La construction d’une organisation territoriale des acteurs de soins primaires face à l’épidémie de Covid-19 : apports d’une étude de cas à l’échelle d’un canton

Comment une organisation territoriale des soins primaires se construit-elle en temps d’épidémie, en prenant appui sur un système d’action préexistant à l’échelle du territoire ? L’étude de cas menée entre mars et septembre 2020 mêle observation participante et entretiens sociologiques avec 21 professionnels impliqués dans cette organisation, à l’échelle d’un canton sous-doté en offre de soins, centré sur une métropole urbaine défavorisée au plan socioéconomique. L’histoire des relations entre les acteurs du territoire, incarnées depuis peu dans une Communauté professionnelle territoriale de santé (CPTS), apparaît centrale dans la construction d’une organisation des soins primaires en temps d’épidémie, permettant aux acteurs - libéraux, élus locaux et hospitaliers - d’exercer un mandat de santé publique. Cette expérience questionne la capacité des CPTS à poursuivre leur contribution, après l’épidémie, à l’organisation des soins primaires répondant à une démarche de promotion de la santé, dans un système où des logiques professionnelles, gestionnaires et politiques peuvent entrer en tension

MLVA Subtyping of Genovar E Chlamydia trachomatis Individualizes the Swedish Variant and Anorectal Isolates from Men who Have Sex with Men

This study describes a new multilocus variable number tandem-repeat (VNTR) analysis (MLVA) typing system for the discrimination of Chlamydia trachomatis genovar D to K isolates or specimens. We focused our MLVA scheme on genovar E which predominates in most populations worldwide. This system does not require culture and therefore can be performed directly on DNA extracted from positive clinical specimens. Our method was based on GeneScan analysis of five VNTR loci labelled with fluorescent dyes by multiplex PCR and capillary electrophoresis. This MLVA, called MLVA-5, was applied to a collection of 220 genovar E and 94 non-E genovar C. trachomatis isolates and specimens obtained from 251 patients and resulted in 38 MLVA-5 types. The genetic stability of the MLVA-5 scheme was assessed for results obtained both in vitro by serial passage culturing and in vivo using concomitant and sequential isolates and specimens. All anorectal genovar E isolates from men who have sex with men exhibited the same MLVA-5 type, suggesting clonal spread. In the same way, we confirmed the clonal origin of the Swedish new variant of C. trachomatis. The MLVA-5 assay was compared to three other molecular typing methods, ompA gene sequencing, multilocus sequence typing (MLST) and a previous MLVA method called MLVA-3, on 43 genovar E isolates. The discriminatory index was 0.913 for MLVA-5, 0.860 for MLST and 0.622 for MLVA-3. Among all of these genotyping methods, MLVA-5 displayed the highest discriminatory power and does not require a time-consuming sequencing step. The results indicate that MLVA-5 enables high-resolution molecular epidemiological characterisation of C. trachomatis genovars D to K infections directly from specimens

Distinct Genetic Loci Control Plasma HIV-RNA and Cellular HIV-DNA Levels in HIV-1 Infection: The ANRS Genome Wide Association 01 Study

Previous studies of the HIV-1 disease have shown that HLA and Chemokine receptor genetic variants influence disease progression and early viral load. We performed a Genome Wide Association study in a cohort of 605 HIV-1-infected seroconverters for detection of novel genetic factors that influence plasma HIV-RNA and cellular HIV-DNA levels. Most of the SNPs strongly associated with HIV-RNA levels were localised in the 6p21 major histocompatibility complex (MHC) region and were in the vicinity of class I and III genes. Moreover, protective alleles for four disease-associated SNPs in the MHC locus (rs2395029, rs13199524, rs12198173 and rs3093662) were strikingly over-represented among forty-five Long Term HIV controllers. Furthermore, we show that the HIV-DNA levels (reflecting the HIV reservoir) are associated with the same four SNPs, but also with two additional SNPs on chromosome 17 (rs6503919; intergenic region flanked by the DDX40 and YPEL2 genes) and chromosome 8 (rs2575735; within the Syndecan 2 gene). Our data provide evidence that the MHC controls both HIV replication and HIV reservoir. They also indicate that two additional genomic loci may influence the HIV reservoir

Développement et enregistrement des médicaments génériques en France et dans l' Union européenne

PARIS-BIUP (751062107) / SudocSudocFranceF

Des vies extraordinaires : motifs héroïques et hagiographiques.

International audienc

Prise en charge des méningiomes de l' angle ponto-cérébelleux et de la face postérieure du rocher (à propos de 48 patients)

BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF