93 research outputs found
BMJ Med
OBJECTIVE: To evaluate the efficacy of covid-19 convalescent plasma to treat patients admitted to hospital for moderate covid-19 disease with or without underlying immunodeficiency (CORIPLASM trial). DESIGN: Open label, randomised clinical trial. SETTING: CORIMUNO-19 cohort (publicly supported platform of open label, randomised controlled trials of immune modulatory drugs in patients admitted to hospital with moderate or severe covid-19 disease) based on 19 university and general hospitals across France, from 16 April 2020 to 21 April 2021. PARTICIPANTS: 120 adults (n=60 in the covid-19 convalescent plasma group, n=60 in the usual care group) admitted to hospital with a positive SARS-CoV2 test result, duration of symptoms 40. MAIN OUTCOME MEASURES: Primary outcomes were proportion of patients with a WHO Clinical Progression Scale score of â„6 on the 10 point scale on day 4 (higher values indicate a worse outcome), and survival without assisted ventilation or additional immunomodulatory treatment by day 14. Secondary outcomes were changes in WHO Clinical Progression Scale scores, overall survival, time to discharge, and time to end of dependence on oxygen supply. Predefined subgroups analyses included immunosuppression status, duration of symptoms before randomisation, and use of steroids. RESULTS: 120 patients were recruited and assigned to covid-19 convalescent plasma (n=60) or usual care (n=60), including 22 (covid-19 convalescent plasma) and 27 (usual care) patients who were immunocompromised. 13 (22%) patients who received convalescent plasma had a WHO Clinical Progression Scale score of â„6 at day 4 versus eight (13%) patients who received usual care (adjusted odds ratio 1.88, 95% credible interval 0.71 to 5.24). By day 14, 19 (31.6%) patients in the convalescent plasma group and 20 (33.3%) patients in the usual care group needed ventilation, additional immunomodulatory treatment, or had died. For cumulative incidence of death, three (5%) patients in the convalescent plasma group and eight (13%) in the usual care group died by day 14 (adjusted hazard ratio 0.40, 95% confidence interval 0.10 to 1.53), and seven (12%) patients in the convalescent plasma group and 12 (20%) in the usual care group by day 28 (adjusted hazard ratio 0.51, 0.20 to 1.32). In a subgroup analysis performed in patients who were immunocompromised, transfusion of covid-19 convalescent plasma was associated with mortality (hazard ratio 0.39, 95% confidence interval 0.14 to 1.10). CONCLUSIONS: In this study, covid-19 convalescent plasma did not improve early outcomes in patients with moderate covid-19 disease. The efficacy of convalescent plasma in patients who are immunocompromised should be investigated further. TRIAL REGISTRATION: ClinicalTrials.gov NCT04345991
Analysis of polymorphism associated with tandem repeats for the typing of two human pathogenic mycoplasma species : mycoplasma genitalium and Mycoplasma pneumoniae
Au sein des mycoplasmes pathogĂšnes pour lâhomme, il existe des mycoplasmes Ă tropisme respiratoire, parmi lesquels M. pneumoniae, et dâautres dont le tropisme est la sphĂšre urogĂ©nitale, comme M. genitalium. M. genitalium est un agent Ă©mergent dont lâĂ©pidĂ©miologie est encore mal connue. Il est responsable dâinfections sexuellement transmissibles, urĂ©trites chez lâhomme et cervicites chez la femme. M. pneumoniae est responsable dâinfections respiratoires aiguĂ«s chez lâenfant et lâadulte jeune. M. genitalium est une espĂšce extrĂȘmement fastidieuse dont la culture est exceptionnelle Ă partir de prĂ©lĂšvements de patients. Dans le but d'enrichir notre collection de prĂ©lĂšvements positifs pour M. genitalium un protocole de recherche clinique (FeminIST) proposant un dĂ©pistage systĂ©matique par PCR du portage de M. genitalium chez les femmes infectĂ©es par le VIH de la cohorte Aquitaine a Ă©tĂ© mis en place. Les mĂ©thodes gĂ©notypiques ont Ă©tĂ© largement appliquĂ©es pour le typage molĂ©culaire des Mollicutes, mais peu de mĂ©thodes simples, automatisĂ©es et discriminantes lâont Ă©tĂ© Ă M. genitalium et M. pneumoniae. La MLVA (« Multi-Locus Variable-Number of Tandem-Repeats Analysis ») est une mĂ©thode qui analyse le polymorphisme associĂ© aux rĂ©pĂ©titions en tandem, prĂ©sentant de nombreux avantages, comme un pouvoir discriminant Ă©levĂ© et la possibilitĂ© dâĂȘtre rĂ©alisĂ©e directement Ă partir des prĂ©lĂšvements. Cette technique a Ă©tĂ© appliquĂ©e Ă M. genitalium et M. pneumoniae et comparĂ©e aux mĂ©thodes de typage dĂ©jĂ disponibles. Six et cinq VNTR ont Ă©tĂ© respectivement identifiĂ©s comme discriminants pour M. genitalium et M. pneumoniae. Les PCR ont Ă©tĂ© multiplexĂ©es et les amorces marquĂ©es pour faciliter et automatiser lâanalyse rĂ©alisĂ©e par Ă©lectrophorĂšse capillaire. La mĂ©thode a Ă©tĂ© rĂ©alisĂ©e sur notre collection de 265 souches cliniques de M. pneumoniae et directement Ă partir de 123 prĂ©lĂšvements positifs de M. genitalium. La MLVA a permis de typer 89,4 % des prĂ©lĂšvements positifs pour M. genitalium et toutes les souches de M. pneumoniae. Elle sâest rĂ©vĂ©lĂ©e plus discriminante que les autres mĂ©thodes pour les deux espĂšces. Les reprĂ©sentations hiĂ©rarchiques des rĂ©sultats confirment lâhĂ©tĂ©rogĂ©nĂ©itĂ© de lâespĂšce M. genitalium et, en revanche, lâhomogĂ©nĂ©itĂ© de lâespĂšce M. pneumoniae. En rĂ©sumĂ©, la MLVA sâavĂšre ĂȘtre un outil de typage molĂ©culaire performant pour M. genitalium et M. pneumoniae donnant des rĂ©sultats facilement Ă©changeables entre laboratoires.Human pathogenic mycoplasmas include respiratory tract species, such as M. pneumoniae and urogenital species, such as M. genitalium. M. genitalium is an emerging agent for which epidemiology is unclear. It is involved in sexually transmitted infections, mainly urethritis in men and cervicitis in women. M. pneumoniae is responsible for acute respiratory infections especially in children. M. genitalium is a fastidious species for which culture remains extremely difficult. In order to extend our collection of samples positive for M. genitalium, a clinical research study (FeminIST) was conducted. It consisted in a PCR screening for M. genitalium in the urogenital tract of HIV-infected women of the Aquitaine cohort. Genotyping methods have been widely applied to Mollicutes, but few simple and automatized methods have been developed for M. genitalium and M. pneumoniae. The MLVA (Multi-Locus Variable-Number Tandem-Repeats Analysis) method analyzes the genome polymorphism associated with tandem repeats. Its advantages are a high discriminatory power and the possibility of being used directly from clinical samples. This technique was applied to M. genitalium and M. pneumoniae and compared with other available genotyping methods. Six and five VNTR were selected for M. genitalium and M. pneumoniae, respectively. The use of multiplex PCR and capillary electrophoresis enabled a high-throughput analysis and allowed an easy interpretation of the results. The method was applied to our collection of 265 M. pneumoniae clinical strains and used directly from 123 clinical samples positive for M. genitalium. 89.4% of M. genitalium PCR-positive samples and all the M. pneumoniae isolates were amplified and typed. We showed a higher discriminatory power for our MLVA than for other genotyping methods, without the need of a fastidious sequencing step. The hierarchical representation of results confirms the M. genitalium species heterogeneity and the M. pneumoniae species homogeneity. MLVA appears to be a good tool for molecular typing of these two mycoplasma species, allowing an easy exchange of data between laboratories
Analysis of polymorphism associated with tandem repeats for the typing of two human pathogenic mycoplasma species : mycoplasma genitalium and Mycoplasma pneumoniae
Au sein des mycoplasmes pathogĂšnes pour lâhomme, il existe des mycoplasmes Ă tropisme respiratoire, parmi lesquels M. pneumoniae, et dâautres dont le tropisme est la sphĂšre urogĂ©nitale, comme M. genitalium. M. genitalium est un agent Ă©mergent dont lâĂ©pidĂ©miologie est encore mal connue. Il est responsable dâinfections sexuellement transmissibles, urĂ©trites chez lâhomme et cervicites chez la femme. M. pneumoniae est responsable dâinfections respiratoires aiguĂ«s chez lâenfant et lâadulte jeune. M. genitalium est une espĂšce extrĂȘmement fastidieuse dont la culture est exceptionnelle Ă partir de prĂ©lĂšvements de patients. Dans le but d'enrichir notre collection de prĂ©lĂšvements positifs pour M. genitalium un protocole de recherche clinique (FeminIST) proposant un dĂ©pistage systĂ©matique par PCR du portage de M. genitalium chez les femmes infectĂ©es par le VIH de la cohorte Aquitaine a Ă©tĂ© mis en place. Les mĂ©thodes gĂ©notypiques ont Ă©tĂ© largement appliquĂ©es pour le typage molĂ©culaire des Mollicutes, mais peu de mĂ©thodes simples, automatisĂ©es et discriminantes lâont Ă©tĂ© Ă M. genitalium et M. pneumoniae. La MLVA (« Multi-Locus Variable-Number of Tandem-Repeats Analysis ») est une mĂ©thode qui analyse le polymorphisme associĂ© aux rĂ©pĂ©titions en tandem, prĂ©sentant de nombreux avantages, comme un pouvoir discriminant Ă©levĂ© et la possibilitĂ© dâĂȘtre rĂ©alisĂ©e directement Ă partir des prĂ©lĂšvements. Cette technique a Ă©tĂ© appliquĂ©e Ă M. genitalium et M. pneumoniae et comparĂ©e aux mĂ©thodes de typage dĂ©jĂ disponibles. Six et cinq VNTR ont Ă©tĂ© respectivement identifiĂ©s comme discriminants pour M. genitalium et M. pneumoniae. Les PCR ont Ă©tĂ© multiplexĂ©es et les amorces marquĂ©es pour faciliter et automatiser lâanalyse rĂ©alisĂ©e par Ă©lectrophorĂšse capillaire. La mĂ©thode a Ă©tĂ© rĂ©alisĂ©e sur notre collection de 265 souches cliniques de M. pneumoniae et directement Ă partir de 123 prĂ©lĂšvements positifs de M. genitalium. La MLVA a permis de typer 89,4 % des prĂ©lĂšvements positifs pour M. genitalium et toutes les souches de M. pneumoniae. Elle sâest rĂ©vĂ©lĂ©e plus discriminante que les autres mĂ©thodes pour les deux espĂšces. Les reprĂ©sentations hiĂ©rarchiques des rĂ©sultats confirment lâhĂ©tĂ©rogĂ©nĂ©itĂ© de lâespĂšce M. genitalium et, en revanche, lâhomogĂ©nĂ©itĂ© de lâespĂšce M. pneumoniae. En rĂ©sumĂ©, la MLVA sâavĂšre ĂȘtre un outil de typage molĂ©culaire performant pour M. genitalium et M. pneumoniae donnant des rĂ©sultats facilement Ă©changeables entre laboratoires.Human pathogenic mycoplasmas include respiratory tract species, such as M. pneumoniae and urogenital species, such as M. genitalium. M. genitalium is an emerging agent for which epidemiology is unclear. It is involved in sexually transmitted infections, mainly urethritis in men and cervicitis in women. M. pneumoniae is responsible for acute respiratory infections especially in children. M. genitalium is a fastidious species for which culture remains extremely difficult. In order to extend our collection of samples positive for M. genitalium, a clinical research study (FeminIST) was conducted. It consisted in a PCR screening for M. genitalium in the urogenital tract of HIV-infected women of the Aquitaine cohort. Genotyping methods have been widely applied to Mollicutes, but few simple and automatized methods have been developed for M. genitalium and M. pneumoniae. The MLVA (Multi-Locus Variable-Number Tandem-Repeats Analysis) method analyzes the genome polymorphism associated with tandem repeats. Its advantages are a high discriminatory power and the possibility of being used directly from clinical samples. This technique was applied to M. genitalium and M. pneumoniae and compared with other available genotyping methods. Six and five VNTR were selected for M. genitalium and M. pneumoniae, respectively. The use of multiplex PCR and capillary electrophoresis enabled a high-throughput analysis and allowed an easy interpretation of the results. The method was applied to our collection of 265 M. pneumoniae clinical strains and used directly from 123 clinical samples positive for M. genitalium. 89.4% of M. genitalium PCR-positive samples and all the M. pneumoniae isolates were amplified and typed. We showed a higher discriminatory power for our MLVA than for other genotyping methods, without the need of a fastidious sequencing step. The hierarchical representation of results confirms the M. genitalium species heterogeneity and the M. pneumoniae species homogeneity. MLVA appears to be a good tool for molecular typing of these two mycoplasma species, allowing an easy exchange of data between laboratories
Etude prospective de l'osteoporose chez des patients infectés par le VIH de la cohorte ANRS CO3 Aquitaine
BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
Osteoarticular manifestations associated with HIV infection
About 150,000 people are HIV-positive in France, and the number of new cases is estimated at 7000-8000 per year, with no tendency to diminish over time. Admissions of HIV-positive patients have been decreasing, in contrast, since 2008, reflecting the dramatic improvements in quality of life and survival provided by triple antiretroviral regimens. HIV infection is now a chronic disease that exposes patients to the virus and antiretroviral drugs for many years. One consequence has been the emergence of new health conditions in HIV-positive patients, such as tumors, cardiovascular disease, and osteoarticular complications. These epidemiological and clinical changes have made it necessary for rheumatologists to learn about the osteoarticular abnormalities associated with the HIV, which they are likely to encounter at some point during their everyday practice. Osteoporosis is one such abnormality, and this review article starts with a discussion of the literature on this topic. Bone loss is common, chiefly in males. Multiple factors are involved. Studies have demonstrated an increase in the fracture risk and, consequently, recommendations about the screening and treatment of osteoporosis have been issued. The focus of this review article then turns to the other rheumatic manifestations seen in HIV-positive patients, including osteomalacia, avascular necrosis, and inflammatory joint disease. Osteoarticular pain is frequently reported by HIV-positive patients. Identifying the cause is essential to determine the best treatment strategy. Interestingly, immunosuppressant drugs, and even biotherapies, have shown a good safety profile in these immunodeficient patients
LĂ©sions buccales dâecthyma gangrenosum : prĂ©sentation dâun cas
Lâecthyma gangrenosum (EG) est une infection cutanĂ©e
rare, souvent associée à une bactériémie à Pseudomonas aeruginosa
(PA). Le terrain de survenue est celui des infections à PA : imunodéprimés, toxicomanes IV,
patients hospitalisĂ©s⊠LâEG se traduit par lâapparition, dans un
contexte septique systémique, de bulles hémorragiques multiples,
indurées, de petite taille, entourées par un érythÚme marqué, qui
évoluent rapidement vers des ulcérations nécrotiques avec un halo
érythémateux. Dans le cas présenté, les hémocultures étant négatives,
câest lâaspect des lĂ©sions jugales et vulvaires, le contexte dâimmunodĂ©pression
et la présence de PA sur les prélÚvements qui ont permis le diagnostic.
Les lĂ©sions de lâEG doivent ĂȘtre connues des chirurgiens oraux afin
de les traiter précocement avec une antibiothérapie adaptée et de
rechercher une probable immunodéficience méconnue
Necrotic Lip Infection Complicated by Facial Cellulitis and Septic Thoracic Emboli in an 18-year-old Man: A Quiz
Abstract is missing (Quiz
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