[Ten years ahead in infectious diseases : AIDS/ HIV towards stopping transmission]. / Dix ans d'avancées en infectiologie : SIDA/HIV, vers l'arrêt de la transmission.

In order to end the AIDS pandemic, new infections must be avoided. This prevention can be divided into four axes depending on the risk of exposure to the HIV virus. Over the past decade, new prevention strategies supported by various studies have emerged. These are effective when they are used in combination. Some are not without risk or even controversial according to some authors.

Afin d'endiguer l'épidémie du syndrome d'immunodéficience acquise (SIDA), il faut contrôler les nouvelles acquisitions. Cette prévention peut être divisée en quatre axes en fonction du risque d'exposition au virus d'immunodéficience humaine (VIH). Lors de la dernière décennie, de nouvelles stratégies de prévention, soutenues par diverse études, ont vu le jour. Celles-ci sont efficaces à condition d'être utilisées de façon combinée. Certaines ne sont pas dénuées de risque, voire controversées par certains auteurs.

[Miliary tuberculosis in a patient under adalimumab]. / Tuberculose miliaire chez une patiente sous adalimumab : cas clinique.

We describe a case of atypical miliary tuberculosis diagnosed by molecular testing in a patient suffering from psoriasis arthritis treated by adalimumab. Tuberculosis may have a non-classical presentation in patients under biological treatments. We briefly discuss the difficulties underlying the diagnosis and treatment of tuberculosis, especially in patients suffering from fever of unknown origin.

Nous rapportons un cas de tuberculose (TB) miliaire chez une patiente souffrant de polyarthrite psoriasique traitée par adalimumab. L'opportunité nous est ainsi donnée d'illustrer la possibilité de présentations atypiques, en particulier chez les patients traités par agents biologiques. Nous discutons brièvement, aussi, des difficultés inhérentes au diagnostic et au traitement de la tuberculose.

Comparison of the virucidal efficacy of peracetic acid, potassium monopersulphate and sodium hypochlorite on bacteriophages P001 and MS2.

AIMS: The phagicidal activity of peroxy products against the virulent bacteriophage P001 infecting lactic acid bacteria and bacteriophage MS2 used as a surrogate of enteric viruses (EVs) was evaluated and compared to sodium hypochlorite using the EN 13610 European suspension test and a surface test developed in our laboratories. METHODS AND RESULTS: Infectivity tests were adapted and/or developed to determine the activity of disinfectants against reference P001 phage of Lactoccocus lactis and F-specific RNA phage MS2 of Escherichia coli in conditions simulating practical use. Similar concentrations of sodium hypochlorite were phagicidal against both bacteriophages, either at 0·05-0·125% of active chlorine using the suspension test or at 0·12-0·5% using the surface test. For Potassium monopersulphate (MPS), phagicidal concentrations varied from 0·006 to 0·012% whatever the type of test and phages. However, for peracetic acid products (PAP) used in suspension, concentrations 55 times higher were necessary against MS2 (0·271%) than against P001 (0·005%). With the surface test, 0·089-0·178% concentrations of PAP were effective against MS2, but these concentrations were 16-32 times greater than needed against P001. CONCLUSIONS: Sodium hypochlorite and MPS had similar phagicidal activities against P001 and MS2, but PAP did not. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first comparative study to investigate through suspension and surface tests the difference in resistance to peroxy compounds between a reference bacteriophage (P001) used to evaluate phagicidal concentrations in European standards and a surrogate of EVs (MS2). Results underline the importance of validation tests on pertinent surrogates of viruses or bacteriophages to adjust the concentration of disinfectants for use in the food and water industries.

Comparison of the virucidal efficiency of peracetic acid, potassium monopersulfate and sodium hypochlorite on hepatitis A and enteric cytopathogenic bovine orphan virus.

AIMS: The virucidal activity of peroxy-products was evaluated and compared with sodium hypochlorite using the EN 14675 European suspension test and a surface test developed in our laboratory. The classical approach on infectivity of viruses was complemented with a prospective approach on virus genomes. METHODS AND RESULTS: Both infectivity tests were adapted and/or developed to determine the activity of disinfectants against reference bovine enterovirus type 1 [enteric cytopathogenic bovine orphan virus (ECBO)] and resistant hepatitis A virus (HAV) in conditions simulating practical use. Similar concentrations of active chlorine were virucidal against both viruses, either at 0·062% using the suspension test or at 0·50-1% using the surface test. However, for potassium monopersulfate and peracetic acid products, concentrations of approximately three times (3%) to 72 times (9%) higher were necessary against HAV than ECBO when determined with the suspension test. With the surface test, 4-8% peroxy-products were virucidal against HAV, either 16 times more peroxy-products concentrations than against ECBO. No significant impact on the targeted area of the viral genome measured by real-time RT-PCRs was obtained for ECBO and HAV suspensions treated with disinfectants, even with doses higher than the minimal virucidal concentrations. CONCLUSIONS: Sodium hypochlorite, but not peroxy-products, had similar activity against ECBO and HAV. No relation could be established between infectivity tests and genome destruction. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first comparative study that investigates with novel suspension and surface tests the reduction of infectivity and genome destruction of two resistant viruses by peroxy-compounds. The results and conclusions collected with European standards are discussed.

Detection of intraocular Leptospira spp. by real-time polymerase chain reaction in horses with recurrent uveitis in Belgium.

BACKGROUND: Equine recurrent uveitis (ERU) has been associated with Leptospira spp. infection. No information exists concerning the prevalence of Leptospira-associated ERU in Belgium and about the sensitivity of detection of Leptospira in different ocular media. OBJECTIVES: To establish the prevalence of intraocular Leptospira spp. in ERU-affected and healthy eyes of horses examined at the Equine Clinic of the University of Liège by real-time PCR and to compare the results of the aqueous and vitreous humour of the same eye. STUDY DESIGN: Cross-sectional. METHODS: Sixty-six eyes from 59 client-owned horses with a diagnosis of equine recurrent uveitis (ERU-group) were studied from May 2015 to December 2017. Fifty healthy eyes from 28 euthanised horses for unrelated reasons examined during the same period were included in the control group. Intraocular fluids (aqueous and/or vitreous humours) from ERU-affected eyes were sampled and analysed by real-time PCR for Leptospira spp. Aqueous and vitreous humours from the control group were processed in the same way. RESULTS: Both groups were comparable regarding age, sex, eye sampled (OS/OD), humours sampled (aqueous/vitreous humour) but not regarding breeds, with an over-representation of Warmbloods and Appaloosas in the ERU-group. The prevalence of Leptospira spp. was 30.3% (20/66 eyes) in the ERU-group. Leptospira spp. DNA was identified in 11 aqueous and 17 vitreous humours with eight horses testing positive in both humours, nine horses testing positive for vitreous humour alone and third horses for aqueous humour alone. The phi-correlation between aqueous and vitreous humour Leptospira-PCR results is 0.47 suggesting a low association. All the control eyes were negative. MAIN LIMITATIONS: The diagnostic method selected for this study (lipL32 qPCR) did not allow identification of the serovars. CONCLUSIONS: Leptospirosis is a potential cause of ERU in Belgium. Testing both intraocular media is advised whenever possible. The Summary is available in Spanish - see Supporting Information.

[Fusion and function after eight scapulothoracic arthrodesis]. / Consolidation et fonction après huit arthrodèses scapulothoraciques.

PURPOSE OF THE STUDY: Scapula alata resulting from a deficient musculus serratus anterior leads to shoulder instability, pain and loss of elevation. Etiologies include fascioscapulohumeral dystrophy and lesion of the thoracicus longus nerve. Dynamic (muscle transfer) or static (scapulopexia or scapulothoracic arthrodesis) stabilization methods can be proposed. The purpose of this study was to assess fusion and function after eight scapulothoracic arthrodeses performed in five patients. We used cerclage with compression after intercostal avivement to increase the contact surface. MATERIAL AND METHODS: This retrospective study included four men and one woman. Three patients had fascioscapulohumeral dystrophy who underwent bilateral arthrodeses and two patients with post-traumatic injury to one thoracicus longus nerve. All scapulothoracic joints were unstable; six were painful. There was a cosmetic prejudice in all cases. Preoperative function was 71+/-6 degrees antepulsion (range: 60-80 degrees ) and 71+/-7 degrees abduction (range: 60-80 degrees ). Postoperative assessment included: reduction of the scapula alata, gain in motion, Constant score (raw and weighed), subjective assessment of daily activity, complications, respiratory function in patients with double arthrodesis and bone fusion on the CT scan. RESULTS: Patient follow-up was 21.5 months on average. The scapula alata was reduced in all cases. Mean gain in motion was 39+/-21 degrees antepulsion and 41+/-26 degrees abduction. The raw Constant score was 77.75+/-11.4/100 and the weighted score was 81.5+/-9.1/100. Daily activity was scored 100% in four of five patients. Complications were transient intercostal dysesthesia, mild exercise-induced pain, one pneumothorax which did not require drainage. There was no evidence of an impact on respiratory function. The control scans revealed fusion in five shoulders and nonunion in three. DISCUSSION: Scapulothoracic arthrodesis enabled reduction of the scapula alata and improved shoulder function for elevation and daily activities. The gain in motion and Constant score were satisfactory and similar to other results in the literature. The main drawback was deficient external rotation. Pain was mild and resulted from the deafferentation. It resolved six months postoperatively. Secondary exercise-related pain was mild with little impact. Technically, authors have proposed using different ribs for the fusion, depending on the patient's morphology and searching for a good position for the scapula for external rotation. There have been few postoperative complications: we had one pneumothorax and no neurological, vascular or pulmonary complications. Our results are the first reporting CT fusion findings. Indirect signs of nonunion on plain x-rays reported in earlier studies are not fully reliable, since our CT scans demonstrated nonunion in three shoulders. The lack of fusion does not mean poor function, as was also noted by others, since function was improved (mean gain 27 degrees flexion and 25 degrees abduction).

Paroxysmal supraventricular tachycardia: improving diagnosis and management within the accident and emergency department.

Accident and emergency (A&E) senior house offices (SHOs) have difficulties in interpreting the electrocardiogram (ECG) in narrow complex tachycardia. Correct ECG interpretation is fundamental to patient management in paroxysmal supraventricular tachycardia. This study aimed to assess the ability of A&E SHOs to interpret the ECG in this setting. Correct diagnosis in 63% of cases improved to 86% with the introduction of a standard protocol sheet. Ensuring that SHOs follow agreed guidelines in rhythm recognition and management of PSVT improves patient care.

[Arthroscopic treatment of lateral epicondylitis: a prospective study on 14 cases]. / Traitement arthroscopique de l'épicondylite latérale : étude prospective à propos de 14 cas.

Lateral epicondylitis of the elbow is a relatively common pathology and would involve 1-3% of the overall population. Lack of consensus on surgical techniques reflects the difficulty of understanding and treating this disease. Our prospective study reports the results of its arthroscopic treatment on 14 patients operated on between 2009 and 2012. The mean follow-up was 7.15 months. All patients underwent a well conducted medical treatment for an average of 32.5 months. The operation was carried out under regional anesthesia in an outpatient. The technique included a time of joint exploration, joint capsulotomy and a transverse division of the pathological tendon of extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC). The value on the visual analogic scale (VAS) at rest and during exercise increased from 2.85 to 0.43 and from 7.71 to 2.43, respectively, then remained stable over time. Professional activity was resumed on average at 9.1 weeks. Neither intraoperative nor postoperative complications were found. No laxity was observed. The Mayo Clinic and DASH scores were significantly improved from 52.14 to 92.5 and from 54.11 to 9.7, respectively. Overall, we observed 11 very good and three good results. Although our prospective series has a few patients and limited follow-up, our results are better or similar than those reported in the literature on pain relief and functional recovery. In contrast, the average recovery of professional activity was longer. Elbow arthroscopy, less invasive than open procedures, and allowing further joint exploration, seems an excellent alternative technique in this indication.

[Treatment of rheumatoid swan neck deformity by tenodesis of proximal interphalangeal joint with a half flexor digitorum superficialis tendon. About 23 fingers at 61 months follow-up]. / Traitement des déformations des doigts longs en col-de-cygne dans les affections rhumatismales par ténodèse de l'articulation interphalangienne proximale à l'aide d'un hémi-tendon fléchisseur superficiel. À propos de 23 doigts à 61 mois de recul.

OBJECTIVES: Surgical treatment of finger swan neck deformities is versatile. We aimed to assess the outcome of PIP tenodesis on unfixed deformities, in patients suffering from rheumatoid arthritis. METHODS: Twenty-three PIP tenodeses were performed on eight patients, using half of a superficialis flexor digitorum tendon sutured to A2 pulley through a volar approach. Postoperative splinting, in 20° of PIP flexion, was maintained for 4 weeks. The patients were assessed retrospectively, at a mean period of 61 months. RESULTS: The PIP flexion gained 26°. On the other hand, a 4°-flexion contraction was induced. The mean postoperative flexion reached 65°. The PIP hyperextension was corrected by 33°. In one same patient, the correction was insufficient for the four fingers. The DIP lack of extension was totally corrected in 70% of the cases and partially in 30%. Each patient had functional improvement. Nineteen good and excellent, and four fair results were reported. No major complication was observed. CONCLUSION: This tenodesis seems to be reliable and to give good long-term results. It is our intervention of choice for rheumatoid flexible swan-neck deformity.