[Multidrug-resistant tuberculosis: A management problem that weighs heavily on the University Hospitals of Strasbourg]. / Tuberculose multirésistante : une prise en charge qui pèse lourd aux hôpitaux universitaires de Strasbourg.

INTRODUCTION: Multidrug-resistant tuberculosis (MDR-TB) is a major public health problem with great regional disparities. The aim of this study was to describe the epidemiological, clinical, and therapeutics aspects of MDR-TB in Alsace, France. PATIENTS AND METHODS: A 10 years retrospective study, conducted for the years 2006 to 2016, of all MDR-TB cases diagnosed in Alsace and particularly in Strasbourg University Hospitals. RESULTS: We included 22 patients with MDR-TB of whom 90% originated from Eastern Europe, 13.6% had extensively-resistant strains, and 41% reported previously treated tuberculosis. Clinically, 86,4% had a pulmonary form of tuberculosis. The mean length of antibiotic treatment was 21 months with several changes of drugs because of severe side effects. The mean follow-up was 48 months, during which time 2 patients were lost from contact and the 20 remaining patients were cured. CONCLUSIONS: Management of MDR-TB is a real social and medical challenge. Our study shows that the therapeutic protocols used in the management of these patients lead to an unusually high rate of success despite the occurrence of several, sometimes severe, side effects.

Emergence and dissemination of a linezolid-resistant Staphylococcus capitis clone in Europe.

Objectives: We investigated the epidemiological, clinical, microbiological and genetic characteristics of linezolid-resistant (LZR) Staphylococcus capitis isolates from French ICUs, and compared them with LZR S. capitis isolates from other European countries. Methods: All LZR isolates were subjected to antimicrobial susceptibility testing (AST) and the presence of cfr and optrA genes as well as mutations in the 23S rRNA and ribosomal proteins were investigated using specific PCR with sequencing. The genetic relationship between isolates was investigated using PFGE and WGS. Epidemiological data concerning LZR S. capitis were collected retrospectively in French microbiology laboratories. Results: Twenty-one LZR isolates were studied: 9 from France, 11 from Greece and 1 from Finland. All were resistant to methicillin and aminoglycosides. In addition, this unusual AST profile was identified in S. capitis isolates from seven French hospitals, and represented up to 12% of the S. capitis isolates in one centre. A G2576T mutation in 23S rRNA was identified in all isolates; cfr and optrA genes were absent. All isolates belonged to the same clone on the basis of their PFGE profiles, whatever their geographical origin. WGS found at most 212 SNPs between core genomes of the LZR isolates. Conclusions: We identified and characterized an LZR S. capitis clone disseminated in three European countries, harbouring the same multiple resistance and a G2576T mutation in the 23S rRNA. The possible unrecognized wider distribution of this clone, belonging to a species classically regarded as a low-virulence skin colonizer, is of major concern not least because of the increasing use of oxazolidinones.

Sputum smear-positive pulmonary tuberculosis: Is sputum smear examination required to discontinue airborne precautions?

OBJECTIVE: Our aim was to evaluate the criteria required to discontinue airborne precautions for patients presenting with sputum smear-positive pulmonary tuberculosis as the need for sputum smear examinations is still a matter of debate. METHOD: We conducted a retrospective study in the University Hospitals of Strasbourg (France) from July 2011 to July 2013. Our aim was to describe the results of sputum smear examinations and cultures obtained from treated patients presenting with drug-sensitive pulmonary tuberculosis. We included 97 patients in the study. CONCLUSION: Nearly half of patients for whom a sputum smear examination was performed had a negative sputum direct examination but a positive culture. According to the literature, those patients are still likely to be contagious. This questions the safety of discontinuing airborne precautions in this situation. We also observed a great disparity in physicians' behaviors. Only half of them waited to get a negative sputum direct examination before discontinuing airborne precautions.

[Electronic parent-child health records--potentials, aims and international experience]. / Elektronischer Mutter(Eltern)-Kind Pass--Möglichkeiten, Zielsetzungen und internationale Erfahrungen.

AIM OF THE REVIEW: Against the background of a planned re-orientation of the Austrian maternity and child programme, which might include an electronic instead of paper-based realisation, this article aims to give an overview of international pilot projects of electronic parent-child preventive care initiatives (ePCPI) as well as their aims, potentials and constraints. METHODS: A literature search in databases and hand search for international (pilot) projects was undertaken. RESULTS: 9 of the 30 identified ePCPI can be treated as electronic parent and/or child health records, which have been realised within a comprehensive electronic health record, as an electronic version of a paper-based document or as a centre-based IT solution. Only a few ePCPI use the additional potential of health services planning and evaluation besides core components (e. g., administration of care) and facilitate systemic learning based on feedback and evaluation -cycles. CONCLUSION: Based on experiences from international ePCPIs some core components of successful planning and implementation, like the definition of aims and their monitoring, the constitution of teams responsible for planning and conception and the early involvement of end-users and stakeholders, should be considered to minimise avoidable mistakes. Consequent technology assessments, including those of IT-based interventions, are required to allow a reflected approach.

[Legal questions regarding medical centers : Positions and perspectives]. / Rechtsfragen zum Medizinischen Versorgungszentrum : Positionen und Ausblicke.

Medical centers were introduced into the system of statutory health insurance as contractual service providers by the Statutory Health Insurance Modernization Act of 2003. Since 2004 in addition to accredited physicians, authorized physicians, and authorized medical facilities, approved medical centers can also participate in offering contractual care. The introduction of medical centers was intended to permit a new form of patient management that was considered to have the advantage of facilitating close cooperation between the different medical specialties as well as non-medical health care providers.

[Circumcision for boys incapable of giving informed consent]. / Zirkumzision bei nicht einwilligungsfähigen Jungen.

The discussion on circumcision for children, as a ritual as well as a medically indicated intervention, is still being carried out as in the past in a very emotional and not always rational manner. The attempt to criminalize circumcision, even the surgical treatment of phimosis, causes confusion not only for the parents of these children but also for physicians and in particular pediatricians and general practitioners.

[The bought patient : The ethical value of per capita flat rates from a legal viewpoint]. / Der gekaufte Patient : Zum ethischen Wert von Kopfpauschalen aus juristischer Sicht.

From the decisions of the German Medical Council for safeguarding medical independence and the new version of section 18 paragraph 1 MBO with reference to the cooperation between hospitals and physicians for patient relationship management, it can be derived that clear competitive and professional limits exist in the competition for patients within the cooperation of hospitals and physicians. The ethical and professional foundation serving the patient that physicians must make decisions regarding the patient in an independent way free from commercial influences, plays a key role for the legal assessment of models for patient allocation irrespective of the planned increased commercial and competitive nature of the service provided by social health insurance caused by the health reforms.

[Study of hepatitis C virus leukotropism by characterization of viral quasispecies in the liver transplantation setting]. / Etude du leucotropisme du virus de l'hépatite C par analyse des quasi-espèces virales dans le contexte de la transplantation hépatique.

Besides hepatocytes, representing the main replication site of hepatitis C virus, peripheral blood mononuclear cells also represent a crucial target for viral infection. Hepatitis C virus compartmentalization (i.e., non-random distribution) of viral variants between plasma and peripheral blood mononuclear cells, more frequently observed in liver transplant patients compared to non-transplanted patients, makes liver transplantation an interesting model for the analysis of hepatitis C leukotropism. This article aims to present, firstly, in clinical and biological features arguing favour of hepatitis C virus infection leukotropism and, secondly, to review current knowledge about compartmentalization between plasma and peripheral blood mononuclear cells, especially in the liver transplantation setting.

[Judicial opportunities and limitations of Integrated Health Care in cardiology]. / Rechtliche Möglichkeiten und Grenzen der Integrierten Versorgung in der Kardiologie.

Regulations of Integrated Health Care are capable of overriding the barriers of separated outpatient and inpatient health care. These regulations create a situation of competition among health care providers, but not among payers. Since the laws exclude common regulations of competition laws, antitrust laws and public procurement laws from Integrated Health Care, insurance companies gain a relatively strong position in the competition for contracts. This is even enforced by the fact that no health care provider is entitled to request a contract with a specific insurance company. The main result is that insurance companies can determine the contracts deliberately.

Histamine mediates osteoclastic resorption only during the acute phase of bone loss in ovariectomized rats.

Short-term studies have shown that histamine is involved, via its H2 receptors (H2R), in the mediator network regulating trabecular bone loss in long bones of ovariectomized (OVX) rats. It is not known whether this effect of histamine persists over time or involves other skeletal sites. In this study, rats were maintained for 6 months postOVX and treated daily with saline or famotidine (10 mg kg(-1)), an H2R antagonist. At the end of the experimental period, femur trabecular bone mass was markedly decreased in OVX rats, whether or not they were treated with famotidine. In contrast, in the fourth lumbar vertebra, where bone loss starts later than in the femur, famotidine treatment attenuated the decline in trabecular bone volume, protected the trabecular architecture, maintained the thickness of the cortices and reduced the numbers of osteoclasts and tartrate-resistant acid phosphatase-positive preosteoclasts, whereas it had no influence on bone formation parameters. In vertebral bone marrow of OVX rats, the numbers of mast cells (MCs) and non-MC histamine-producing cells increased, while famotidine treatment significantly diminished both cell populations. These data show that H2R antagonism does not protect trabecular bone mass in the long term, and that short-term protection involves all bones. Histamine is involved during the early phase of strong osteoclastic resorption but not during the late phase of slower resorption, suggesting that different mediator networks control the two phases of destruction. Histamine would be part of the network mediating the early phase.