75/4 (±0.10) and 3.60/4 (±0.45), respectively. CONCLUSION: The intervention developed could be transposed to other chronic diseases with similar therapeutic characteristics (including replacement mechanism of action and pharmacokinetics). Understanding the transmitted pharmacological concepts in a playful way is a major challenge to encourage treatment adhesion during adolescence.


Assuntos
Hemofilia A/terapia , Hemofilia B/terapia , Pais , Educação de Pacientes como Assunto/métodos , Adolescente , Fatores de Coagulação Sanguínea/uso terapêutico , Criança , Fator VIII/uso terapêutico , Humanos
19.
Int J Pharm ; 504(1-2): 48-58, 2016 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-26976501

RESUMO

For the last years, the increase of the number of skin cancer cases led to a growing awareness of the need of skin protection against ultraviolet (UV) radiations. Chemical UV filters are widely used into sunscreen formulations as benzophenone-3 (BP-3), a usually used broad spectrum chemical UV filter that has been shown to exercise undesirable effects after topical application. Innovative sunscreen formulations are thus necessary to provide more safety to users. Lipid carriers seem to be a good alternative to formulate chemical UV filters reducing their skin penetration while maintaining good photo-protective abilities. The aim of this work was to compare percutaneous absorption and cutaneous bioavailability of BP-3 loaded into solid lipid nanoparticles (SLN), nanostructured lipid carriers (NLC), nanostructured polymeric lipid carriers (NPLC) and nanocapsules (NC). Particle size, zeta potential and in vitro sun protection factor (SPF) of nanoparticle suspensions were also investigated. Results showed that polymeric lipid carriers, comprising NPLC and NC, significantly reduced BP-3 skin permeation while exhibiting the highest SPF. This study confirms the interesting potential of NPLC and NC to formulate chemical UV filters.


Assuntos
Benzofenonas/administração & dosagem , Nanocápsulas/administração & dosagem , Nanopartículas/administração & dosagem , Absorção Cutânea/efeitos dos fármacos , Protetores Solares/administração & dosagem , Animais , Benzofenonas/química , Benzofenonas/farmacocinética , Técnicas In Vitro , Lipídeos/administração & dosagem , Lipídeos/química , Nanocápsulas/química , Nanopartículas/química , Tamanho da Partícula , Polímeros/administração & dosagem , Polímeros/química , Pele/metabolismo , Fator de Proteção Solar , Protetores Solares/química , Protetores Solares/farmacocinética , Suínos
20.
J Clin Virol ; 73: 32-35, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26528903

RESUMO

BACKGROUND: As first generation HCV-specific protease inhibitors, boceprevir (BOC) or telaprevir (TVR) can achieve 60% to 70% sustained virological response (SVR) for HCV infected patients with genotype 1 infections, they could remain temporary a therapeutic option in patients living in resources limited countries with limited access to the new anti-HCV direct acting antiviral (DAA) drugs, such as sofosbuvir. OBJECTIVES AND STUDY DESIGN: Here we evaluated in a routine practice setting, the treatment responses, tolerance and factors associated with SVR of a triple therapy with BOC or TVR, combined with pegylated interferon and ribavirin (PegIFN/RBV) in HIV/HCV co-infected patients, included in a large cohort of HIV/HCV coinfected patients (ANRS CO13-HEPAVIH). RESULTS: Among the 89 HIV/HCV coinfected patients treated, 65% of whom were previous non-responders to PegIFN/RBV therapy, 65%, 55% and 41% had at baseline genotype 1a, a high baseline HCV-RNA (≥800,000 IU/ml) and a cirrhosis, respectively. The SVR12 rate was 63% overall, 53% for BOC-based regimen and 66% for TVR-based regimen. In multivariate analysis, two factors were significantly associated with HCV SVR: HCV viral load <800,000 IU/mL at treatment initiation versus ≥800,000 IU/mL (OR 4.403, 95% CI 1.29-15.04; p=0.018) and virological response at W4 (HCV-RNA undetectable after 4 weeks of triple therapy) (OR 3.35, 95% CI 1.07-10.48; p=0.038). CONCLUSIONS: Overall SVR12 was 63% and our results suggest that HIV/HCV coinfected patients with low HCV viral load (<800,000 IU/mL) and undetectable HCV-RNA after 4 weeks of triple therapy with TVR or BOC-based regimen have a higher probability of treatment success.


Assuntos
Antivirais/administração & dosagem , Infecções por HIV/tratamento farmacológico , Hepacivirus/fisiologia , Hepatite C/tratamento farmacológico , Oligopeptídeos/administração & dosagem , Prolina/análogos & derivados , Antivirais/farmacologia , Coinfecção/tratamento farmacológico , Coinfecção/virologia , Feminino , Infecções por HIV/virologia , Hepacivirus/efeitos dos fármacos , Hepatite C/virologia , Humanos , Interferons/administração & dosagem , Interferons/farmacologia , Masculino , Pessoa de Meia-Idade , Oligopeptídeos/farmacologia , Prolina/administração & dosagem , Prolina/farmacologia , Ribavirina/administração & dosagem , Ribavirina/farmacologia , Resultado do Tratamento , Carga Viral/efeitos dos fármacos
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