021: Clopidogrel low response and correlation between the different tests: light transmission aggregometry, VerifyNow-P2Y12 and V ASP

BackgroundClopidogrel low response correlates with poor prognosis after percutaneous coronary intervention (PCI). Many biological tests are currently available to test the clopidogrel response. However, the presence of any correlation between the different tests is today poorly reported.MethodsIn this prospective study, clopidogrel response was assessed in 100 consecutive patients. All patients were tested between 18h and 24h after a600mg clopidogrel loading dose using 3 different tests: light transmission aggregometry with 10μmol ADP (LTA, results expressed as platelet inhibition percentage), VerifyNow-P2Y12 (VN, results expressed as PRU) and vasodilatator stimulated phosphoprotein (VASP, results expressed as IRP). Patients under chronic clopidogrel therapy were excluded.ResultsThe mean platelet inhibition percentage, PRU value and IRP value were 38.5±13% by LTA, 178±89 PRU by VN and 52±21% by VASP. When results were analyzed as continuous variables, there was a good correlation between the different tests: LTA/VN (R2=0,642, p<0,001), LTA/VASP (R2=0,409, p<0,001) and VN/VASP (R2=0,616, p<0,001). However, when results were analyzed as pre-specified cut-off points to define patients as “low or good responders” (according to the literature: 50% for LTA, 235 PRU for VN and 50% IRP for VASP), only 47% of the patients were defined as “good” or “low responders” by the 3 tests. Altogether, 33% of the patients were defined as “low responders” by only 1 test, 20% by 2 tests and only 16% by the 3 tests.ConclusionIf the correlation between the different tests is good when results are analyzed as continuous variables, each individual is rarely (less than 50%) defined as “low or good responder” by all the 3 tests when recognized cut-off values are used. In that way, a sole test might not be sufficient to manage antiplatelet therapy in an individual patient

Evaluation de la qualité de vie chez les personnes infectées par le VIH

[Table des matières] I. Patients et méthodes. 1. Enquête auprès de personnes infectées par le VIH : participation et caractéristiques des participants. 2. Modalités de l'enquête. 3. Patients séropositifs hospitalisés. 4. Questionnaire. 5. Calcul des scores du SF-36 et du SF-36+CF. - II. Résultats commentés de l'enquête auprès de personnes infectées par le VIH et des autres groupes comparatifs de patients. 1. Comparaison entre le groupe de patients séropositifs et le groupe Consultation anonyme sida (PMU). 2. Comparaison entre le groupe des patients séropositifs et la population générale vaudoise. 3. Auto-évaluation de l'état de santé par rapport à l'année précédente. 4. Evolution des variables cliniques à 12 mois. 5. Analyse factorielle et scores synthétiques du SF-36. 6. Relation entre les scores des dimensions du SF-36+CF et la survenue du décès. - III. Evaluation du questionnaire. 1. Mesure de la qualité de vie liée à l'état de santé. 2. Adjonction de la dimension "fonctionnement cognitif". 3. Conclusions et recommandations

Impact on construction project planning council of aqueduct Fruticas Chipaque

En los últimos años Colombia ha tenido un papel destacado en el escenario internacional por ser un país emergente económicamente, fortaleciendo significativamente los aspectos más relevantes para el desarrollo de un país. Dentro de estos factores relevantes se encuentra la construcción de infraestructurapública, que aporta grandes beneficios y brinda bienestar a la comunidad en general. Sin embargo muchas de estas obras se han visto afectadas por la mala planeación con la que se programan, incurriendo en sobrecostos que han llevado en el mejor de los casos a tiempos más largos de ejecución y en los casos más críticos al abandono de los proyectos, causando un notorio detrimento en el patrimonio de la nación y de los colombianos. Una vez revisada la información concerniente a la construcción del acueducto Fruticas del municipio de Chipaque se pudo determinar que son varios los factores que intervinieron para que su ejecución no se realizara dentro de los tiempos establecidos, siendo los más relevantes una pésima planeación de la obra dentro de su parte inicial y una gestión del riesgo inadecuada e inoportuna. El propósito fundamental de este artículo es hacer un análisis de un caso específico de un mal proyecto de construcción de infraestructura pública en Colombia, con el fin emitir algunas conclusiones, que de ser tenidas en cuenta, contribuyan a evitar que nuevos casos similares a este se presenten, afectando directamente a la economía del país y al mejoramiento de la calidad de vida de todos los colombianos.In recent years Colombia has had a prominent role on the international stage for being an economically emerging country, significantly strengthening the most important for a country's development issues. These relevant factors are the construction of public infrastructure, which provides great benefits and provides welfare to the community. However many of these works have been affected by the poor planning that are programmed with, incurring cost overruns that led to the best at longer runtimes and the most critical project abandonment cases causing a noticeable detriment to the heritage of the nation and Colombians. After reviewing the information concerning the construction of Fruticas aqueduct Township Chipaque it was determined that several factors intervened to your execution is not carried out within the established time, the most important being a lousy planning of the work within part of their initial management and inadequate and inappropriate risk. The main purpose of this paper is to analyze a specific case of a bad project to build public infrastructure in Colombia, to issue some conclusions, which if taken into account, help prevent new cases similar to this one submit, directly affecting the economy and improving the quality of life for all Colombians

Impact of initial clinical presentation on clopidogrel low response

SummaryBackgroundLarge interindividual variability exists in clopidogrel response. Clopidogrel low response correlates with poor prognosis after percutaneous coronary intervention. Some authors also suggest intraindividual variability over time.AimTo assess the impact of initial clinical presentation on clopidogrel low response.MethodsIn this prospective study, clopidogrel response was assessed in 100 patients. Fifty patients presenting with acute coronary syndromes (ACS group) were compared with 50 patients with stable coronary artery disease matched 1:1 for age, sex, body mass index and diabetes (stable group). All patients were tested 18–24h after a 600mg loading dose of clopidogrel using the VerifyNow-P2Y12 test (results expressed as platelet reaction units [PRUs]). Patients under chronic clopidogrel therapy or treated with glycoprotein IIb/IIIa inhibitors, bivalirudin or thrombolytics were excluded.ResultsMean age was 61±12 years in each group; 28% of patients in each group were diabetic; mean body mass index was 27.6±5.6kg/m2 in the ACS group and 27.9±5.9kg/m2 in the stable group (p=0.80). Mean PRU values were 197±81 in the ACS group and 159±94 in the stable group (p=0.03). By multivariable analysis, the ACS group was significantly associated with a higher PRU value (p=0.02). There were significantly more clopidogrel low responders (PRU value>230) in the ACS group (38% vs. 18%; p=0.04).ConclusionOur study confirms that initial clinical presentation, especially ACS, is a strong predictor of clopidogrel low response; this suggests that the evolution of coronary artery disease for one patient influences the clopidogrel response over time. These results are in accordance with recent trials showing a benefit for more aggressive antiplatelet therapy in ACS patients

Fibre orientation effects on high strain rate of carbon / epoxy composites

Specific mechanical properties of composites make them particularly attractive. Dynamic loads are of prime interest for their applications. Laminated structures’ impact modelling implies prior material dynamic characterisation. This study suggests an analysis of split Hopkinson bar compression testing on T300/914 carbon/epoxy composite material. First, the effect of fibre orientation and stratification on compression dynamic behaviour is studied. Results show a high non-linearity for +/-45° laminates testing. This non-linearity is not observed when the laminates are reinforced with 0° and 90° plies. Analytical modelling is in agreement with the experimental results. Secondly, experiments are performed on pre-cracked specimens to show the influence of cracking on dynamic behaviour

Nouvelles données sur Phosphatherium escuilliei (Mammalia, Proboscidea) de l'Éocène inférieur du Maroc, apports à la phylogénie des Proboscidea et des ongulés lophodontes 6208 Rabat-Instituts (Maroc)

International audienc

Prevalence and Associated Factors for Chlamydia trachomatis Infection Among Undocumented Immigrants in a Primary Care Facility in Geneva, Switzerland: A Cross-Sectional Study

Chlamydia trachomatis infection (CTI) is the most frequent sexually transmitted infection in western countries. Its prevalence in undocumented immigrants, a rapidly growing vulnerable population, remains unknown. We aimed to document the prevalence of CTI and associated factors at the primary health care level. This cross-sectional study included all undocumented immigrants attending a health care facility in Geneva, Switzerland. Participants completed a questionnaire and were tested for CTI by PCR assay. Three-hundred thirteen undocumented immigrants (68.4% female, mean age 32.4 (SD 8) years) agreed to participate. CTI prevalence was 5.8% (95% CI 3.3-8.4). Factors associated with higher prevalence were age ≤25 (OR 3.9, 95% CI 1.3-12.2) and having had two or more sexual partners during the precedent year (OR 4.5, 95% CI 1.5-13.7). Prevalence and associated factors for infection in this vulnerable population were comparable with other populations in Western countries. Our findings support the importance of facilitating access to existing screening opportunities in particular to individuals at higher ris

Tuberculosis in HIV-Negative and HIV-Infected Patients in a Low-Incidence Country: Clinical Characteristics and Treatment Outcomes

BACKGROUND: In Switzerland and other developed countries, the number of tuberculosis (TB) cases has been decreasing for decades, but HIV-infected patients and migrants remain risk groups. The aim of this study was to compare characteristics of TB in HIV-negative and HIV-infected patients diagnosed in Switzerland, and between coinfected patients enrolled and not enrolled in the national Swiss HIV Cohort Study (SHCS). METHODS AND FINDINGS: All patients diagnosed with culture-confirmed TB in the SHCS and a random sample of culture-confirmed cases reported to the national TB registry 2000-2008 were included. Outcomes were assessed in HIV-infected patients and considered successful in case of cure or treatment completion. Ninety-three SHCS patients and 288 patients selected randomly from 4221 registered patients were analyzed. The registry sample included 10 (3.5%) coinfected patients not enrolled in the SHCS: the estimated number of HIV-infected patients not enrolled in the SHCS but reported to the registry 2000-2008 was 146 (95% CI 122-173). Coinfected patients were more likely to be from sub-Saharan Africa (51.5% versus 15.8%, P<0.0001) and to present disseminated disease (23.9% vs. 3.4%, P<0.0001) than HIV-negative patients. Coinfected patients not enrolled in the SHCS were asylum seekers or migrant workers, with lower CD4 cell counts at TB diagnosis (median CD4 count 79 cells/µL compared to 149 cells/µL among SHCS patients, P = 0.07). There were 6 patients (60.0%) with successful outcomes compared to 82 (88.2%) patients in the SHCS (P = 0.023). CONCLUSIONS: The clinical presentation of coinfected patients differed from HIV-negative TB patients. The number of HIV-infected patients diagnosed with TB outside the SHCS is similar to the number diagnosed within the cohort but outcomes are poorer in patients not followed up in the national cohort. Special efforts are required to address the needs of this vulnerable population