Safety of efavirenz in first-trimester of pregnancy: a systematic review and meta-analysis of outcomes from observational cohorts.

INTRODUCTIO

Safety of efavirenz in the first trimester of pregnancy: an updated systematic review and meta-analysis

Article approval pendingEvidence of the risk of birth defects with efavirenz use is limited. We updated a meta-analysis of birth defects in infants with first trimester efavirenz exposure up to July 2011. In 21 studies, there were 39 defects among live births in 1437 women receiving first trimester efavirenz [2.0%, 95% confidence interval (CI) 0.82-3.18]. The relative risk of defects comparing women on efavirenz-based (1290 live births) and nonefavirenz-based regimens (8122 live births) was 0.85 (95% CI 0.61-1.20). One neural tube defect was observed (myelomeningocele), giving an incidence of 0.07% (95% CI 0.002-0.39)

Circulating microRNAs in sera correlate with soluble biomarkers of immune activation but do not predict mortality in ART treated individuals with HIV-1 infection: A case control study

Introduction: The use of anti-retroviral therapy (ART) has dramatically reduced HIV-1 associated morbidity and mortality. However, HIV-1 infected individuals have increased rates of morbidity and mortality compared to the non-HIV-1 infected population and this appears to be related to end-organ diseases collectively referred to as Serious Non-AIDS Events (SNAEs). Circulating miRNAs are reported as promising biomarkers for a number of human disease conditions including those that constitute SNAEs. Our study sought to investigate the potential of selected miRNAs in predicting mortality in HIV-1 infected ART treated individuals. Materials and Methods: A set of miRNAs was chosen based on published associations with human disease conditions that constitute SNAEs. This case: control study compared 126 cases (individuals who died whilst on therapy), and 247 matched controls (individuals who remained alive). Cases and controls were ART treated participants of two pivotal HIV-1 trials. The relative abundance of each miRNA in serum was measured, by RTqPCR. Associations with mortality (all-cause, cardiovascular and malignancy) were assessed by logistic regression analysis. Correlations between miRNAs and CD4+ T cell count, hs-CRP, IL-6 and D-dimer were also assessed. Results: None of the selected miRNAs was associated with all-cause, cardiovascular or malignancy mortality. The levels of three miRNAs (miRs -21, -122 and -200a) correlated with IL-6 while miR-21 also correlated with D-dimer. Additionally, the abundance of miRs -31, -150 and -223, correlated with baseline CD4+ T cell count while the same three miRNAs plus miR- 145 correlated with nadir CD4+ T cell count. Discussion: No associations with mortality were found with any circulating miRNA studied. These results cast doubt onto the effectiveness of circulating miRNA as early predictors of mortality or the major underlying diseases that contribute to mortality in participants treated for HIV-1 infection

Development and Validation of a Risk Score for Chronic Kidney Disease in HIV Infection Using Prospective Cohort Data from the D:A:D Study

Ristola M. on työryhmien DAD Study Grp ; Royal Free Hosp Clin Cohort ; INSIGHT Study Grp ; SMART Study Grp ; ESPRIT Study Grp jäsen.Background Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. Methods and Findings A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with >= 3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1: 393 chance of developing CKD in the next 5 y in the low risk group (risk score = 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria. Conclusions Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.Peer reviewe

L’industrialisation du bâtiment par les systèmes constructifs hors-site : un procédé pérenne et appropriable en tant que maître d’ouvrage afin de répondre aux enjeux de la nouvelle réglementation énergétique 2020 ?

En 2019, ce n’est pas moins de 43.1 milliards de tonnes de CO21 qui ont été émis par les activités anthropiques sur Terre. Ce chiffre ne cesse d’augmenter d’années en années et contribue en majeure partie au phénomène de changement climatique de notre planète. Sans rentrer de manière exhaustive dans le sujet, les conséquences à venir s’annoncent dramatiques pour l’ensemble des habitants. Lors de la COP21 en décembre 2015, les experts du sujet ont annoncé un ensemble de conséquences à venir si l’humanité ne changeait pas radicalement de cap. Entre autres, la montée des eaux, des phénomènes météorologiques bien plus dévastateurs, des canicules, des incendies, une explosion de la pauvreté, la multiplication de maladies ou bien encore, l’augmentation du nombre de réfugiés climatiques, etc. Sachant les défis qui se profilent à l’horizon et les causes de ceux-ci, l’humanité se doit de réduire drastiquement ses consommations d’énergies fossiles et ses rejets de CO2 si elle veut pouvoir habiter sur Terre de manière pérenne et confortable dans les décennies et siècles à venir

Statut immunitaire du personnel soignant vis-à-vis du virus de la varicelle et du zona à l'hopital Jean Verdier de Bondy

PARIS13-BU Serge Lebovici (930082101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

LYMPHOME CARDIAQUE PRIMAIRE (AU COURS DU SYNDROME D'IMMUNO-DEFICIENCE HUMAINE ; A PROPOS D'UN CAS ; REVUE DE LA LITTERATURE)

PARIS13-BU Serge Lebovici (930082101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Reading Performances of Illness Scripts, Clinical Authority, and Narrative Self-Care in Samuel Beckett’s <i>Malone Dies</i> and Jérôme Lambert’s <i>Chambre Simple</i>

Malone Dies (1956) by Samuel Beckett and Chambre simple (2018) by Jérôme Lambert present the narratives of precarity in the clinical setting, wherein the clinical caregivers view the suffering of the patients as a spectacle and chart out pre(script)ions and pro(script)ions for them. Both novels open on a note of uncertainty. This paper examines the narratives of fear and anxiety of the institutionalized patients (probably) in the mental asylum in Malone Dies and the public hospital in Chambre simple. The caregivers in both novels represent the voice of medical authority who focus on cure rather than care, providing their patients food and medications or conducting tests. Hence, Malone and le Patient are compelled to develop artistic coping mechanisms of self-care, reclaiming the ownership of the self. In Malone Dies, the abatement of in-person care and the fear of spending time in isolation before death motivates Malone to devise the narratives. Malone is the sole performer and spectator of his performance of patienthood. Similarly, le Patient chooses the position of the spectator, thus turning upside down the “spectacle” of the epilepsy script, where the patient is viewed as the performer of catharsis by the clinical audience. Here, the lens of performance studies helps us understand clinical caregivers’ emphasis on preparing an illness script that governs Malone and le Patient’s script of narrative self-care. We argue that caregivers’ expectations pressurize patients with chronic conditions to implement forms of artistic self-care in clinical settings

Les ferrites à mémoire

Après un bref rappel des conditions de fonctionnement des tores à mémoire, et la définition des paramètres usuels des fabricants, les caractéristiques idéales du tore à mémoire sont précisées. Les différents diagrammes utilisés sont cités, ainsi que l'évolution des dimensions géométriques. Les modes de préparation des tores, avec différentes variantes possibles, sont donnés rapidement. Deux problèmes particuliers soulevés par la recherche de meilleures performances électromagnétiques sont exposés : un phénomène de résonance magnétoélastique lié à la magnétostriction, et un vieillissement des caractéristiques du tore dans certaines conditions de frittage rapide. Les grands axes de l'évolution actuelle des matériaux pour tores à mémoire sont donnés ainsi qu'une comparaison avec les semi-conducteurs

Les ferrites à mémoire

After a short recall of working conditions of memory cores and definition of usual parameters of manufacturers, ideal characteristics of memory core are stated. The different diagrams used are shown as well as development of geometrical sizes. Core preparation methods are given with various possibilities. Two particular problems raised by research of best electromagnetic performances are : Phenomenon of magnetoelastic resonance due to magnetostriction and aging of core characteristics in certain conditions of quick sintering. The large lines of actual development of materials for memory cores are given as well as a comparison with semi-conductors.Après un bref rappel des conditions de fonctionnement des tores à mémoire, et la définition des paramètres usuels des fabricants, les caractéristiques idéales du tore à mémoire sont précisées. Les différents diagrammes utilisés sont cités, ainsi que l'évolution des dimensions géométriques. Les modes de préparation des tores, avec différentes variantes possibles, sont donnés rapidement. Deux problèmes particuliers soulevés par la recherche de meilleures performances électromagnétiques sont exposés : un phénomène de résonance magnétoélastique lié à la magnétostriction, et un vieillissement des caractéristiques du tore dans certaines conditions de frittage rapide. Les grands axes de l'évolution actuelle des matériaux pour tores à mémoire sont donnés ainsi qu'une comparaison avec les semi-conducteurs