HLA-DRB1*15 allele influences the later course of relapsing remitting multiple sclerosis.

Most of the published works so far have aimed at finding genes associated with multiple sclerosis (MS) susceptibility. Very few studies have attempted to correlate disease features with DNA variants. In a well-characterized sample (651 patients) representative of multiple sclerosis natural history, we engaged a comprehensive study of the role of human leukocyte antigen (HLA) in the course of the disease. We investigated the role of HLA-DRB1*15 allele in samples stratified according to severity evaluated by the Multiple Sclerosis Severity Score (MSSS), time to reach EDSS 6.0 and disease type. We found that HLA-DRB1*15 genotype does not influence MS severity even among patients presenting with a given type of the disease. However, we show for the first time that HLA-DRB1*15 allele modulates the course of MS for relapsing-remitting (RR) onset patients likely by precipitating the secondary progressive (SP) phase.

[Dental status, access to care and precariousness]. / Etat dentaire, recours aux soins et précarité.

BACKGROUND: The oral status of people living in precarious conditions is problematic. Although the public universal health insurance should allow better access to care, access to dental care remains a critical issue. The analysis of the patient population of a hospital dental consultation (Groupe Pitié-Salpêtrière, Paris) seemed relevant to evaluate the needs of care and the means to provide it. The principal objectives are: to estimate dental health and needs of this population, to describe their sociodemographic characteristics and to compare them with patients living in common social conditions. METHODS: A cross sectional study was conducted from February to June 2003. A medical questionnaire and a dental file record were used. All outpatients coming to the dental consultation, in need of conservative or prosthetic treatment, were included. We analysed the risk factors associated with poor dental health. RESULTS: Three hundred and thirty three questionnaires were analysed: two third were men, 45% were foreigners. More than half of them benefited from a special social health insurance for disadvantaged people or didn't have any health insurance. The comparative analysis of this precarious group vs regular insured people showed significant differences for sociodemographic and oral characteristics. Namely, in the precarious group, a poor dental status was generally observed: more cavities (3.6 versus 2), more absent teeth not replaced (6.8 versus 3.5) and less treated teeth (1.9 versus 3.9)--p < 0.0001. Multivariate analysis showed that main risk factors of poor dental status were to be aged and to be a foreigner. CONCLUSION: This study stresses the importance of the dental care needs in a context of poor insurance refunding for the costs of dental treatments and the lack of structures able to provide dental care for patients living in difficult social condition. These findings question the organization of the dental care system in France.

Genetic variability affects the detection of HIV by polymerase chain reaction.

Nine isolates of HIV-1 obtained from Congolese AIDS patients were amplified by the polymerase chain reaction (PCR) using primer pairs and oligomer probes derived from the HIV-1 LAV-BRU (BRU) sequence. When compared to BRU, two isolates exhibited a significant decrease of PCR efficiency with a given primer pair. Moreover, the DNA amplified from two other isolates did not hybridize with the corresponding probe despite efficient PCR. Base substitutions were detected in the regions of proviral genomes involved in oligonucleotide annealing and were assumed to be responsible for the failure of both amplification and probing. Our data confirm that the genetic variability of HIV-1 may reduce the efficiency of PCR as a diagnostic procedure, especially in the case of African isolates.

Usefulness of procalcitonin as a marker of systemic infection in emergency department patients: a prospective study.

We prospectively evaluated serum procalcitonin concentrations in patients who presented to an emergency department (ED) with suspected infectious or inflammatory disease. Of 195 study patients, 68 had final diagnosis of systemic infection, and 24 of those 68 had elevated serum procalcitonin levels (>0.5 ng/mL). The procalcitonin level had a sensitivity of 0.35 and specificity of 0.99 for the diagnosis of systemic infection. In multivariate analysis, the procalcitonin level was the only independent variable associated with this diagnosis; in contrast, the C-reactive protein level was not. All patients with systemic infections who ultimately died had procalcitonin levels of >0.5 ng/mL at admission. Procalcitonin levels were significantly higher in patients who ultimately died of systemic infection than in patients who survived. The optimal procalcitonin threshold for the ED population may be lower than that proposed for critically ill patients. Determination of the procalcitonin level may be useful for screening and prognosis of more-severely ill ED patients.

Variations of serum IgG subclass levels in hepatitis C virus infection during interferon-alpha therapy.

Serum IgG1 levels are selectively increased in patients with chronic hepatitis C virus (HCV) infection. In 15 patients who received interferon (IFN)-alpha therapy, serum levels of immunoglobulin classes and IgG subclasses were measured during treatment and after it was discontinued. In spite of important individual variations, mean IgG, IgG1, IgA and IgM levels decreased during therapy and tended to return to pre-treatment levels afterwards, with no detectable correlation with clinical and biological parameters. These results suggest an effect of IFN-alpha on in vivo immunoglobulin production, in HCV carriers.

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in health care workers (HCWs): guidelines for prevention of transmission of HBV and HCV from HCW to patients.

The transmission of viral hepatitis from health care workers (HCW) to patients is of worldwide concern. Since the introduction of serologic testing in the 1970s there have been over 45 reports of hepatitis B virus (HBV) transmission from HCW to patients, which have resulted in more than 400 infected patients. In addition there are six published reports of transmissions of hepatitis C virus (HCV) from HCW to patients resulting in the infection of 14 patients. Additional HCV cases are known of in the US and UK, but unpublished. At present the guidelines for preventing HCW to patient transmission of viral hepatitis vary greatly between countries. It was our aim to reach a Europe-wide consensus on this issue. In order to do this, experts in blood-borne infection, from 16 countries, were questioned on their national protocols. The replies given by participating countries formed the basis of a discussion document. This paper was then discussed at a meeting with each of the participating countries in order to reach a Europe-wide consensus on the identification of infected HCWs, protection of susceptible HCWs, management and treatment options for the infected HCW. The results of that process are discussed and recommendations formed. The guidelines produced aim to reduce the risk of transmission from infected HCWs to patients. The document is designed to complement existing guidelines or form the basis for the development of new guidelines. This guidance is applicable to all HCWs who perform EPP, whether newly appointed or already in post.

Two PBMC-based neutralization assays depict low reactivity of both anti-V3 monoclonal antibodies and immune sera against HIV-1 primary isolates.

The neutralizing activity of anti-V3 monoclonal antibodies (MAbs) and anti-HIV-1 immune sera was tested against HIV-1 laboratory strains and African primary isolates. Neutralization was investigated in Phytohaemagglutinin (PHA)-stimulated peripheral blood mononuclear cell (PBMC) cultures by means of two distinct viral titer reduction assays. In these assays, virus was detected by means of either p24 antigen measurement using ELISA or HIV provirus synthesis using PCR, respectively. Anti-V3 MAbs and anti-HIV-1 immune sera neutralized efficiently the homologous laboratory HIV-1 strains used for eliciting immune response but showed no neutralizing activity against most primary isolates. The two neutralization assays used provided similar results. However, a PCR-based assay circumvented the limitations due to low levels of virus replication. The mechanism of resistance of the primary isolates to neutralizing antibodies was complex and was not simply predicted by partial sequence determination of the epitopes. This points out the need for reliable neutralization assays of HIV-1 primary isolates in order to evaluate the role of humoral immunity during HIV-1 infection and for future vaccine strategies.

[Proposals for a strategy for evaluation and utilization of screening tests for hepatitis C]. / Propositions pour une stratégie d'évaluation et d'utilisation des tests de dépistage de l'hépatite C.

New assays for the screening of anti-HCV antibodies are regularly proposed for registration. The evaluation of new tests is based on the measurement of their intrinsic value: sensitivity and specificity. To assess the sensitivity of a test, it is very important to be able to obtain sera samplets tested with a "Gold Standard", which is, for HCV, RNA detection. Sensitivity is defined as the ratio of the number of true positive to the number of true positive added to the number of false negative samples. The problem is to define the samples to be tested. It is methodologically impossible to use a serological test for samples selection. The Gold Standard might be performed on samples from the general population or more easily from risk groups. The estimation of the precocity is more difficult. The constitution of an acute hepatitis panel is of interest an the follow up of risk groups has to be encouraged. The estimation of the number of samples needed depends on the required precision in the sensitivity measurement. The confidence interval (CI) decreases when the number of samples tested increases and when the sensitivity is high. The important questions are opposite: if the test is positive what is the probability for the patient to be really positive? (positive predictive value PPV), and, if the test is negative, what is the probability for the patient to be non-infected? (negative predictive value: NPV). The NPV depends on the prevalence of HCV infection in the tested population and on the sensitivity of the test. PPV increases with the prevalence rate and the specificity. Regarding these results, one may suggest that donor screening assays and tests used for diagnose HCV infection in patients may be evaluated with different strategies. Regarding blood donors screening, sensitivity is the most important parameter, the best strategy is to eliminate risk groups, and then, to perform very sensitive assays on negative samples. On the other hand, for patients diagnosis, specificity (avoid false positive results) is more important. The best strategy is to select patients at risk from clinical findings and then, to perform a specific test. Screening strategies for the general population have to take into account these two different strategies.

[Needle aspiration biopsy in the diagnosis of cutaneous leishmaniasis]. / Prélèvement par aspiration à l'aiguille dans le diagnostic de la leishmaniose cutanée.

The classic diagnostic procedure for cutaneous leishmaniasis is based on the examination of Giemsa-stained smears made from the fluid obtained by scraping the edges of the lesion with a lancet, or prepared with small plugs of superficial tissues. In this report, we compare the results given by this standard method with those obtained by the examination of needle aspirates. Aspirates are secured by injecting a few millimetres outside the external border of the lesion 0.3 to 0.5 ml of saline through a thin needle, rubbing the injured skin, and thereafter pulling back slowly the plunger. Amastigotes were found in all smears from needle aspirates, and in only 11 out 15 obtained by scraping. Aspirates were also more suitable for cultures of parasites.

[Human immunodeficiency virus (HIV) infection in Mali]. / L'infection par le virus de l'immunodéficience humaine (VIH) au Mali.

This review summarises epidemiological and clinical data of HIV infection who was recognized in Mali since 1985. The most important rate of seropositivity for HIV is observed in the prostitutes group (40%). The estimated seroprevalence for adult population is between 1% and 5%. 46 cases for AIDS are reported in both sexes. The mean age is 35 years. Main signs are weight loss (91%), fever (80%), diarrhea (70%) and lymphadenopathy (50%). Three among the five cases of Kaposi's sarcoma are aggressive. 19.5% of AIDS have antibodies to HIV1, 41.3% to HIV2 and 39.1% to HIV1 and HIV2. Death rate is more than 50%. These data are compared with other countries of Africa.

Anterior shoulder instability arthroscopic treatment outcomes measures: the WOSI correlates with the Walch-Duplay score.

PURPOSE: New techniques and instrumentation for arthroscopic management of shoulder instability require accurate measurement tools to investigate possible clinical improvements. The aim of the study was to assess the self-administrated Western Ontario Shoulder Instability Index (WOSI), which is a subjective quality of life measurement tool specific to shoulder instability, and also to validate this score by comparison with the Walch-Duplay score, which is the gold standard score used in Europe. These two scores had never been compared. METHODS: Forty-eight patients, who underwent arthroscopic surgery for anterior shoulder instability, were evaluated using the WOSI and the Walch-Duplay score at 42.7 months' follow-up. The correlation between these two scores was investigated. RESULTS: The WOSI significantly correlated with the Walch-Duplay score (global score, and specific items of pain, stability, return to activity). The standard correlation coefficient was 0.8 and the Lin correlation coefficient was 0.65. The WOSI did not correlate with the mobility item of the Walch-Duplay score. DISCUSSION: The WOSI was found to correlate with the Walch-Duplay score. However, the WOSI was more sensitive than the Walch-Duplay score for the assessment of patient satisfaction. It is likely that both self-administrated questionnaires and physical examinations are complementary for an accurate investigation of the functional objective and subjective outcome after shoulder stabilization surgery. TYPE OF STUDY: Retrospective. Level IV.