Detecting Mutations in the Mycobacterium tuberculosis Pyrazinamidase Gene pncA to Improve Infection Control and Decrease Drug Resistance Rates in Human Immunodeficiency Virus Coinfection.

Hospital infection control measures are crucial to tuberculosis (TB) control strategies within settings caring for human immunodeficiency virus (HIV)-positive patients, as these patients are at heightened risk of developing TB. Pyrazinamide (PZA) is a potent drug that effectively sterilizes persistent Mycobacterium tuberculosis bacilli. However, PZA resistance associated with mutations in the nicotinamidase/pyrazinamidase coding gene, pncA, is increasing. A total of 794 patient isolates obtained from four sites in Lima, Peru, underwent spoligotyping and drug resistance testing. In one of these sites, the HIV unit of Hospital Dos de Mayo (HDM), an isolation ward for HIV/TB coinfected patients opened during the study as an infection control intervention: circulating genotypes and drug resistance pre- and postintervention were compared. All other sites cared for HIV-negative outpatients: genotypes and drug resistance rates from these sites were compared with those from HDM. HDM patients showed high concordance between multidrug resistance, PZA resistance according to the Wayne method, the two most common genotypes (spoligotype international type [SIT] 42 of the Latino American-Mediterranean (LAM)-9 clade and SIT 53 of the T1 clade), and the two most common pncA mutations (G145A and A403C). These associations were absent among community isolates. The infection control intervention was associated with 58-92% reductions in TB caused by SIT 42 or SIT 53 genotypes (odds ratio [OR] = 0.420, P = 0.003); multidrug-resistant TB (OR = 0.349, P < 0.001); and PZA-resistant TB (OR = 0.076, P < 0.001). In conclusion, pncA mutation typing, with resistance testing and spoligotyping, was useful in identifying a nosocomial TB outbreak and demonstrating its resolution after implementation of infection control measures

Chronic granulomatous disease: value of the newer imaging modalities

The contribution of computed tomography (CT), ultrasound (US), and nuclear medicine studies in the evaluation and management of seven patients with chronic granulomatous disease was retrospectively reviewed. These modalities proved valuable in detecting sites of infection, particularly in the abdomen. Three patients had liver abscesses, two had suppurative retroperitoneal lymphadenopathy, one had empyema, and one had a scrotal abscess. Furthermore, CT or US-guided percutaneous aspiration and/or drainage of infected material was successfully performed on three separate occasions in a single patient, obviating the need for surgery. The newer imaging modalities are useful in the prompt diagnosis and in some instances non-operative therapy of complications of chronic granulomatous disease.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46682/1/247_2005_Article_BF01601886.pd

Multi-Society Guideline for Reprocessing Flexible Gastrointestinal Endoscopes

Flexible gastrointestinal endoscopy is a valuable diagnostic and therapeutic tool for the care of patients with gastrointestinal and pancreaticobiliary disorders. Compliance with accepted guidelines for the reprocessing of gastrointestinal endoscopes between patients is critical to the safety and success of their use. When these guidelines are followed, pathogen transmission can be effectively prevented. Increased efforts and resources should be directed to improve compliance with these guidelines. Further research in the area of gastrointestinal endoscope reprocessing should be encouraged. The organizations that endorsed this guideline are committed to assisting the FDA and manufacturers in addressing critical infection control issues in gastrointestinal device reprocessing

US Military Intervention in Latin America: Testing Grounds for New Defense Policies

International audienceDiscussion of major evolutions in US defense policy from 1989 to 2017, notably treating the Post-Cold War environment; Southcom/defense reorganization; Panama (Just Cause 1990-1991);Haiti (1993 and Uphold Democracy 1994-1995); Disaster Relief and nontraditional missions; Plan Colombia and militarized counternarcotics; Border Security (Joint Task Force – North)

Les dividendes de la paix et la reconversion de la défense américaine après la Guerre froide, 1989-2001

Cette étude de l’histoire des dépenses militaires américaines pendant les années 1990 allie la recherche sur le développement économique local, les débats sur le budget national et la stratégie internationale des États-Unis pour illustrer la gestion de l’investissement dans le domaine militaire à la fin de la Guerre froide. Pendant plus de quarante ans de Guerre froide, les dépenses militaires américaines historiquement importantes étaient justifiées par l’éventualité d’un conflit militaire avec l’Union soviétique. Entre 1989 et 1991, cette menace existentielle disparaît, créant aux États-Unis des attentes pour que les fonds dédiés auparavant à la Défense puissent être redéployés sur des besoins de politique intérieure. Les appels pour ces « dividendes de la paix » sont alors d’autant plus nombreux que le pays entre dans une phase de crise économique au début de la décennie. Cependant, à la fin des années 1990, le budget militaire le plus bas est à peu près au même niveau que les dépenses moyennes pendant la Guerre froide. Ce projet doctoral analyse les raisons politiques à l'origine de la poursuite de dépenses militaires historiquement élevées pendant cette période de l’après-Guerre froide (1989-2001). Il explore aussi les décisions politiques concernant le budget militaire, la stratégie militaire, le développement économique et la politique industrielle dans ce contexte de l’après-guerre.This study of the history of American defense spending policy in the 1990s combines local economic development, national budget debates and international strategy to discuss the planning and management of the post-Cold War defense drawdown. For over 40 years during the Cold War, the primary justification for historically high levels of American defense spending was the threat of military conflict with the Soviet Union. Between 1989 and 1991, that existential threat effectively disappeared, creating expectations within the United States that funds previously dedicated to defense could be applied to domestic needs. Calls for this “peace dividend” were increased by an ongoing economic recession. However, by the end of the 1990s, the lowest the defense budget would fall was merely equal to the Cold War average level of spending. This doctoral project documents the primary political reasons for the continuation of historically high defense budgets during the post-Cold War period (1989-2001) and the related decisions about managing defense spending, defense policy, economic development and industrial policy in the context of this post-war drawdown

La Continuité budgétaire et stratégique de la défense américaine

Retour sur la JE “America First” du 22 mars 201

Democracy at Home and Abroad: Grand Strategy on the Ballot

International audienceThe 2024 rematch presents two radically different visions of America’s role in the world. Joe Biden ardently argues for American leadership on liberal internationalist lines. Conversely, Donald Trump’s America First represents a transactional form of extreme realism that would mean, if implemented, fundamentally altering many of the US’s long standing foreign policies. This difference is sufficiently stark that both candidates have made Trump’s challenge to American norms, abroad like at home, central to their campaigns. The two foreign policies are built on different intellectual architectures and use different logics for the application of American power in the world, that is to say they represent two competing grand strategies. Rarely in US history have the structuring principles of foreign policy been on the ballot. This analysis will outline the ideas driving Trump and Biden’s foreign policies, suggest that a second Trump term could mean more successful implementation of a radically divergent America First foreign policy, look at the international networks of illiberal political movements that Trump’s campaign participates in, and conclude with the link between anti-democratic projects in the US and a rejection of current US strategy built on reinforcing democratic alliances abroad. Two important caveats need to be included if we are discussing the rematch in terms of divergent foreign policies strategies: consistency between the first Trump administration and the Biden and Obama administrations it sat between, especially in terms of great power competition, and the limits of implementation in Biden’s liberal internationalism. With this in mind, the election may range from simply major stylistic differences to fundamental realignments (although there are good reasons to think changes will be more extreme if Trump wins this time)

« Indo-pacifique » : regards croisés entre les États-Unis et L'Amérique latine

International audienceSino-American rivalry in the Pacific Ocean has led the US to develop a strategy of isolating the PRC, notably by building multilateral military alliances and promoting alternatives to the BRI. In this context, how have Latin American states responded? If many have turned towards China to increase their autonomy, there has not yet been a common strategy and their conception of the "Asia-Pacific" contrasts with the United States' current promotion of the "Indo-Pacific" alternative.This seminar sought to think about how the US and Latin American countries considered their relationship with the Pacific and Asia, comparing defense, economic and diplomatic approaches.La rivalité sino-américaine dans l’océan Pacifique a conduit les États-Unis à élaborer une stratégie d’isolation de la République Populaire de Chine, notamment basée sur des alliances militaires multilatérales et la promotion d’une alternative aux Nouvelles routes de la soie. Dans ce contexte, comment réagissent les pays latino-américains ? Si nombre d’entre eux se tournent également vers la Chine afin de consolider leur autonomie, on ne décèle pas de stratégie commune et leur conception de l’Asie-Pacifique est confrontée à celle de l'Indo-Pacifique promue par les États-Unis.Cette séance thématique aura pour objectif de réfléchir à comment les États-Unis et les pays latino-américains considèrent leur relation face à l’espace Pacifique et à l’Asie en prenant en compte les domaines de la défense, de l’économie et de la diplomatie