Factors Associated with Negative Direct Sputum Examination in Asian and African HIV-Infected Patients with Tuberculosis (ANRS 1260)

OBJECTIVE: To identify factors associated with negative direct sputum examination among African and Cambodian patients co-infected by Mycobacterium tuberculosis and HIV. DESIGN: Prospective multicenter study (ANRS1260) conducted in Cambodia, Senegal and Central African Republic. METHODS: Univariate and multivariate analyses (logistic regression) were used to identify clinical and radiological features associated with negative direct sputum examination in HIV-infected patients with positive M. tuberculosis culture on Lowenstein-Jensen medium. RESULTS: Between September 2002 and December 2005, 175 co-infected patients were hospitalized with at least one respiratory symptom and pulmonary radiographic anomaly. Acid-fast bacillus (AFB) examination was positive in sputum samples from 110 subjects (63%) and negative in 65 patients (37%). Most patients were at an advanced stage of HIV disease (92% at stage III or IV of the WHO classification) with a median CD4 cell count of 36/mm³. In this context, we found that sputum AFB negativity was more frequent in co-infected subjects with associated respiratory tract infections (OR = 2.8 [95%CI:1.1-7.0]), dyspnea (OR = 2.5 [95%CI:1.1-5.6]), and localized interstitial opacities (OR = 3.1 [95%CI:1.3-7.6]), but was less frequent with CD4 ≤ 50/mm³ (OR = 0.4 [95%CI:0.2-0.90), adenopathies (OR = 0.4 [95%CI:0.2-0.93]) and cavitation (OR = 0.1 [95%CI:0.03-0.6]). CONCLUSIONS: One novel finding of this study is the association between concomitant respiratory tract infection and negative sputum AFB, particularly in Cambodia. This finding suggests that repeating AFB testing in AFB-negative patients should be conducted when broad spectrum antibiotic treatment does not lead to complete recovery from respiratory symptoms. In HIV-infected patients with a CD4 cell count below 50/mm3 without an identified cause of pneumonia, systematic AFB direct sputum examination is justified because of atypical clinical features (without cavitation) and high pulmonary mycobacterial burden

Intensive care of the cancer patient: recent achievements and remaining challenges

A few decades have passed since intensive care unit (ICU) beds have been available for critically ill patients with cancer. Although the initial reports showed dismal prognosis, recent data suggest that an increased number of patients with solid and hematological malignancies benefit from intensive care support, with dramatically decreased mortality rates. Advances in the management of the underlying malignancies and support of organ dysfunctions have led to survival gains in patients with life-threatening complications from the malignancy itself, as well as infectious and toxic adverse effects related to the oncological treatments. In this review, we will appraise the prognostic factors and discuss the overall perspective related to the management of critically ill patients with cancer. The prognostic significance of certain factors has changed over time. For example, neutropenia or autologous bone marrow transplantation (BMT) have less adverse prognostic implications than two decades ago. Similarly, because hematologists and oncologists select patients for ICU admission based on the characteristics of the malignancy, the underlying malignancy rarely influences short-term survival after ICU admission. Since the recent data do not clearly support the benefit of ICU support to unselected critically ill allogeneic BMT recipients, more outcome research is needed in this subgroup. Because of the overall increased survival that has been reported in critically ill patients with cancer, we outline an easy-to-use and evidence-based ICU admission triage criteria that may help avoid depriving life support to patients with cancer who can benefit. Lastly, we propose a research agenda to address unanswered questions

Human malarial disease: a consequence of inflammatory cytokine release

Malaria causes an acute systemic human disease that bears many similarities, both clinically and mechanistically, to those caused by bacteria, rickettsia, and viruses. Over the past few decades, a literature has emerged that argues for most of the pathology seen in all of these infectious diseases being explained by activation of the inflammatory system, with the balance between the pro and anti-inflammatory cytokines being tipped towards the onset of systemic inflammation. Although not often expressed in energy terms, there is, when reduced to biochemical essentials, wide agreement that infection with falciparum malaria is often fatal because mitochondria are unable to generate enough ATP to maintain normal cellular function. Most, however, would contend that this largely occurs because sequestered parasitized red cells prevent sufficient oxygen getting to where it is needed. This review considers the evidence that an equally or more important way ATP deficency arises in malaria, as well as these other infectious diseases, is an inability of mitochondria, through the effects of inflammatory cytokines on their function, to utilise available oxygen. This activity of these cytokines, plus their capacity to control the pathways through which oxygen supply to mitochondria are restricted (particularly through directing sequestration and driving anaemia), combine to make falciparum malaria primarily an inflammatory cytokine-driven disease

From the Single- to the Triple-Decker Sandwich. Effect of Stacking on the Redox and UV-Visible Spectroscopic Properties of Lutetium(III) 1,2-Naphthalocyaninate Complexes

International audience(1,2-Naphthalocyaninato)lutetium(III), bis(1,2-naphthalocyaninato)lutetium(III), and tris(1,2-naphthalocyaninato)-dilutetium(III) have been synthesized in good yields. These complexes were characterized by UV-visible, 1H NMR, and mass spectroscopies and by electrochemical techniques. Bis(1,2-naphthalocyaninato)lutetium(III) is compared to bis(2,3-naphthalocyaninato)lutetium(III): the good correspondance between the experimental data and theoretical results obtained by others is emphasized in this work. Stacking one to three macrocyclic rings is possible in the series of the 1,2-naphthalocyanine sandwich-like complexes with lutetium(III); as shown by UV-visible spectroelectrochemistry and voltammetry, this influences greatly the π-conjugated systems, modifying spectacularly their spectroscopic and redox properties

Photogeneration of charges in poly(N-vinylcarbazole) doped with lutetium bisphthalocyanines and lutetium bisnaphthalocyanines

cited By 7International audienceLutetium bisphthalocyanines and bisnaphthalocyanines, sandwich complexes having interesting electronic properties were studied as electron-acceptors associated with the donor polyvinylcarbazole (PVCz) in single-layer photoconductors. It is known, from their redox properties, that these lanthanide complexes are potential electron-acceptors as well as electron-donors; moreover, they strongly absorb light from the near-UV to the near-IR. The xerographic spectra recorded between 400 and 900 nm show that the polymeric phases doped with the lutetium bisphthalocyanines are photoconductive. These new photoconducting phases are active in the near IR domain which is promising with regard to their potential applications. Copyright © 2003 Society of Porphyrins & Phthalocyanines

Photogeneration of charges in poly(N-vinylcarbazole) doped with lutetium bisphthalocyanines and lutetium bisnaphthalocyanines

cited By 7International audienceLutetium bisphthalocyanines and bisnaphthalocyanines, sandwich complexes having interesting electronic properties were studied as electron-acceptors associated with the donor polyvinylcarbazole (PVCz) in single-layer photoconductors. It is known, from their redox properties, that these lanthanide complexes are potential electron-acceptors as well as electron-donors; moreover, they strongly absorb light from the near-UV to the near-IR. The xerographic spectra recorded between 400 and 900 nm show that the polymeric phases doped with the lutetium bisphthalocyanines are photoconductive. These new photoconducting phases are active in the near IR domain which is promising with regard to their potential applications. Copyright © 2003 Society of Porphyrins & Phthalocyanines

Tracheotomy in the Intensive Care Unit: Guidelines from a French Expert Panel: the French Intensive Care Society and the French Society of Anaesthesia and Intensive Care Medicine

International audienc

What Ventilation and Blood Gases Are "desirable'' in Adult Mechanically Ventilated Patients

INTRODUCTION. Transfer of clinical/physiological knowledge in medical devices such as mechanical ventilators is getting popular in order to shorten the time spent on the ventilator and to improve patient's safety. Several closed loop systems (SmartCare®, IntelliVent®) already available on the market need further investigations to assess whether ventilation and arterial blood gases obtained with such closed loop systems fit the user's expectations as compared to conventional ventilation i.e. manual setting of the ventilator. However little is known on what ventilation and arterial blood gases are “desirable”. OBJECTIVES. The aim of the present investigation is to estimate from a panel of clinicians the ranges of “desirable” tidal volume (TV), plateau pressure (Pplat), SpO2, EtCO2 and respiratory rate (RR). METHODS. The Delphi method[1] was used to achieve an agreement regarding “desirable” TV, Pplat, SpO2, EtCO2 and RR. Between October 2009 and April 2010, four intensivists and one respiratory therapist from 5 hospitals/3 countries (Canada, France, Belgium) and having different adult ICU populations were entering rounds to find an agreement regarding the “desirable” values for 4 different underlying conditions (ALI/ARDS - Chronic hypercapnia - Brain injury - none of the previous) and for 2 respiratory muscles states (active or passive). RESULTS. Three rounds were needed to find an agreement. “Desirable“ values are summarized in the table. They were more discussions on “desirable” ranges in chronic hypercapanic patients as compared to ALI/ARDS patients. CONCLUSIONS. The present “desirable” values will be further estimate on a larger panel of clinicians and should help evaluating how much closed loop systems keep the patient in such “desirable” ranges