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1.
Int J Numer Method Biomed Eng ; : e03409, 2020 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-33098246

RESUMO

Fenestrated endovascular aneurism repair (FEVAR) is a minimally invasive technique, and its success depends on the adequacy of the correspondence between the visceral arteries ostia and position of the fenestrations of the stent graft (SG) during its deployment in juxtarenal aneurisms. However, the fenestration position is generally determined from a preoperative computerised tomography (CT) scan, without considering the vascular deformation induced by the insertion of the endovascular tools. Catheterisation difficulties may occur during clinical procedures. Accordingly, the objective of this work is to present an initial proof of concept aimed at anticipating and optimising the position of the fenestrations, while considering the vascular deformation induced by the insertion of the endovascular tools. The proposed method relies on the finite element method to simulate the SG deployment in a vascular structure (VS), and considers the vascular deformation induced by the tools. After determining the optimal simulation parameters for a patient-specific case, the robustness of the method is demonstrated on six other representative anatomies. The simulated SG is also compared with post-deployment CT observations, and demonstrates good adequacy. The results show that the numerically corrected fenestration positions, as determined from the simulated results following the insertion of the endovascular tools, deviate from those of the standard plan (as determined from the preoperative CT scan). This indicates that the SG-VS adequacy could be improved via simulation-based planning, to anticipate potential catheterisation difficulties.

2.
Artigo em Inglês | MEDLINE | ID: mdl-32740538

RESUMO

OBJECTIVES: Crohn disease (CD) can affect patient's quality of life (QOL) with physical, social, and psychological impacts. This study aimed to investigate the QOL of children with CD and its relationship with patient and disease characteristics. METHODS: Children ages from 10 to 17 years with diagnosed CD for more than 6 months were eligible to this cross-sectional study conducted in 35 French pediatric centers. QOL was assessed by the IMPACT-III questionnaire. Patient and disease characteristics were collected. RESULTS: A total of 218 children (42% of girls) were included at a median age of 14 years (interquartile range [IQR]: 13--16). Median duration of CD was 3.2 years (IQR: 1.7-5.1) and 63% of children were in clinical remission assessed by wPCDAI. Total IMPACT-III score was 62.8 (±11.0). The lowest score was in "emotional functioning" subdomain (mean: 42.8 ±â€Š11.2). Clinical remission was the main independent factor associated with QOL of children with CD (5.74 points higher compared with those "with active disease", 95% confidence interval [CI] 2.77--8.70, P < 0.001). Age of patient at the evaluation was found negatively correlated with QOL (-0.76 per year, 95% CI: -1.47 to -0.06, P = 0.009). Presence of psychological disorders was associated with a lower QOL (-9.6 points lower to those without, 95% CI: -13.34 to -5.86, P < 0.0001). Total IMPACT-III and its subdomains scores were not related to sex, disease duration, or treatments. CONCLUSIONS: These results not only confirm that clinical remission is a major issue for the QOL of patients, but also highlights the importance of psychological care.

3.
BMJ Open ; 10(5): e036400, 2020 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-32430452

RESUMO

INTRODUCTION: Low bone mineral density (BMD) is a frequent issue in children and adolescents with inflammatory bowel disease (IBD). Several studies in healthy populations have reported a positive impact of physical activity (PA) on bone health. Recently, an observational study in paediatric patients with IBD showed a significant positive relationship between daily PA and BMD. However, intervention studies investigating a causal relationship between PA and BMD are warranted to confirm these results. The aim of this randomised controlled trial will be to investigate the effect of a PA programme on BMD in paediatric patients with IBD. METHODS AND ANALYSIS: This trial is a multicentre (four centres), randomised, controlled, blinded end-point study. Eighty children with IBD will be randomly assigned in a 1:1 ratio to receive a programme with adapted physical exercises (intervention group) or usual PA (control group) during a 9-month period. The primary outcome is the change from baseline at 9 months (the end of the study) in whole-body BMD assessed by dual-energy X-ray absorptiometry. Secondary efficacy outcomes include the changes from baseline at 9 months in: BMD assessed in the lumbar spine and trochanter; daily PA (time spent in moderate-to-vigorous PA); body composition (fat mass and fat-free mass); fatigue resistance; quality of life and activity of IBD. ETHICS AND DISSEMINATION: The study was approved by the Research Ethics Committee in France (Comité de Protection des Personnes, Sud-Ouest and Outre-Mer III, Bordeaux, France, No 2018/27). All procedures will be performed according to the ethical standards of the Helsinki Declaration of 1975, as revised in 2008, and the European Union's Guidelines for Good Clinical Practice. Written informed consent will be obtained from the parents or legal guardian and from the children. Research findings will be disseminated in peer-reviewed journals and scientific meetings. TRIAL REGISTRATION NUMBER: NCT03774329.

4.
Ann Vasc Surg ; 61: 291-298, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31352087

RESUMO

BACKGROUND: During endovascular aneurysm repair (EVAR), complex iliac anatomy is a source of complications such as unintentional coverage of the hypogastric artery. The aim of our study was to evaluate ability to predict coverage of the hypogastric artery using a biomechanical model simulating arterial deformations caused by the delivery system. METHODS: The biomechanical model of deformation has been validated by many publications. The simulations were performed on 38 patients included retrospectively, for a total of 75 iliac arteries used for the study. On the basis of objective measurements, two groups were formed: one with "complex" iliac anatomy (n = 38 iliac arteries) and the other with "simple" iliac anatomy (n = 37 iliac arteries). The simulation enabled measurement of the lengths of the aorta and the iliac arteries once deformed by the device. Coverage of the hypogastric artery was predicted if the deformed renal/iliac bifurcation length (Lpre) was less than the length of the implanted device (Lstent-measured on the postoperative computed tomography [CT]) and nondeformed Lpre was greater than Lstent. RESULTS: Nine (12%) internal iliac arteries were covered unintentionally. Of the coverage attributed to perioperative deformations, 1 case (1.3%) occurred with simple anatomy and 6 (8.0%) with complex anatomy (P = 0.25). All cases of unintentional coverage were predicted by the simulation. The simulation predicted hypogastric coverage in 35 cases (46.7%). There were therefore 26 (34.6%) false positives. The simulation had a sensitivity of 100% and a specificity of 60.6%. On multivariate analysis, the factors significantly predictive of coverage were the iliac tortuosity index (P = 0.02) and the predicted margin between the termination of the graft limb and the origin of the hypogastric artery in nondeformed (P = 0.009) and deformed (P = 0.001) anatomy. CONCLUSIONS: Numerical simulation is a sensitive tool for predicting the risk of hypogastric coverage during EVAR and allows more precise preoperative sizing. Its specificity is liable to be improved by using a larger cohort.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Simulação por Computador , Procedimentos Endovasculares/efeitos adversos , Artéria Ilíaca/fisiopatologia , Modelos Cardiovasculares , Análise Numérica Assistida por Computador , Complicações Pós-Operatórias/etiologia , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/fisiopatologia , Aortografia/métodos , Fenômenos Biomecânicos , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/instrumentação , Feminino , Análise de Elementos Finitos , Humanos , Artéria Ilíaca/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/fisiopatologia , Desenho de Prótese , Fluxo Sanguíneo Regional , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
5.
J Vasc Interv Radiol ; 30(9): 1386-1392, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31155497

RESUMO

PURPOSE: To quantify the displacement of the vascular structures after insertion of stiff devices during endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm and to identify potential parameters influencing this displacement. MATERIALS AND METHODS: A total of 50 patients from a single center undergoing EVAR were prospectively enrolled between January 2016 and December 2017. Fusion imaging was employed using the EndoNaut (Therenva, Rennnes, France) station through a 3-dimensional (3D)/2-dimensional (2D) technology synchronizing the 3D computed tomography scan to the live intraoperative fluoroscopy. The accuracy of the fusion roadmap was evaluated before deployment by conventional digital subtraction angiogram on a single plane (with different C-arm incidences). RESULTS: The mean displacement error of the ostium of the lowest renal artery was 4.1 ± 2.4 mm (range, 0-11.7 mm), with a left/right displacement of 1.6 ± 1.7 mm (range, 0-6.9 mm) and a craniocaudal displacement of 3.5 ± 2.4 mm (range, 0-11.3 mm). The correction required for the ostium of the lower renal artery was mostly cranial and to the left. Multiple linear regression analysis revealed only the sharpest angle between the aneurysm neck and sac as the factor influencing the accuracy of fusion imaging. All other parameters did not show any correlation. CONCLUSIONS: This study identified the sources of fusion error after insertion of rigid material during EVAR. As the sharpest angulation between aneurysm neck and sac increases, the overall accuracy of the fusion might be affected.


Assuntos
Angiografia Digital , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Aortografia/métodos , Implante de Prótese Vascular , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares , Idoso , Idoso de 80 Anos ou mais , Pontos de Referência Anatômicos , Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Interpretação de Imagem Radiográfica Assistida por Computador , Reprodutibilidade dos Testes , Stents , Resultado do Tratamento
6.
Ann Surg ; 264(6): 1004-1008, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26720426

RESUMO

OBJECTIVE: To study the prevalence of Barrett esophagus (BE) (gastric and/or intestinal metaplasia) in adolescents treated for esophageal atresia (EA). SUMMARY OF BACKGROUND DATA: EA patients are at high risk of BE. METHODS: This multicenter prospective study included EA patients aged 15 to 19 years. All eligible patients were proposed an upper endoscopy with multistaged esophageal biopsies under general anesthesia. Histological suspicion of metaplasia was confirmed centrally. RESULTS: One hundred twenty patients [mean age, 16.5 years (±1.4)] were included; 70% had been treated for gastroesophageal reflux disease (GERD) during infancy. At evaluation, 8% were undernourished, 41% had received antireflux surgery, and 41% presented with GERD symptoms, although only 28% were receiving medical treatment. Esophagitis was found at endoscopy in 34% and confirmed at histology in 67%. BE was suspected after endoscopy in 37% and was confirmed by histology for 43% of patients (50 gastric and 1 intestinal metaplasia). No endoscopic or histological anomalies were found at the anastomosis site. BE was not significantly related to clinical symptoms. In multivariate analysis, BE was associated with EA without fistula (P = 0.03), previous multiple antireflux surgery (P = 0.04), esophageal dilation (P = 0.04), suspicion of BE at endoscopy (P < 0.001), and histological esophagitis (P = 0.02). CONCLUSIONS: Patients with EA are at high risk of persistent GERD and BE. The development of BE is related to GERD history. Long-term systematic follow-up of the esophageal mucosa including multistaged biopsies is required, even in asymptomatic patients. (NCT02495051).


Assuntos
Esôfago de Barrett/epidemiologia , Atresia Esofágica/cirurgia , Adolescente , Biópsia , Esofagite/complicações , Esofagoscopia , Feminino , França/epidemiologia , Refluxo Gastroesofágico/complicações , Humanos , Masculino , Prevalência , Estudos Prospectivos , Adulto Jovem
8.
BMC Infect Dis ; 15: 512, 2015 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-26563141

RESUMO

BACKGROUND: Extended-spectrum ß-lactamases producing Escherichia coli (ESBL-E) are increasingly identified in health care facilities. As previously done for the control of methicillin-resistant Staphylococcus aureus, many hospitals have established screening strategies for early identification of patients being carriers of ESBL producers in general and ESBL-E in particular, and have implemented contact precautions (CP) for infected and colonized patients. METHODS: The incidence of ESBL-E has been compared retrospectively between two French university hospitals (A and B) with different infection control policies over a 5-year long period of time (2006-2010). RESULTS: While hospital A only implemented standard precautions after identification of patients colonized with ESBL-E, hospital B recommended additional CP. During the period of the study, the ESBL-E incidence rate significantly increased in both hospitals, but no significant difference was observed between the two hospitals. CONCLUSIONS: This observational study did not reveal that additional CP measures had a greater impact on the incidence of ESBL-E in hospital settings.


Assuntos
Portador Sadio/microbiologia , Infecção Hospitalar/prevenção & controle , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/prevenção & controle , Escherichia coli/enzimologia , Controle de Infecções/métodos , beta-Lactamases/metabolismo , Portador Sadio/epidemiologia , Portador Sadio/prevenção & controle , Portador Sadio/transmissão , Criança , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/transmissão , Enterobacteriaceae/enzimologia , Enterobacteriaceae/isolamento & purificação , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/transmissão , Feminino , Hospitais Universitários , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Paris/epidemiologia , Estudos Retrospectivos , Resistência beta-Lactâmica
9.
PLoS One ; 10(7): e0130813, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26162088

RESUMO

In bacteria, mechanisms that incorporate DNA into a genome without strand-transfer proteins such as RecA play a major role in generating novelty by horizontal gene transfer. We describe a new illegitimate recombination event in Escherichia coli K-12: RecA-independent homologous replacements, with very large (megabase-length) donor patches replacing recipient DNA. A previously uncharacterized gene (yjiP) increases the frequency of RecA-independent replacement recombination. To show this, we used conjugal DNA transfer, combining a classical conjugation donor, HfrH, with modern genome engineering methods and whole genome sequencing analysis to enable interrogation of genetic dependence of integration mechanisms and characterization of recombination products. As in classical experiments, genomic DNA transfer begins at a unique position in the donor, entering the recipient via conjugation; antibiotic resistance markers are then used to select recombinant progeny. Different configurations of this system were used to compare known mechanisms for stable DNA incorporation, including homologous recombination, F'-plasmid formation, and genome duplication. A genome island of interest known as the immigration control region was specifically replaced in a minority of recombinants, at a frequency of 3 X 10(-12) CFU/recipient per hour.


Assuntos
Escherichia coli K12/genética , Proteínas de Escherichia coli/genética , Transferência Genética Horizontal , Recombinases Rec A/genética , Cromossomos Bacterianos/genética , Conjugação Genética , DNA Bacteriano/genética , Resistência Microbiana a Medicamentos/genética , Escherichia coli K12/metabolismo , Proteínas de Escherichia coli/metabolismo , Genoma Bacteriano/genética , Ilhas Genômicas/genética , Recombinação Homóloga , Modelos Genéticos , Recombinases Rec A/metabolismo
10.
Environ Microbiol Rep ; 5(1): 49-57, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23757130

RESUMO

We undertook a large-scale epidemiological survey of commensal Escherichia coli in Trois-Sauts, an isolated village located in the south of French Guiana where human population exchanges are restricted and source of antibiotics controlled. Stools from 162 Wayampi Amerindians and rectal swabs from 33 human associated and 198 wild animals were collected in the close proximity of the village. The prevalence of E. coli was decreasing from humans (100%) to human associated (64%) and wild (45%) animals. A clear genetic structure between these three E. coli populations was observed with human strains belonging very rarely to B2 phylogroup (3.7%), exhibiting few virulence genes and bacteriocins but being antibiotic resistant whereas wild animal strains were characterized by 46.1% of B2 phylogroup belonging, with very unique and infrequent sequence types, numerous extraintestinal genes and bacteriocins but no antibiotic resistance; the human-associated animal strains being intermediate. Furthermore, an unexpected genetic diversity was observed among the strains, as the housekeeping gene nucleotide diversity per site of the Trois-Sauts's strains was higher than the one of reference strains representative of the known species diversity. The existence of such E. coli structured phylogenetic diversity within various hosts of a single localization has never been reported.


Assuntos
Escherichia coli/isolamento & purificação , Variação Genética , Animais , Animais Selvagens , Antibacterianos/farmacologia , Bacteriocinas/farmacologia , DNA Bacteriano/genética , Farmacorresistência Bacteriana/efeitos dos fármacos , Escherichia coli/classificação , Escherichia coli/genética , Escherichia coli/patogenicidade , Fezes/microbiologia , Guiana Francesa , Especificidade de Hospedeiro , Humanos , Filogenia , Virulência
11.
Proc Biol Sci ; 280(1764): 20130519, 2013 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-23782877

RESUMO

Pneumococcus is an important human pathogen, highly antibiotic resistant and a major cause of bacterial meningitis worldwide. Better prevention requires understanding the drivers of pneumococcal infection incidence and antibiotic susceptibility. Although respiratory viruses (including influenza) have been suggested to influence pneumococcal infections, the underlying mechanisms are still unknown, and viruses are rarely considered when studying pneumococcus epidemiology. Here, we propose a novel mathematical model to examine hypothetical relationships between Streptococcus pneumoniae meningitis incidence (SPMI), acute viral respiratory infections (AVRIs) and antibiotic exposure. French time series of SPMI, AVRI and penicillin consumption over 2001-2004 are analysed and used to assess four distinct virus-bacteria interaction submodels, ascribing the interaction on pneumococcus transmissibility and/or pathogenicity. The statistical analysis reveals strong associations between time series: SPMI increases shortly after AVRI incidence and decreases overall as the antibiotic-prescription rate rises. Model simulations require a combined impact of AVRI on both pneumococcal transmissibility (up to 1.3-fold increase at the population level) and pathogenicity (up to threefold increase) to reproduce the data accurately, along with diminished epidemic fitness of resistant pneumococcal strains causing meningitis (0.97 (0.96-0.97)). Overall, our findings suggest that AVRI and antibiotics strongly influence SPMI trends. Consequently, vaccination protecting against respiratory virus could have unexpected benefits to limit invasive pneumococcal infections.


Assuntos
Antibacterianos/uso terapêutico , Meningite Pneumocócica/epidemiologia , Modelos Estatísticos , Modelos Teóricos , Infecções Respiratórias/epidemiologia , França/epidemiologia , Humanos , Meningite Pneumocócica/tratamento farmacológico , Análise Multivariada , Penicilinas , Streptococcus pneumoniae/patogenicidade
12.
Antimicrob Agents Chemother ; 56(1): 315-23, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22064532

RESUMO

Nasal carriage of methicillin-resistant coagulase-negative staphylococci (MR-CoNS) is highly prevalent in community subjects, but its dynamic has been little investigated. Nasal swabbing was performed in 2006 and 2008 in 154 Amerindians living isolated in French Guiana. MR-CoNS strains were identified and characterized by non-ß-lactam susceptibility testing and staphylococcal cassette chromosome mec element (SCCmec) typing, characterizing the associations of ccr and mec gene complex allotypes, and for MR Staphylococcus epidermidis (MRSE), multilocus variable number of tandem repeats analysis (MLVA) was used. The impact of sociodemographic and medical characteristics on the persistence of MR-CoNS carriage was assessed by bivariate analysis. Prevalence of MR-CoNS carriage was 50.6% in 2006 and 46.8% in 2008. The 274 MR-CoNS isolates, including S. epidermidis (n = 89, 62 MLVA patterns), Staphylococcus haemolyticus (n = 78), and Staphylococcus hominis (n = 72), exhibited 41 distinct ccr and mec gene complex associations. Persistent carriage (in 2006 and 2008), intermittent carriage (either in 2006 or 2008), and noncarriage were documented in 25.3, 47.4, and 27.3% of the participants, respectively. Persistent carriage of a given MRSE isolate was rarely observed (n = 8 isolates). Furthermore, no epidemiological factor, including antibiotic exposure, was associated with persistent carriage. The high diversity of MRSE clones and their ccr and mec gene complex associations contrasted with the high carriage rates in this isolated community, which might reflect the occurrence of SCCmec rearrangement and the generation of new MR-CoNS strains.


Assuntos
Coagulase/genética , Resistência a Meticilina/genética , Nariz/microbiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus epidermidis/genética , Staphylococcus haemolyticus/genética , Staphylococcus hominis/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Técnicas de Tipagem Bacteriana , Portador Sadio , Cromossomos Bacterianos , Coagulase/deficiência , Feminino , Guiana Francesa/epidemiologia , Genes Bacterianos , Ligação Genética , Variação Genética , Humanos , Masculino , Resistência a Meticilina/efeitos dos fármacos , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Prevalência , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia , Staphylococcus epidermidis/efeitos dos fármacos , Staphylococcus epidermidis/isolamento & purificação , Staphylococcus haemolyticus/efeitos dos fármacos , Staphylococcus haemolyticus/isolamento & purificação , Staphylococcus hominis/efeitos dos fármacos , Staphylococcus hominis/isolamento & purificação
13.
J Microbiol Methods ; 87(3): 295-301, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22001717

RESUMO

Solid phase cytometry in conjunction with fluorescent probe was applied to rapidly quantify cellular esterase activity of Listeria monocytogenes cells. Viability of cells stressed by several treatments (starvation, NaCl, lactic acid and peracetic acid) was assessed simultaneously by their esterase activity estimated by fluorescence intensity and by their ability to multiply in liquid and solid, non-selective and selective, culture media. It was determined that cell physiological state has a significant impact on the cellular fluorescence intensity which was very dependent on the stress suffered by cells. No general relationship was observed between the bacterial populations observed by cytometry and the populations able to grow on culture media. The link between the cell culturability in non-selective and selective media and the esterase activity was always dependent on the stress suffered. Nevertheless, it was also established that solid phase cytometry is an efficient, sensitive and accurate tool to characterize the ability of non-selective and selective enrichment broths to allow the repair of stressed L. monocytogenes cells by examining the increase in the fraction of the most esterase active cells during the course of resuscitation.


Assuntos
Técnicas Bacteriológicas/métodos , Meios de Cultura/química , Esterases/análise , Listeria monocytogenes/enzimologia , Listeria monocytogenes/crescimento & desenvolvimento , Viabilidade Microbiana , Humanos , Estatística como Assunto
14.
J Infect Dis ; 202(6): 924-34, 2010 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-20677941

RESUMO

BACKGROUND: Staphylococcus aureus nasal carriage is influenced by multifactorial interactions which are difficult to study in open populations. Therefore, we concomitantly assessed the epidemiological, microbiological, and human-genetic carriage-related factors in a nearly closed population. METHODS: In 2006 and 2008, we collected nasal S. aureus strains, human DNA, and epidemiological data from 154 adult Wayampi Amerindians living in an isolated village in the Amazonian forest. The genetics of the strains (multilocus sequence type, spa type, and toxin-content type), epidemiological risk factors, antibiotic exposure, and allelic polymorphism of human genes putatively involved in carriage of the persistent carriers were compared with those of other volunteers. RESULTS: Overall carriage prevalence was 41.7% in 2006 and 57.8% in 2008, but the overall prevalence of persistent carriage was only 26%. The rare and phylogenetically distant multilocus sequence type ST1223 was present in 18.5% of the carriers in 2006 and 34.8% in 2008. No epidemiological factors or antibiotic exposure were significantly associated with persistent carriage, but single nucleotide polymorphism distribution in C-reactive proteins C2042T and C1184T and interleukin-4 C524T genes was significantly associated (P=.02, by global test). CONCLUSION: Host genetic factors appeared to be the predominant determinant for S. aureus persistent nasal carriage in humans.


Assuntos
Portador Sadio/microbiologia , Cavidade Nasal/microbiologia , Infecções Estafilocócicas/genética , Staphylococcus aureus/isolamento & purificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Técnicas de Tipagem Bacteriana , Proteína C-Reativa/genética , Portador Sadio/epidemiologia , Impressões Digitais de DNA , Feminino , Frequência do Gene , Genótipo , Humanos , Índios Sul-Americanos , Interleucina-4/genética , Masculino , Pessoa de Meia-Idade , Polimorfismo Genético , Prevalência , Fatores de Risco , População Rural , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/classificação , Staphylococcus aureus/genética , Adulto Jovem
15.
J Infect Dis ; 202(4): 515-23, 2010 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-20617925

RESUMO

BACKGROUND: Intestinal carriage is a key factor in extended-spectrum beta-lactamase (ESBL) infection epidemiology but is difficult to study in open communities. To overcome this problem, we studied a highly stable group of Amerindians for whom we reported an ESBL carriage prevalence of 3.2% in 2001. METHODS: In 2006, ESBL carriage was assessed among 163 healthy volunteer adults. ESBL isolates were identified, and their molecular resistance mechanisms were characterized. Antibiotic use in the year before sampling and the epidemiological characteristics of the population were analyzed. Results were compared to those obtained in 2001. RESULTS: In 2006, the ESBL carriage prevalence, exclusively comprising Escherichia coli, was 8.0%. It mainly consisted of CTX-M-type ESBL. The strains and plasmids carrying ESBL were heterogeneous, but 1 CTX-M-2-producing strain was found in 4.3% of the subjects analyzed. No individual risk factor was identified. However, overall antibiotic use had almost doubled since 2001. A 3-fold increase was noted for beta-lactams. CONCLUSIONS: In this population, the frequency of ESBL increased with time because of the appearance of CTX-M ESBL, mimicking what occurs in the developed world. This resulted from the probable repeated introduction of new strains and plasmids and from interindividual dissemination. During the same period, antibiotic use substantially increased.


Assuntos
Portador Sadio/microbiologia , Infecções Comunitárias Adquiridas/microbiologia , Infecções por Escherichia coli/microbiologia , Escherichia coli/enzimologia , Escherichia coli/isolamento & purificação , Resistência beta-Lactâmica , beta-Lactamases/biossíntese , Adulto , Antibacterianos/uso terapêutico , Portador Sadio/transmissão , Infecções Comunitárias Adquiridas/transmissão , Uso de Medicamentos/estatística & dados numéricos , Infecções por Escherichia coli/transmissão , Feminino , Guiana Francesa , Genes Bacterianos , Humanos , Índios Sul-Americanos , Masculino , Plasmídeos , Prevalência , Fatores de Risco , População Rural , beta-Lactamases/genética
17.
Appl Environ Microbiol ; 75(10): 3069-76, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19304822

RESUMO

The impacts of 12 common food industry stresses on the single-cell growth probability and single-cell lag time distribution of Listeria monocytogenes were determined in half Fraser broth, the primary enrichment broth of the International Organization for Standardization detection method. First, it was determined that the ability of a cell to multiply in half Fraser broth is conditioned by its history (the probability for a cell to multiply can be decreased to 0.05), meaning that, depending on the stress in question, the risk of false-negative samples can be very high. Second, it was established that when cells are injured, the single-cell lag times increase in mean and in variability and that this increase represents a true risk of not reaching the detection threshold of the method in the enrichment broth. No relationship was observed between the impact on single-cell lag times and that on growth probabilities. These results emphasize the importance of taking into account the physiological state of the cells when evaluating the performance of methods to detect pathogens in food.


Assuntos
Meios de Cultura/química , Microbiologia de Alimentos , Listeria monocytogenes/fisiologia , Estresse Fisiológico , Contagem de Colônia Microbiana , Listeria monocytogenes/crescimento & desenvolvimento , Fatores de Tempo
18.
Mol Nutr Food Res ; 52(8): 875-84, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18711759

RESUMO

Enteral nutrition has long been a therapeutic alternative often used in adult Crohn's disease patients to obtain remission or clinical response, especially in those not responding to conventional therapy such as corticosteroids. However, the increasing use of immunosuppressors (6-mercaptopurine and azathioprine, methotrexate, etc.), and the advent of biotherapies (especially anti-tumor necrosis factor-alpha (TNF-alpha) antibodies), decreased its use in adult Crohn's disease. Nevertheless, enteral nutrition remains of interest in patients presenting concomitant malnutrition (in particular in nonobstructed patients needing surgery), or in those intolerant or who failed to other therapeutics. In addition, recent studies provide data indicating its potential interest in maintenance therapy in selected patients groups. Finally, future research (in particular in the field of immuno- or pharmaconutrition) could lead to enteral formula's improvement, with better tolerance and acceptability, as well as increased efficacy.


Assuntos
Doença de Crohn/terapia , Nutrição Enteral/métodos , Adulto , Doença de Crohn/complicações , Glutamina/administração & dosagem , Humanos , Lipídeos/administração & dosagem , Fator de Crescimento Transformador beta2/administração & dosagem
19.
J Forensic Leg Med ; 15(3): 193-7, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18313018

RESUMO

Ferrets are becoming more and more popular pets in American homes. Nevertheless, they can cause potentially dangerous injuries, particularly in small children. Based on the case of an infant injured by a ferret, the characteristics of the wounds are described and compared with those of other animals. The potential legal implications are also discussed.


Assuntos
Mordeduras e Picadas/patologia , Orelha Externa/lesões , Orelha Externa/patologia , Traumatismos Faciais/patologia , Animais , Furões , Patologia Legal , Humanos , Lactente , Masculino
20.
Sante Publique ; 19(3): 183-91, 2007.
Artigo em Francês | MEDLINE | ID: mdl-17708483

RESUMO

The development of the Regional Plan for Health Organisation (SROS III) in the Nord-Pas-de-Calais has provided an opportunity for further reflection on the operation and organisation of professionals and structures in the field of prenatal diagnoses. The alleged claims resulting from this reflection process are not only integrated in the perinatal stream of the SROS but also in the objectives of the regional public health plan. The study which was carried out takes into account the regional data available, complemented by interviews with professionals working on the ground, which are then compared with national data. All of these elements contributed to the construction of proposals for an improved organisation of this regional management system, on the one hand curative and on the other preventive.


Assuntos
Diagnóstico Pré-Natal , Regionalização/organização & administração , Aborto Terapêutico/estatística & dados numéricos , Adolescente , Adulto , Biomarcadores/sangue , Diagnóstico por Imagem/estatística & dados numéricos , Feminino , Doenças Fetais/diagnóstico , França , Aconselhamento Genético/estatística & dados numéricos , Técnicas Genéticas/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Gravidez , Diagnóstico Pré-Natal/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Regionalização/estatística & dados numéricos , Programas Médicos Regionais/organização & administração , Programas Médicos Regionais/estatística & dados numéricos , Fatores de Risco , Ultrassonografia Pré-Natal/estatística & dados numéricos
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