Prevention of urinary tract infection in spinal cord-injured patients: safety and efficacy of a weekly oral cyclic antibiotic (WOCA) programme with a 2 year follow-up--an observational prospective study.

POPULATION: Spinal cord injury (SCI) patients with neurogenic bladder have an increased risk for symptomatic urinary tract infection (UTI). Recurrent UTI requires multiple courses of antibiotic therapy, markedly increasing the incidence of multidrug-resistant (MDR) bacteria. METHODS: During an observational prospective study, we determined the safety and efficacy of a weekly oral cyclic antibiotic (WOCA) regimen to prevent UTI in SCI adult patients with neurogenic bladder undergoing clean intermittent catheterization. The WOCA regimen consisted of the alternate administration of an antibiotic once per week over a period of at least 2 years. The antibiotics chosen were efficient for UTI, well tolerated and with low selection pressure. RESULTS: There was a significant decrease in antimicrobial consumption linked to the dramatic decrease in the incidence of UTI. Before intervention, there were 9.4 symptomatic UTIs per patient-year, including 197 episodes of febrile UTI responsible for 45 hospitalizations. Under the WOCA regimen there were 1.8 symptomatic UTIs per patient-year, including 19 episodes of febrile UTI. No severe adverse events and no new cases of colonization with MDR bacteria were reported. CONCLUSIONS: In this prospective, observational pilot study a novel approach to the prevention and treatment of UTI in SCI was investigated. Our study shows the benefit of WOCA in preventing UTI in SCI patients

Clinical Study Impact of Anti-Inflammatory Drugs on Pyogenic Vertebral Osteomyelitis: A Prospective Cohort Study

Objective. Pyogenic vertebral osteomyelitis (PVO) are frequently misdiagnosed and patients often receive anti-inflammatory drugs for their back pain. We studied the impact of these medications. Methods. We performed a prospective study enrolling patients with PVO and categorized them depending on their drugs intake. Then, we compared diagnosis delay, clinical presentation at hospitalization, incidence of complications, and cure rate. Results. In total, 79 patients were included. Multivariate analysis found no correlation between anti-inflammatory drug intake and diagnosis delay, clinical presentation, complications, or outcome. Conclusion. Anti-inflammatory drugs intake does not affect diagnostic delay, severity at diagnosis, or complications of PVO

Rabies, Still Neglected after 125 Years of Vaccination

International audienceno abstrac

HER2 Status in Ovarian Carcinomas: A Multicenter GINECO Study of 320 Patients

BACKGROUND: Despite a typically good response to first-line combination chemotherapy, the prognosis for patients with advanced ovarian cancer remains poor because of acquired chemoresistance. The use of targeted therapies such as trastuzumab may potentially improve outcomes for patients with ovarian cancer. HER2 overexpression/amplification has been reported in ovarian cancer, but the exact percentage of HER2-positive tumors varies widely in the literature. In this study, HER2 gene status was evaluated in a large, multicentric series of 320 patients with advanced ovarian cancer, including 243 patients enrolled in a multicenter prospective clinical trial of paclitaxel/carboplatin-based chemotherapy. METHODOLOGY/PRINCIPAL FINDINGS: The HER2 status of primary tumors and metastases was evaluated by both immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) analysis of paraffin-embedded tissue on conventional slides. The prognostic impact of HER2 expression was analyzed. HER2 gene was overexpressed and amplified in 6.6% of analyzed tumors. Despite frequent intratumoral heterogeneity, no statistically significant difference was detected between primary tumors and corresponding metastases. CONCLUSIONS/SIGNIFICANCE: Our results show that the decision algorithm usually used in breast cancer (IHC as a screening test, with equivocal results confirmed by FISH) is appropriate in ovarian cancer. In contrast to previous series, HER2-positive status did not influence outcome in the present study, possibly due to the fact that patients in our study received paclitaxel/carboplatin-based chemotherapy. This raises the question of whether HER2 status and paclitaxel sensitively are linked

Real-world study of the efficacy and safety of belantamab mafodotin (GSK2857916) in relapsed or refractory multiple myeloma based on data from the nominative ATU in France: the IFM 2020-04 study

Belantamab mafodotin (BM) is an anti-BCMA antibody-drug conjugate (GSK2857916) that represents an alternative option in multiple myeloma. We sought to assess the efficacy and safety of BM in a real-world setting in patients who benefited from an early access program. We conducted an observational, retrospective, multicenter study. Eligibility criteria were treatment of relapsed or refractory multiple myeloma (RRMM) in monotherapy in adult patients who have received at least three lines of therapy previously, including at least one immunomodulatory agent (IMiD), a proteasome inhibitor (PI) and an anti-CD38 monoclonal antibody, and whose disease progressed during the last treatment period. The primary endpoint of the study is to assess the overall survival (OS). Between November 2019 and December 2020, 106 patients were treated with BM; 97 were eligible for the efficacy evaluation and 104 for safety. The median age was 66 (range, 37–82) years. High-risk cytogenetics were identified in 40.9% of patients. Fifty-five (56.7%) patients were triple-class refractory and 11 (11.3%) were penta-class refractory. The median number of prior lines of treatment was five (range, 3–12). The median number of BM cycles administered was three (range, 1–22). The overall response rate at best response was 38.1% (37/97). The median OS was 9.3 months (95% confidence interval [CI]: 5.9-15.3), and median progression-free survival was 3.5 months (95% CI: 1.9-4.7). The median duration of response was 9 months (range, 4.65-10.4). Treatment was delayed for 55 (52.9%) patients including 36.5% for treatment-related toxicity. Ophthalmic adverse events, mainly grade ≤2, were the most common toxicity (48%). The occurrence of keratopathy was 37.5%. Overall, our data are concordant with the results from DREAMM-2 in terms of efficacy and safety on a non-biased population

Première étude prospective avec suivi ambulatoire de la survenue des infections du site opératoire au Cambodge

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF

Impact d'une antibiothérapie prolongée sur des symptômes évocateurs de maladie de Lyme chronique

La maladie de Lyme, pathologie due à la bactérie Borrelia burgdorferi, présente une phase aigue (ECM) et une phase secondaire disséminée, mais l existence d une phase tertiaire et son étiologie de nature infectieuse ou réactionnelle, est discutée. Cette phase, de diagnostic difficile dans sa forme incomplète (absence d ECM ou sérologie négative), regroupe des symptômes pluri-organiques, souvent subjectifs et d évolution chronique. L expérience acquise dans le service de pathologies infectieuses du CHU de GARCHES (92) a permis de réaliser une étude, de nature rétrospective, portant sur 100 patients suspects de Lyme chronique et recevant un traitement antibiotique prolongé. Son objectif était de réaliser une description épidémiologique de cette cohorte et, en l absence d examen de certitude, d établir des critères de probabilité de maladie de Lyme chronique, se basant sur l évolution des symptômes sous antibiothérapie.PARIS13-BU Serge Lebovici (930082101) / SudocSudocFranceF

Préfaces

L’alimentation et l’activité physique sont des sources de plaisir, de bien-être et des déterminants majeurs de notre état de santé. Agir sur ces deux volets est un des objectifs premiers de la politique de prévention portée par le gouvernement. La continuité de l’action de l’État dans ce domaine depuis près de vingt ans a permis de limiter l’expansion du surpoids et de l’obésité. À ce titre, le Livre bleu Outre-mer et le volet Outre-mer de la stratégie nationale de santé, en réaffirmant la pr..

Coronavirus outbreak: the role of companies in preparedness and responses

International audienc

Surveillance épidémiologique et veille sanitaire. Principes, méthodes et applications en santé publique (2° Éd.)

International audienceInitialement centrée sur la prévention et le contrôle des maladies infectieuses, la surveillance épidémiologique a connu un essor considérable en France depuis une vingtaine d’années, devenant l’un des axes majeurs de l’action en santé publique. Les grandes affaires de santé publique (sang contaminé, canicule, pandémie grippale, COVID-19, …) ont d’ailleurs bien montré la nécessité de pouvoir disposer d’un système de surveillance efficace, fiable et réactif. Premier ouvrage en langue française spécifiquement consacré à ce sujet, Surveillance Épidémiologique et Veille Sanitaire a pour objectifs de faire connaître aux professionnels de santé les principes des systèmes de surveillance existants, de fournir aux épidémiologistes et chercheurs des outils méthodologiques, de permettre aux étudiants et enseignants de disposer d’un manuel complet et précis et enfin d’apporter aux décideurs en santé publique des informations de référence. L’ouvrage est organisé en quatre grandes parties, dans lesquelles sont développés :- les principes généraux et l’organisation de la surveillance épidémiologique et de la veille sanitaire ;- les méthodes et théories spécifiques à ce domaine, avec un souci constant d’accessibilité pour les non-spécialistes ;- les différents champs d’application (pathologies ou groupes de population particuliers…) ;- les relations de la surveillance épidémiologique avec les autres domaines de la santé publique (prévention, réglementation, aspects sociopolitiques…).Une attention particulière a également été portée à la surveillance en santé internationale. L’ouvrage, agrémenté de nombreux graphiques et tableaux, est complété par une série de fiches techniques expliquant et définissant les notions fondamentales de l’épidémiologie descriptive. Il intéressera tous les médecins, chercheurs, enseignants et étudiants en santé publique ainsi que tous ceux en charge de la santé publique, de la surveillance, de la veille ou de la prévention dans les agences ou organismes publics et dans les réseaux de professionnels.Cette seconde édition, traversée par la crise pandémique de la COVID-19, a vu l’ensemble de ses chapitres révisés à l’aune de la pandémie