Le paracétamol à dose thérapeutique : quelles populations à risque d’hépatotoxicité ?

Le risque d’hépatotoxicité après l’ingestion volontaire d’une dose unique et excessive de paracétamol peut être actuellement correctement évalué, même s’il persiste des éléments de sensibilité individuelle liée notamment à des facteurs toxiques ou nutritionnels. Les facteurs prédisposant à une hépatotoxicité du paracétamol à dose thérapeutique sont plus largement débattus. Ils appartiennent à cinq catégories principales : la consommation alcoolique qui doit être envisagée sous une forme aiguë et une forme chronique, l’état nutritionnel, la surcharge pondérale, la stéatose hépatique non alcoolique et l’utilisation conjointe de médicaments partageant des voies métaboliques identiques. Pour ces différents facteurs, il peut exister des discordances entre les données expérimentales animales et les données humaines. Ces discordances sont en partie expliquées par l’intrication possible de plusieurs éléments : définition d’une dose ou d’une concentration supra-thérapeutique de paracétamol, historique de consommation de paracétamol et d’alcool, rapports entre consommation chronique d’alcool et état nutritionnel, … Les données expérimentales incitent néanmoins à considérer que la consommation chronique d’alcool, le jeûne et la stéatose hépatique non alcoolique doivent être pris en compte dans l’analyse du risque d’hépatotoxicité en dehors des surdosages aigus en paracétamol

Evaluation of the automated BD Phoenix CPO Detect test for detection and classification of carbapenemases in Gram negatives.

We evaluated the performance of the automated BD Phoenix CPO Detect test (BD-CPO test) for detection and Ambler classification of carbapenemases in Enterobacteriaceae, P.aeruginosa and A.baumannii complex. A collection of 287 Gram-negative clinical isolates, with a reduced susceptibility to at least one carbapenem including 184 carbapenemase-producing organisms (CPO) and 103 non-CPO, was tested. The BD-CPO test showed an overall sensitivity of 89.7% and specificity of 83.5% for carbapenemase detection. 1/7 of class A, 82.9% of class B, and 89.8% of class D carbapenemases were correctly classified. Poor detection sensitivity of 68.9% and specificity of 62.1% in P.aeruginosa was observed. However, combination with ceftazidime/avibactam susceptibility, provided by this panel, increased the performances for P.aeruginosa. The integration of an automated carbapenemase detection and classification in routine susceptibility panels would save time and help for therapeutic management. Further developments are needed to improve the accuracy of the BD-CPO test

Cellular response to COVID-19 vaccines in hematologic malignancies patients: a new hope for non-responders?

SARS-CoV-2 vaccines offered great hope in controlling the worldwide COVID-19 pandemic. At present, SARS-CoV-2 vaccines have shown excellent efficacy to prevent COVID-19 but immunocompromised patients were left-off most vaccine clinical trials albeit their extreme vulnerability. Indeed, immunosuppression is associated with a higher risk of developing severe COVID-19 with mortality rates over 30% reported in patients with hematologic malignancies (HM). [...

Evaluation of a commercial interferon-γ release assay for the detection of SARS-CoV-2 T-cell response after vaccination

OBJECTIVE: Evidence regarding the role of cellular immunity in protecting against COVID-19 is emerging. To better assess immune status, simple and robust assays measuring specific T-cell responses associated with humoral responses are needed. We aimed to evaluate the Quan-T-Cell SARS-CoV-2 test for measuring cellular immune responses in vaccinated healthy and immunosuppressed subjects. METHODS: T-cell responses were assessed in healthy vaccinated and unvaccinated and unexposed healthcare workers to determine the sensitivity and specificity of the EUROIMMUN SARS-CoV-2 Quan-T-Cell IGRA test performed on vaccinated kidney transplant recipients (KTRs). RESULTS: The EUROIMMUN SARS-CoV-2 Quan-T-Cell IGRA test showed good sensitivity (87.2%) and specificity (92.3%) at the calculated 147 mIU/mL cutoff, with an 88.33% accuracy. In KTRs, specific cellular immunity was lower than the antibody response; however, those with a positive IGRA result produced as much IFN-γ as healthy individuals. CONCLUSIONS: The EUROIMMUN SARS-CoV-2 Quan-T-Cell IGRA test showed good sensitivity and specificity for the detection of specific T-cell responses against the SARS-CoV-2 spike protein. These results present an additional tool for better management of COVID-19, especially in vulnerable populations