0051: Acute coronary syndrome and diabetes mellitus in elderly patients

Coronary heart disease is the first cause of morbidity and mortality in diabetic patients. Its incidence in elderly patients increases with the increase of their life expectancy. The aim of our study was to evaluate the characteristics and the management of elderly patients with diabetes and compared this with non- diabetics patients.This is a comparative retrospective study of 204 elderly patients (>75 years) admitted for ACSin haguenau Hospital center in France, between August 2012 and August 2013. We compared 63 elderly patients diabetics (GI), with 141 elderly patients non-diabetic (GII)The mode age: 80years (GI), 82years (GII). A male predominance noted in the both groups. More risk factors in (GI): hypertension (p=0.002), dyslipidemia (p=0.034), while (GII) is more smoker (p=0.003). More comorbidities for (GI), especially high frequency of renal failure (p<0.001). Predominance of atypical pain in both groups. NSTEMI was predominant in the both groups. At coronary angiography, three-vessel involvement was more frequent in (GI). Percutaneous coronary intervention (PCI) is less used in theGI (62.7%) toGII (69.5%). Hospital complications were higher in diabetics particulary: renal failure (p=0.04). Evolution at6and12month ago shows a more predominance of complications in diabetics. The quality of life of nondiabetic is better than in diabetics. On the other hand, the quality of life of the diabetics after PCI was better to conventional therapy. Elderly diabetic patients are very high cardiovascular risk, characterized by the severity of coronary artery disease. Diabetics are treated less aggressively than non-diabetics yet that diabetics quality of life improves better with angioplasty in comparison with the conventional treatment

T Cell Reactivity against Mycolyl Transferase Antigen 85 of M. tuberculosis in HIV-TB Coinfected Subjects and in AIDS Patients Suffering from Tuberculosis and Nontuberculous Mycobacterial Infections

The mycolyl transferase antigen 85 complex is a major secreted protein family from mycobacterial culture filtrate, demonstrating powerful T cell stimulatory properties in most HIV-negative, tuberculin-positive volunteers with latent M.tuberculosis infection and only weak responses in HIV-negative tuberculosis patients. Here, we have analyzed T cell reactivity against PPD and Ag85 in HIV-infected individuals, without or with clinical symptoms of tuberculosis, and in AIDS patients with disease caused by nontuberculous mycobacteria. Whereas responses to PPD were not significantly different in HIV-negative and HIV-positive tuberculin-positive volunteers, responses to Ag85 were significantly decreased in the HIV-positive (CDC-A and CDC-B) group. Tuberculosis patients demonstrated low T cell reactivity against Ag85, irrespective of HIV infection, and finally AIDS patients suffering from NTM infections were completely nonreactive to Ag85. A one-year follow-up of twelve HIV-positive tuberculin-positive individuals indicated a decreased reactivity against Ag85 in patients developing clinical tuberculosis, highlighting the protective potential of this antigen

In Leishmaniasis due to Leishmania guyanensis infection, distinct intralesional interleukin-10 and foxp3 mRNA expression are associated with unresponsiveness to treatment

The presence of intralesional natural regulatory T cells, characterized by the expression of Foxp3 mRNA, was analyzed in patients with localized leishmaniasis due to Leishmania guyanensis infection that was unresponsive to treatment with pentamidine isethionate. Foxp3 mRNA levels were associated with unresponsiveness to treatment among patients with a lesion duration of ⩾1 month, but this association was not observed among patients with a lesion duration of <1 month. In conclusion, high intralesional expression of Foxp3 might be an indicator of poor response to treatment, depending on the duration of lesion

Outbreak of Leishmania braziliensis cutaneous leishmaniasis, Saül, French Guiana [letter]

New World cutaneous leishmaniasis (CL), a zoonotic disease, is increasingly seen among travelers returning from Latin American countries, particularly from Bolivia, Belize, and French Guiana (1). The epidemiology of CL in the Americas is heterogeneous and has complex variations in transmission cycles, reservoir hosts, and sandfly vectors. Changing human activities that affect these factors may have resulted in the emergence of species with distinct pathogenic potentials and responses to therapy. In the Guianan ecoregion complex, leishmaniasis is endemic, and 5 coexisting Leishmania parasite species are known to infect humans: L. guyanensis, L. braziliensis, L. amazonensis, L. naiffi, and L. lainsoni. Among these species, L. guyanensis accounts for ≈85% of CL cases (2). We report an outbreak of 7 cases of L. braziliensis CL that occurred among 24 scientists who participated in a field mission at Limonade Creek in Saül, French Guiana, during October 10–25, 2013. Saül is an isolated village in the Amazonian rainforest (3°55′18′′N, 53°18′02′′W)

Caractéristiques de la toxoplasmose chez les patients infectés par le virus d el'immunodéficience humaine en Guyane française (étude rétrospective de 58 cas hospitalisés au centre hospitalier de Cayenne de 1997 à 2003)

Propos : caractéristiques de la toxoplasmose chez les patients VIH en Guyane ; Matériel :étude rétrospective : 58 épisodes de toxoplasmose cérébrale, extra-cérébrale ou de séroconversion toxoplasmique ; Résultats : l'âge moyen est de 44ans, le sex-ratio à 1,15. Les signes cliniques : confusion 42,4%, céphalées 36,2%, convulsions 25,9%, hémiparésie 41,4%, atteinte d'une paire crânienne 19%, altération de la conscience 41,4%, troubles du comportement 22,4%, localisations extra-cérébrales 5,2% et maladies associées 75,9%. Radiologie : 37,7% de lésions cérébrales uniques, 69,8% de lésions rehaussées en couronne, 35,8% d'œdème péri-lésionnel ; Biologie : les CD4+ moyens sont à 88,4/mm3, ponction lombaire 18,9%, hyponatrémie 44,4%. Le traitement est le Cotrimoxazole fort (46,6%), 18,5% d'effets secondaires versus 64,7% sous Sulfadiazine/pyriméthamine (p=0,001), durée du traitement > à 6 semaines (71,5%), l'évolution est favorable (64,3%), le décès survient dans 12,5% des cas et il existe 29,3% de récidives ; Conclusion : bonne tolérance et efficacité du traitement par Cotrimoxazole fort. Existence d'un problème lié à l'observance thérapeutiqueGRENOBLE1-BU Médecine pharm. (385162101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

La Leishmaniose cutanée en Guyane (études épidémiologique, clinique et thérapeutique des cas recensés au centre hospitalier de Cayenne de 1994 à 2010)

Le service de dermatologie de Cayenne est le principal centre médical civil pour la prise en charge des leishmanioses en Guyane.Les formes cutanées dues à Leishmania guyanensis prédominent mais les contaminations par L.braziliensis, qui peuvent causer des lésions muqueuses,sont préoccupantes.Cette étude avait pour objectifs d étudier les aspects épidémiologiques,cliniques et thérapeutiques de la cohorte de patients ayant consulté dans ce service entre 1994 et 2010.Après une description épidémiologique des cas,l influence du climat a été étudiée à l aide de série temporelle.Les tableaux cliniques en fonction de l espèce,L.guyanensis versus L.braziliensis,ont été analysés à l aide d une régression logistique.L efficacité de la pentamidine était évaluée 2 mois après l injection initiale.La cohorte comptait 1563 nouveaux cas, soit en moyenne 92 cas/an (25 à 214).Le nombre annuel de contaminations était corrélé négativement aux précipitations de la même année (r=-0,71;p=0,0018) et une diminution des précipitations mensuelles s accompagnait d une augmentation des contaminations 2 mois plus tard.Le tableau clinique le plus fréquent montrait 2 lésions ulcéreuses de 2cm de diamètre au niveau des parties découvertes du corps.Selon l espèce,cette présentation initiale n était pas significativement différente.La pentamidine permettait une guérison à 2 mois,partielle ou complète,dans 86% des cas (IC95=82,7-88,7).Malgré les limites inhérentes aux méthodes utilisées,cette étude souligne l intérêt d un dispositif concerté de surveillance avec un diagnostic d espèce systématique.L identification des lieux et des périodes à risque suggère un renforcement ciblé des mesures prophylactiques.The Department of Dermatology, Cayenne is the main civilian medical center for support of leishmaniasis in French Guiana. Cutaneous forms due to Leishmania guyanensis predominate but contamination by Leishmania braziliensis, which may cause mucosal injuries are a concern. This study aimed to investigate the epidemiological, clinical and therapeutic aspects of the cohort of patients seen from 1994 to 2010. After an epidemiological description of cases, the influence of climate has been studied using time series. The clinical presentations depending on the species were analyzed using logistic regression. The efficacy of pentamidine on Leishmania guyanensis and Leishmania braziliensis were compared using test for paired data. The cohort included 1563 new cases, averaging 92 (+- 46) cases per year. The number of infections per year was negatively correlated with rainfall in the same year (r=-0.71, p=0.0018) and lower monthly precipitation was accompanied by an increase in contamination 2 months later. The most common clinical presentation was 2 ulcerative lesions of 2 cm in diameter at the exposed parts of body. According to species, the initial clinical presentation was not significantly different and no difference in efficacy of pentamidine was highlighted. Despite the limitations inherent in the methods used, this study highlights the value of a device for the monitoring of leishmaniasis with a systematic diagnosis of the species. The identification of locations and risk periods suggests a targeted strengthening of preventive measuresCAYENNE-BU (973022101) / SudocSudocFranceFrench GuianaFRG

LA MALADIE DE KAPOSI (LE PARADOXE GUYANAIS)

MONTPELLIER-BU Médecine UPM (341722108) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Facteurs de risque d'infection par le VIH parmi les consultants de la consultation de dépistage anonyme et gratuit (CDAG) du Centre hospitalier de Cayenne

MONTPELLIER-BU Médecine UPM (341722108) / SudocPARIS-BIUM (751062103) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Ulcérations et ulcères des membres inférieurs en milieu tropical amazonien (étude prospective en Guyane Française)

CAEN-BU Médecine pharmacie (141182102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF