Foscarnet Decreases Human Immunodeficiency Virus RNA

Foscarnet inhibits human immunodeficiency virus (HIV) replication in vitro and decreases p24 antigenemia in patients with cytomegalovirus (CMV) retinitis. To evaluate the effect of foscarnet on HIV replication, HIV RNA was quantitated in 17 patients before and during foscarnet therapy. Fifteen patients had CMV retinitis, 1 had CMV encephalitis, and 1 had intractable zoster. A decrease in HIV RNA was observed in 16 of 17 patients. Before the introduction of foscarnet, mean HIV RNA was 5.82 ± 0.24 log RNA/mL and, after a median of 13 days of therapy, mean HIV RNA was 5.30 ± 0.27 log RNA/mL (P < .001). Among patients with detectable p24 antigen at baseline, a significant decrease was observed (P = .017). This decrease in HIV RNA demonstrates that foscarnet is a potent antiretroviral dru

Cytomegalovirus Retinitis: Decreased Risk of Bilaterality with Increased Use of Systemic Treatment

Cytomegalovirus (CMV) retinitis may be treated systemically or intravitreally. We reviewed retrospectively patients with CMV retinitis, in order to determine whether systemic treatment was associated with less spread of CMV retinitis from one eye to the other. Of 222 cases, 92 patients had bilateral disease at onset of CMV retinitis, leaving 130 for analysis. Bilaterality occurred in 10 patients during 12,687 days of systemic treatment and in 34 during 14,791 days without systemic treatment (odds ratio [OR] = 2.92; confidence interval [CI], 1.44-5.90). Patients who had received systemic treatment for <50% of the follow-up period had a greater risk of bilaterality (OR = 3.7; CI, 2.79-4.54) than did the more intensively treated patients. CD4 cell levels also contributed to increased risk, but multivariate analysis showed that CD4 cell counts and treatment intensity were independent risk factors. CMV retinitis was more likely to become bilateral in patients who received less intravenous therapy. Local treatment can complete but does not replace systemically administered therap

La contention entre soins et maltraitance

Compte-rendu

Foscarnet Decreases Human Immunodeficiency Virus RNA

Foscarnet inhibits human immunodeficiency virus (HIV) replication in vitro and decreases p24 antigenemia in patients with cytomegalovirus (CMV) retinitis. To evaluate the effect of foscarnet on HIV replication, HIV RNA was quantitated in 17 patients before and during foscarnet therapy. Fifteen patients had CMV retinitis, 1 had CMV encephalitis, and 1 had intractable zoster. A decrease in HIV RNA was observed in 16 of 17 patients. Before the introduction of foscarnet, mean HIV RNA was 5.82 ± 0.24 log RNA/mL and, after a median of 13 days of therapy, mean HIV RNA was 5.30 ± 0.27 log RNA/mL (P < .001). Among patients with detectable p24 antigen at baseline, a significant decrease was observed (P = .017). This decrease in HIV RNA demonstrates that foscarnet is a potent antiretroviral drug

Les directives anticipées, un outil d'humanisation des soins

La relation médecin-malade est complexe tant sur le plan humain, que juridique et pratique. Elle dépend du cadre légal et déontologique, mais également des mœurs présentes dans ce domaine. Or, nous sommes confrontés aujourd'hui à une modification fondamentale de cette relation pour laquelle des recommandations d'instances professionnelles existent mais sont encore trop rarement appliquées dans la pratique au quotidien et trop rarement enseignées dans nos facultés. Pourtant, les patients sont avides de voir évoluer une relation trop souvent paternaliste, vers une relation plus harmonieuse et plus respectueuse des valeurs de chacun («value based medicine»). Les directives anticipées, anciennement appelées «testament biologique», sont un moyen de modifier positivement notre pratique en accord avec les besoins et souhaits de chaque patient.The relationship between the patient and a medical care giver is complex specially as it implies to the human, juridical and practical points of view. It depends on legal and deontological considerations, but also on professional habits. Today, we are confronted to a fundamental modification of this relationship. Professional guidelines exist, but are rarely applied and rarely taught in universities. Howerver, patients are eager to move from a paternalistic relationship to a true partnership, more harmonious and more respectful of individual values («value based medicine»). Advance directives give us an opportunity to improve our practices and to provide care consistent with the needs and wishes of each patient

Santé communautaire pour les personnes âgées: l'activité de la policlinique de gériatrie à Genève

Outre son activité clinique principalement domiciliaire, la Policlinique de gériatrie a choisi de développer trois programmes d'activité spécifiques ayant pour objectifs communs la promotion de la santé et le maintien à domicile, dans les meilleures conditions, aussi longtemps que désiré. Cet article décrit ces programmes.In addition to its mainly home-based clinical activity, the Geriatric Policlinic has chosen to develop three programmes with a specific activity. Their common objectives being promoting health and maintaining home-based treatment in the best conditions and for as long as possible. This article describes these programmes