Long-term prediction of adherence to continuous positive air pressure therapy for the treatment of moderate/severe obstructive sleep apnea syndrome

BACKGROUND: Continuous positive airway pressure (CPAP) therapy is a highly effective treatment for obstructive sleep apnea syndrome (OSAS). However, poor adherence is a limiting factor, and a significant proportion of patients are unable to tolerate CPAP. The aim of this study was to determine predictors of long-term non-compliance with CPAP. METHODS: CPAP treatment was prescribed to all consecutive patients with moderate or severe OSAS (AHI ≥15 events/h) (n = 295) who underwent a full-night CPAP titration study at home between February 1, 2002 and December 1, 2016. Adherence was defined as CPAP use for at least 4 h per night and five days per week. Subjects had periodical follow-up visits including clinical and biochemical evaluation and assessment of adherence to CPAP. RESULTS: Median follow-up observation was 74.8 (24.2/110.9) months. The percentage of OSAS patients adhering to CPAP was 41.4% (42.3% in males and 37.0% in females), and prevalence was significantly higher in severe OSAS than in moderate (51.8% vs. 22.1%; p < 0.001; respectively). At multivariate analysis, lower severity of OSAS (HR = 0.66; CI 95 0.46-0.94) p < 0.023), cigarette smoking (HR = 1.72; CI 95 1.13-2.61); p = 0.011), and previous cardiovascular events (HR = 1.95; CI 95 1.03-3.70; p = 0.04) were the only independent predictors of long-term non-adherence to CPAP after controlling for age, gender, and metabolic syndrome. CONCLUSIONS: In our cohort of patients with moderate/severe OSAS who were prescribed CPAP therapy, long-term compliance to treatment was present in less than half of the patients. Adherence was positively associated with OSAS severity and negatively associated with cigarette smoking and previous cardiovascular events at baseline

Données épidémiologiques dans le monde et traitements disponibles du VHB

Date du colloque&nbsp;: 09/2008</p

Traitement des hépatites B, C, D

Les hépatites virales sont un problème majeur de santé publique au niveau international. Environ 2 milliards de sujets dans le monde ont été en contact avec le VHB, soit qu\u27ils aient une infection, soit qu\u27ils aient éliminé partiellement le virus [1]. Quatre cents millions d\u27individus sont porteurs chroniques d\u27une infection par le virus de l\u27hépatite B (VHB) et parmi ceux-ci, environ à 15 millions sont co-infectés par un virus satellite du virus de l\u27hépatite B appelé le virus de l\u27hépatite Delta (VHD).Dans le monde, près de 200 millions de sujets sont également infectés par le virus de l\u27hépatite C [2]. Les chiffres concernant la mortalité et la morbidité globale de ces infections sont partiellement connus. L\u27OMS estime qu\u27environ 2 millions de décès par an sont dus aux infections par les virus des hépatites C (http://www.who.int/fr/). On sait également que les patients porteurs d\u27une infection chronique ont un risque majeur d\u27évoluer vers la cirrhose du foie et le carcinome hépato-cellulaire (le risque serait de 200 par rapport à un sujet non infecté [3, 4] ). Dans les pays développés, les hépatites B et C sont également responsables d\u27une grande partie des transplantations hépatiques [1] . L\u27objectif de cette revue est de faire le point sur le traitement des hépatites B, C et Delta en envisageant les schémas thérapeutiques les plus adaptés à l\u27Afrique. Nous aborderons d\u27abord le traitement des hépatites B, le traitement des co-infections B-Delta, le traitement des hépatites B chez les patients VIH puis le traitement des hépatites C et celui des hépatites C chez les patients vivant avec le VIH

MAPPA. Methodologies applied to archaeological potential Predictivity

The fruitful cooperation over the years between the university teaching staff of Univerità di Pisa (Pisa University), the officials of the Soprintendenza per i Beni Archeologici della Toscana (Superintendency for Archaeological Heritage of Tuscany), the officials of the Soprintendenza per i Beni Architettonici, Paesaggistici, Artistici ed Etnoantropologici per le Province di Pisa e Livorno (Superintendency for Architectural, Landscape and Ethno-anthropological Heritage for the Provinces of Pisa and Livorno), and the Comune di Pisa (Municipality of Pisa) has favoured a great deal of research on issues regarding archaeological heritage and the reconstruction of the environmental and landscape context in which Pisa has evolved throughout the centuries of its history. The desire to merge this remarkable know-how into an organic framework and, above all, to make it easily accessible, not only to the scientific community and professional categories involved, but to everyone, together with the wish to provide Pisa with a Map of archaeological potential (the research, protection and urban planning tool capable of converging the heritage protection needs of the remains of the past with the development requirements of the future) led to the development of the MAPPA project – Methodologies applied to archaeological potential predictivity - funded by Regione Toscana in 2010. The two-year project started on 1 July 2011 and will end on 30 June 2013. The first year of research was dedicated to achieving the first objective, that is, to retrieving the results of archaeological investigations from the archives of Superintendencies and University and from the pages of scientific publications, and to making them easily accessible; these results have often never been published or have often been published incompletely and very slowly. For this reason, a webGIS (“MappaGIS” that may freely accessed at http://mappaproject.arch.unipi.it/?page_id=452) was created and will be followed by a MOD (Mappa Open Data archaeological archive), the first Italian archive of open archaeological data, in line with European directives regarding access to Public Administration data and recently implemented by the Italian government also (the beta version of the archive can be viewed at http://mappaproject.arch.unipi.it/?page_id=454). Details are given in this first volume about the operational decisions that led to the creation of the webGIS: the software used, the system architecture, the organisation of information and its structuring into various information layers. But not only. The creation of the webGIS also gave us the opportunity to focus on a series of considerations alongside the work carried out by the MAPPA Laboratory researchers. We took the decision to publish these considerations with a view to promoting debate within the scientific community and, more in general, within the professional categories involved (e.g. public administrators, university researchers, archaeology professionals). This allowed us to overcome the critical aspects that emerged, such as the need to update the archaeological excavation documentation and data archiving systems in order to adjust them to the new standards provided by IT development; most of all, the need for greater and more rapid spreading of information, without which research cannot truly progress. Indeed, it is by comparing and connecting new data in every possible and, at times, unexpected way that research can truly thrive

Les mutants précore et du promoteur basal du core du virus de l’hépatite B

Le virus de l’hépatite B (VHB) est le seul virus à ADN qui possède une étape de reverse transcription au cours de son cycle de réplication. L’absence d’activité 3’-5’ exonucléasique de la fonction reversetranscriptase de l’ADN polymérase du virus génère une accumulation de mutations sur l’ensemble du génome viral. Ainsi, chez un même individu vont coexister des populations virales sauvages et mutées qui pourront évoluer tout au long de l’histoire naturelle de l’infection. La variabilité génétique du VHB s’observe dans toutes les régions du génome viral. La mutation la plus fréquemment décrite dans la région précore (PC) du VHB est la mutation G1896A qui induit la formation d’un codon stop dans l’ARN précore et abolit la synthèse de l’antigène HBe. Dans la région du promoteur basal du core (PBC), la double mutation (A1762T-G1764A) est associée à une baisse de la synthèse de l’antigène HBe. L’impact des mutants PC et du PBC dans l’histoire naturelle de l’hépatite B et dans la sévérité des lésions hépatiques n’est pas clairement établi

Systemic diseases and biotherapies: Understanding, evaluating, and preventing the risk of hepatitis B reactivation

Hepatitis B virus (HBV) reactivation can occur in chronic carriers of the HBV surface antigen (HBsAg) and constitutes a well-known complication of immunosuppressive therapy. HBV reactivation has also been reported after contact with the HBV. The increasing use of biological agents (TNFα antagonists, rituximab, abatacept, and tocilizumab) to treat systemic diseases has resulted in numerous publications about the risk of HBV reactivation. The relevant scientific societies have issued recommendations designed to prevent HBV reactivation. The main measures consist of screening for markers indicating chronic HBV infection (HBsAg) or HBV infection in the distant past (antibodies to the HBV core antigen) before initiating biological therapies, vaccinating marker-negative patients, and considering close follow-up or antiviral treatment before immunosuppressive treatment initiation or in the event of HBV reactivation. Here, we discuss the pathophysiological mechanisms underlying HBV reactivation during biological treatments, most notably in patients with occult HBV infection or markers for remote HBV infection, whose hepatocyte nuclei may contain a resistance form of HBV DNA known as covalently closed circular DNA (cccDNA). Assessment of the risk of reactivation relies on the HBV status, drugs used, and data from the literature. Finally, we discuss the various recommendations and modalities for HBV vaccination, preemptive treatment, and patient management, according to the level of risk and to the circumstances in which reactivation occurs

Time trend of Legionella colonization in the waterline of a hospital of Rome, Italy

Background: In many hospital’s Legionella outbreaks, hot water systems are the most frequent source of infection. Objectives: Considering the old age of the hospital waterline, an investigation on Legionella spp. water colonization was performed to evaluate the system weakness and to implement environmental preventive measures. Methods: From 2004 to 2010, a total of 5 sampling campaigns were performed, collecting 99 water samples from 13 wards and 3 other points of the water line (boilers, point of connection with public water line, hospital waterworks). The samples were analyzed, following national Legionella spp. standard methods. Results: A total of 28 samples (28.3%) were positive for Legionella spp. There has been an increasing time trend until 2008, from 4.5% to 75% in 2008; in the first month of 2010 only 26.3% of the samples were positive. The boiler was positive in 45.5% of samples collected since 2006. In total, surgeries were positive in 38% of cases (8/21): 100% of positive samples in 2006 and 2008, reduced at 50% in the first month of 2010. Only in these wards Legionella spp. were found four times to be >10,000 cfu/L. Among other wards, emergency medicine and oncology are the most contaminated (31% of positive samples). The worst year was 2008 with 75% of positive samples. Conclusion: Hospital water system seems to be affected by Legionella spp. colonization most frequently from 2006 to 2010. The high percentage of positivity in 2008 was related to the presence of a building yard in the hospital. In 2010 there was an improvement, although boilers, surgery, medicine and oncology are still contaminated. It is necessary now to investigate the temperature level mantained in hot-water system and also to observe if the structural characteristics of water ducts could have influenced the colonization observed

Actualités sur les co-infections VIH–VHC

Objectives To evaluate the incidence of HIV–HCV co-infections and analyse the outcome in co-infected patients. Epidemiology. Effects of antivirals The prevalence of the co-infection by the HCV thus varies from 10 to 14% on subjects who have sexual behaviors at risk at 80 or 90% on users of drug IV. Numerous studies showed that the infection by the HIV made worse the natural history of the infection by the HCV [J Acquir Immune Defic Syndr 6 1993 602–610; J Hepatol 28 1998 945–950]. On the other hand, the studies which endeavoured to appreciate the effect of the antiretroviral therapeutics on the natural history of the chronic hepatitis C, on the co-infected patients, are more discussed. In cohorts of big size, it was demonstrated that the hepatic mortality increased with the exposure to antiretrovirals. However, the duration of the antiretroviral treatment also reports the more important survival of the patients, which distorts credibly the figures. The effect of the infection by the HCV on the progress of the disease with HIV is more discussed. The patients infected by the HIV, in any case, have to benefit from the research for a co-infection by the viruses of hepatitis B and C (HBV and HCV). This screening must be renewed every year, in particular on the drug addicts patients or presenting behaviors at risk. Viral replication The research of a viral replication, must be implemented for any confirmed positive HCV serology. The research of the HCV RNA needs ultrasensitive techniques of molecular biology which allow a qualitative detection andor a quantification of the viral genome (viral load). The techniques of last generation of real-time PCR combine both approaches (detection and quantification). The viral load HCV is not correlated to the degree of hepatic disease and does not predict the severity of the hepatic disease, contrary to the correlation demonstrated in the infection by the HIV. On the other hand, it can be a predictive factor in the response to the treatment. The pretherapeutic check-up also includes a determination of the viral genotype because a strong involvement in the response to the treatment was clearly demonstrated. Hepatic fibrosis The hepatic fibrosis must be estimated on patients having a chronic hepatitis because it conditions the prognosis and the treatment of the hepatitis. The anatomopathological study after hepatic biopsy (DHB) remains the reference method. Recently, the development of non invasive methods of measure of the hepatic fibrosis improved the care of hepatitis C, notably the blood tests (fibrotest BioPredictive Paris, fibrometer BLS Angers) and physical measures as the impulsional elastometry (Fibroscan® Echosens) which substitutes more and more in practice to the draining hepatic biopsy. Treatment Numerous studies now validated the treatment associating interferon pegilated and ribavirine as the reference treatment on the co-infected patients HIV/HCV. This treatment involves a high virological response going from 14 to 36% in the patients infected by a genotype 1 and 2 and from 43 to 73% in the patients infected by a genotype 2 or 3. The duration of the treatment is 48 weeks. As well as usual virological factors on the mono-infected patients (genotype, viral load), the rate of CD4 is one of the best predictive factors with a good response. Many hopes go towards the new molecules in development (inhibitors of protease), inhibitors of polymerase), with promising results on the mono-infected patients. However, the toxicity of these molecules is not very well known at the moment in the co-infected patients. It is thus necessary to perform trials in this group of patient, by watching very carefully the toxicity of the therapeutic associations

Quantification de l’antigène HBs : intérêts et limites dans le suivi des patients infectés par le virus de l’hépatite B

Hepatitis B surface antigen (HBsAg) is usually used as a qualitative marker for the diagnosis of hepatitis B virus (HBV) infection, ant its persistence for more 6 months defines chronic hepatitis B (CHB) infection. HBsAg quantification was introduced several years ago. Commercial quantitative assays are now available and studies have suggested its interest for the monitoring patients with chronic hepatitis B. Indeed, HBsAg titers can correlate with intrahepatic cccDNA levels. Several studies have shown that HBsAg titers vary in the different phases of the natural history of the CHB infection. The kinetic of serum HBsAg seems to have a predictive value of HBsAg clearance after treatment or of reactivation, in the case of lack of response to treatment. However, interpretation has to take into account the phase of CHB infection, the HBV genotype, HBeAg status and serum HBV DNA