RESUMEN
PURPOSE OF THE RESEARCH: We describe two interventions to screen for SARS-CoV-2 in two squats of exiled persons in France following the diagnosis of symptomatic COVID-19 cases. PRINCIPAL RESULTS: In squat A, 50 (25%) persons were screened; 19 were found positive, and three accepted a transfer. In squat B, 65 (54%) persons were screened at three different times, and only two were found positive. MAJOR CONCLUSIONS: Discrepant outcomes may reflect different levels of sanitation, prevention, and acceptance of interventions. Refusal to be transferred to specific COVID-19 homes if tested positive underscores the importance of local sanitary solutions for all. Cross-curricular strategies addressed to exiled persons are essential means of providing medical and public health solutions designed to deter COVID-19 outbreaks in these populations.
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COVID-19/diagnóstico , Tamizaje Masivo , Migrantes , Adolescente , Adulto , Francia , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenAsunto(s)
Etanercept/uso terapéutico , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Estomatitis Aftosa/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Adulto , VIH-1 , Personas con Mala Vivienda , Humanos , Masculino , Índice de Severidad de la Enfermedad , Estomatitis Aftosa/virologíaRESUMEN
PURPOSE: Misuse of high-dose buprenorphine (HDB), mainly by injection, is responsible of frequent infectious adverse events. METHODS: This is a retrospective study of infectious complications occurring in patients using HDB by injection. Forty-two cases were identified (29 men and ten women) and the data were collected between March 1999 and December 2008. RESULTS: The infectious complications included cutaneous infections (27 cases), endocarditis (nine cases), osteoarticular infections (four spondylodiscitis and one sacroiliitis), and a vascular embolism with decrease in visual acuity. CONCLUSION: The results of HDB maintenance treatment must be improved, both from the point of view of substitution and to limit its misuse by intravenous route injection. Health professionals have to play an important role in drug addict patients' education and supervision, to prevent buprenorphine injection and related infectious complications.
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Infecciones Bacterianas/etiología , Buprenorfina/administración & dosificación , Inyecciones Intravenosas/efectos adversos , Inyecciones Subcutáneas/efectos adversos , Antagonistas de Narcóticos/administración & dosificación , Absceso/etiología , Adulto , Discitis/etiología , Relación Dosis-Respuesta a Droga , Endocarditis Bacteriana/etiología , Femenino , Dependencia de Heroína/rehabilitación , Humanos , Masculino , Estudios RetrospectivosRESUMEN
Gabonese authorities are strongly mobilized in the fight against AIDS. With a national seroprevalence of 5.9%, 54,000 people are living with HIV-AIDS. Starting from the experience conducted on three ambulatory treatment centers (ATC) [Libreville, Franceville, Port-Gentil] in collaboration with the French Red Cross, Gabonese authorities decided the scaling up of HIV patients' care to seven new ATC at a national level. The increasing number of structures conducted to standardize treatment's guidelines, training of caregivers, quality of care, coordination, monitoring and evaluation. Technical and medical supervision of the ten ATC were attributed to the French Red Cross by Gabonese authorities with the financial support of the French Agency for Development. The ten ATC, founded by the ministry of public health, were then organized within a network under the responsibility of a national coordination. This structure created in September 2007 represents the main organism to conduct, evaluate and follow-up activities and functioning of the ten ATC. All these activities are conducted in agreement with the national program of fight against AIDS. Within one year this structure of coordination allowed to organize the training of 208 caregivers, to elaborate a team of national and international experts, to start a process of national guidelines, to elaborate technical procedures and indicators for monitoring, follow-up and evaluation. In June 2007, 5 ATC were in function taking care of 7,062 PLWA. In November 2008, 9 ATC were in function taking care of 8,174 PLWA. This project is planned for four years. It might allow to structure and organize a national network of care for PLWA according to the national strategy. This procedure of scaling up under the responsibility of a national team of technical and operational coordination is a new process. It completes and strengthens the national organization process.
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Síndrome de Inmunodeficiencia Adquirida/terapia , Atención Ambulatoria , Infecciones por VIH/terapia , Calidad de la Atención de Salud , Cruz Roja , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Atención Ambulatoria/normas , Antirretrovirales/uso terapéutico , Francia , Gabón , Infecciones por VIH/tratamiento farmacológico , Humanos , Calidad de Vida , Recursos HumanosRESUMEN
INTRODUCTION: Spinal cord lesions are an uncommon mode of discovering acquired immunodeficiency syndrome because they usually appear at a later stage. EXEGESIS: We report a 58-year-old patient who had a spastic paraparesia and sphincter dysfunction. The spinal cord magnetic resonance imaging showed spontaneous hypersignals on T2-weighted images at the cervical and thoracic levels, enhanced with gadolinium, and without swelling. No cause was found. The HIV serology was positive and allowed us to consider an HIV-associated myelopathy. The antiretroviral therapy led to functional recovery. CONCLUSION: An HIV serology is suggested whenever an unexplained intramedullary lesion is discovered. Indeed, the diagnosis of HIV-associated myelopathy implies a specific therapeutic approach.
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Infecciones por VIH/complicaciones , Enfermedades de la Médula Espinal/etiología , Diagnóstico Diferencial , Infecciones por VIH/diagnóstico , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Mielitis , Paraparesia Espástica/etiología , Enfermedades de la Médula Espinal/patología , Enfermedades de la Médula Espinal/virologíaAsunto(s)
Fármacos Anti-VIH/efectos adversos , Infecciones por VIH/complicaciones , Metadona/efectos adversos , Narcóticos/efectos adversos , Nevirapina/efectos adversos , Oxazinas/efectos adversos , Síndrome de Abstinencia a Sustancias/fisiopatología , Adulto , Alquinos , Benzoxazinas , Ciclopropanos , Interacciones Farmacológicas , Humanos , Masculino , Metadona/farmacocinética , Narcóticos/farmacocinéticaAsunto(s)
Fármacos Anti-VIH/uso terapéutico , Seropositividad para VIH/complicaciones , Seropositividad para VIH/tratamiento farmacológico , Hepatitis C/complicaciones , Indinavir/uso terapéutico , Lamivudine/uso terapéutico , Porfiria Cutánea Tardía/complicaciones , Estavudina/uso terapéutico , Adulto , Quimioterapia Combinada , Humanos , Masculino , Trastornos Relacionados con Opioides/complicaciones , Remisión EspontáneaAsunto(s)
Infecciones por VIH/prevención & control , Infecciones por Pneumocystis/prevención & control , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Hipersensibilidad a las Drogas/etiología , Estudios de Seguimiento , Infecciones por VIH/complicaciones , Humanos , Tolerancia Inmunológica , Infecciones por Pneumocystis/complicaciones , Equivalencia Terapéutica , Factores de Tiempo , Combinación Trimetoprim y Sulfametoxazol/efectos adversosRESUMEN
BACKGROUND: Hypersensitivity reactions to trimethoprim-sulfamethoxazole (TMP-SMX) are very common in HIV-infected patients, leading to drug discontinuation. However, it is the drug of choice as prophylaxis for Pneumocystis carinii pneumonia. OBJECTIVES: We sought to determine the safety and long-term efficacy of a 6-hour TMP-SMX-graded challenge in a group of hypersensitive HIV-infected patients. METHODS: Forty-four consecutive HIV-infected patients with documented TMP-SMX hypersensitivity were seen in our outpatient allergy department. They ingested 12 doses of increasing amounts of TMP-SMX at half-hour intervals. Thereafter, they took 80/400 mg TMP-SMX daily and were advised to "treat through" every nonbullous cutaneous adverse reaction. RESULTS: All 44 patients tolerated the procedure without any adverse reactions during the day of challenge. Eleven of the 44 patients experienced mild hypersensitivity reactions on days 1 to 2 (8 patients) and 8 to 10 (3 patients), consisting mainly on a 1-day pruritic maculopapular eruption. Two patients stopped TMP-SMX at day 1, and 2 stopped it at days 10 and 15, giving an overall success rate at 1 month of 91% (40 of 44). Two were successfully rechallenged late. After a median follow-up of 10 months, 42 patients were taking TMP-SMX without any adverse reaction, giving an overall success rate of 95%. CONCLUSIONS: A 6-hour graded challenge with cautious "treating through" of mild reactions enables more patients to take TMP-SMX and is safe and effective.
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Hipersensibilidad a las Drogas/inmunología , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/inmunología , Combinación Trimetoprim y Sulfametoxazol/administración & dosificación , Administración Oral , Adulto , Esquema de Medicación , Hipersensibilidad a las Drogas/sangre , Hipersensibilidad a las Drogas/prevención & control , Femenino , Humanos , Masculino , Estudios ProspectivosAsunto(s)
Hipersensibilidad a las Drogas/etiología , Inhibidores de la Proteasa del VIH/efectos adversos , Nelfinavir/efectos adversos , Urticaria/inducido químicamente , Urticaria/terapia , Adulto , Linfocitos T CD4-Positivos/inmunología , Desensibilización Inmunológica , Hipersensibilidad a las Drogas/terapia , Infecciones por VIH/terapia , Inhibidores de la Proteasa del VIH/uso terapéutico , Humanos , Masculino , Nelfinavir/uso terapéuticoRESUMEN
An improved direct agglutination test (DAT) is assessed for the detection of Leishmania infantum antibodies in man and in the canine reservoir in Southern France. The test performance in 32 human visceral leishmaniasis patients was in agreement with the parasitological diagnosis and the immunofluorescence (IFAT) results. In six patients diagnosed earlier as kala-azar cases, both DAT and IFAT revealed negative results. The specificity of the DAT was reproduced in this study by the absence of cross-reactions with sera from other patients. In the dog reservoir, the DAT results were compared with those obtained by IFAT, the enzyme-linked immunosorbent assay (ELISA), cross-over electrophoresis and the latex agglutination test. All 34 dogs with parasitologically positive lymph node aspirates also had positive DAT titres (less than or equal to 1:640); the sensitivity in the other four tests was relatively low. Positive DAT and IFAT results were found in 16 unconfirmed cases of canine leishmaniasis, most probably due to prepatent L. infantum infections.