Firth global symposium on research of healthcare système, Liverpool (United Kingdom), October 8-12, 2018.

The most recent international symposium on research on healthcare systems took place in Liverpool in October, 2018. Its theme was the promotion of healthcare systems for all in the era of the Sustainable Development Goals. This biennial event is the occasion to bring together all the players in this domain- researchers, policy-makers, and field workers - to share the newest work. Numerous subjects were raised, some of them mentioned in the article: quality of care in healthcare systems through the necessary improvement in the practices of professionals, the issues of scaling up health interventions, mobilization of knowledge for the development of public policy, and the role of the private sector. Although this field has developed greatly over the past 20 years and has become central in both development aide and international health, it remains relatively little known in the French-speaking world and France is largely absent from it.

[Lack of bioavailability of generic lopinavir/ritonavir not prequalified by WHO marketed in Africa (Congo Brazzaville)]. / Absence de bio-équivalence d'un générique du lopinavir/ritonavir non préqualifié par l'OMS commercialisé en Afrique (Congo Brazzaville).

Although second-line generic antiretroviral drugs are of great value in developing countries there are concerns regarding their quality and safety. This study is a case report and pharmacological study in healthy volunteers. A French subject of sub-saharan origin who visited Republic of Congo received a post-exposure treatment with AZT+3TC and LPV/r (200/50 mg, Arga-L®, India) following unprotected sexual intercourse. Two days later, in France, tests showed that plasma concentrations of lopinavir and ritonavir were undetectable. The WHO prequalification list showed Arga-L® was not prequalified. A pharmacological study in healthy volunteers evaluated oral bioavailability: plasma concentrations of generic LPV/r Arga-L® and LPV/r Kaletra® (400/100 mg) were measured after one single dose at 7 days apart in four healthy volunteers. Concentrations of Arga-L® at 12 h after intake were considerably lower than those of Kaletra®, revealing very low oral bioavailability of generic lopinavir and ritonavir (<10%) compared to the brand-name drug. We found that Arga-L®, despite having adequate qualitative and quantitative drug contents, had very poor bio availability compared to Kaletra®. In order to avoid the selection and the spread of drug-resistant HIV strains, rigorous pharmacological monitoring of generic antiretroviral drugs that are not pre-qualified by WHO, but are marketed in Africa, must be a priority for health authorities.

Interference of the most frequent haemoglobin variants on quantification of HbA1c: comparison between the LC-MS (IFCC reference method) and three routinely used methods.

AIM: Assaying HbA1c in patients with haemoglobin variants has long been a technical challenge, despite methodological advances that have progressively limited the problem. The purpose of this study was to evaluate the impact of the most frequent haemoglobin variants on three routine separation methods compared with the IFCC reference method. PATIENTS: Blood samples from heterozygous patients (AS, AC, AD, AE) were analyzed using the IFCC reference method (LC-MS), and the results compared with those obtained by capillary electrophoresis (CAPILLARYS 2 Flex Piercing, Sebia) and two HPLC methods using cation-exchange (Variant II, Bio-Rad) and affinity chromatography (Ultra(2), Primus). RESULTS: HbA1c values obtained by the IFCC reference method were comparable to those obtained by the three tested methods whatever the haemoglobin variant. Mean relative biases did not exceed the threshold of 7% (above which differences are generally considered clinically significant), although some individual values were above this limit with Variant II in samples with HbS and for all three methods in samples with HbE. CONCLUSION: This comparative study of the LC-MS reference method and three field methods has demonstrated that these assays are not clinically influenced by the presence of the most common haemoglobin variants. The present results also confirm that the interpretation of HbA1c values in patients with Hb variants remains complex and depends on the assays used and should, in some cases, take into account parameters other than analytical ones (such as differences in glycation rates and half-lives of haemoglobin variants).

[ICU acquired neuromyopathy]. / La neuromyopathie acquise en réanimation.

ICU acquired neuromyopathy (IANM) is the most frequent neurological pathology observed in ICU. Nerve and muscle defects are merged with neuromuscular junction abnormalities. Its physiopathology is complex. The aim is probably the redistribution of nutriments and metabolism towards defense against sepsis. The main risk factors are sepsis, its severity and its duration of evolution. IANM is usually diagnosed in view of difficulties in weaning from mechanical ventilation, but electrophysiology may allow an earlier diagnosis. There is no curative therapy, but early treatment of sepsis, glycemic control as well as early physiotherapy may decrease its incidence. The outcomes of IANM are an increase in morbi-mortality and possibly long-lasting neuromuscular abnormalities as far as tetraplegia.

Communication Systems Interactive Software (COMSIS): Modeling of Components and its Application to the Simulation of Optical Communication Systems.

comsis, which stands for communication systems interactive software, is a computer-aided-design tool based on a time approach. It allows the design, analysis, and performance optimization of optical transmission systems by use of various optical devices. comsis allows scalar or vectorial simulations, depending on whether the polarization is taken into account. An overview concerning the optical component models is given. A new model of an erbium-doped fiber amplifier allows the user to describe the amplifier through either physical or system parameters by using silicate or fluoride glass fibers or any other material, provided the user can give a file that contains the amplifier's characteristics. The new model of a single-mode fiber allows the user to describe chromatic dispersion through a constant, a function, or a file (given by the user) and to take optionally into account the Kerr and the Raman effects and the polarization-mode dispersion. The simulation tools that are used to characterize the quality of an optical transmission system are also presented. To show the system's full range of capabilities in the optical domain, we describe examples of wavelength-division-multiplexing and soliton-transmission systems.