A national cross-sectional study among drug-users in France: epidemiology of HCV and highlight on practical and statistical aspects of the design

<p>Abstract</p> <p>Background</p> <p>Epidemiology of HCV infection among drug users (DUs) has been widely studied. Prevalence and sociobehavioural data among DUs are therefore available in most countries but no study has taken into account in the sampling weights one important aspect of the way of life of DUs, namely that they can use one or more specialized services during the study period. In 2004–2005, we conducted a national seroepidemiologic survey of DUs, based on a random sampling design using the Generalised Weight Share Method (GWSM) and on blood testing.</p> <p>Methods</p> <p>A cross-sectional multicenter survey was done among DUs having injected or snorted drugs at least once in their life. We conducted a two stage random survey of DUs selected to represent the diversity of drug use. The fact that DUs can use more than one structure during the study period has an impact on their inclusion probabilities. To calculate a correct sampling weight, we used the GWSM. A sociobehavioral questionnaire was administered by interviewers. Selected DUs were asked to self-collect a fingerprick blood sample on blotting paper.</p> <p>Results</p> <p>Of all DUs selected, 1462 (75%) accepted to participate. HCV seroprevalence was 59.8% [95% CI: 50.7–68.3]. Of DUs under 30 years, 28% were HCV seropositive. Of HCV-infected DUs, 27% were unaware of their status. In the month prior to interview, 13% of DUs shared a syringe, 38% other injection parapharnelia and 81% shared a crack pipe. In multivariate analysis, factors independently associated with HCV seropositivity were age over 30, HIV seropositivity, having ever injected drugs, opiate substitution treatment (OST), crack use, and precarious housing.</p> <p>Conclusion</p> <p>This is the first time that blood testing combined to GWSM is applied to a DUs population, which improve the estimate of HCV prevalence. HCV seroprevalence is high, indeed by the youngest DUs. And a large proportion of DUs are not aware of their status. Our multivariate analysis identifies risk factors such as crack consumption and unstable housing.</p

Lave-endoscopes et désinfection des endoscopes à l'hôpital. Un exempte de dysfonctionnement

L'endoscopie, tant interventionnelle qu'exploratrice, est en plein essor. Les endoscopes souples sont de plus en plus utilisés dans le diagnostic et le traitement de nombreuses affections. Ainsi, 1 300 endoscopies sont effectuées par mois à Cochin (hôpital de 1 027 lits). Au cours de ces examens endoscopiques, nul n'est à l'abri d'un problème infectieux (infections nosocomiales post-endoscopiques). Afin de prévenir ces risques infectieux, la circulaire de la D.G.S./D.H. n° 236 du 2 avril1996, fixe les règles de la désinfection manuelle des endoscopes souples. Celle-ci comprend cinq étapes : le traitement préliminaire, le rinçage, la désinfection proprement dite (glutaraldéhyde à 2% pendant 20 minutes), le rinçage terminal et le stockage. Ces procédures peuvent également être automatisées. Le traitement manuel est long, pénible et présente un risque d'exposition aux aldéhydes pour le personnel. De plus, il est rarement correctement suivi, ce qui conduit à un échec de la procédure et à l'augmentation du risque infectieux. Seule l'automatisation de la désinfection des endoscopes par des lave-endoscopes permet d'augmenter la fiabilité, la traçabilité, la reproductibilité des traitements et d'améliorer la qualité de la désinfection. Malheureusement, des dysfonctionnements des lave-endoscopes ont été observés. Par exemple en novembre 1998, une panne sur le circuit de détergent du lave-endoscope du service d'endoscopie digestive de l'hôpital Cochin a été constatée. Cette panne a eu pour conséquences : (1) la convocation de 69 patients, pour dépistage gratuit (par sérologies) des hépatites B et C et du VIH, (2) la contamination du lave-endoscope défectueux par une souche de Pseudo-monas aeruginosa, (3) un surcoût pour l'hôpital. Les dysfonctionnements de ces lave-endoscopes doivent être évités : en renforçant les procédures écrites et les contrôles, en modifiant la conception de ces machines et en définissant une méthodologie pour le bon fonctionnement et l'efficacité microbiologique de ces laveurs. Enfin, il faut privilégier l'achat d'endoscopes stérilisables

Determinants of aspirin resistance in patients with type 2 diabetes

International audienceBackground: Cardiovascular disease is a leading cause of mortality among patients with type 2 diabetes mellitus (T2DM). Numerous patients with T2DM show resistance to aspirin treatment, which may explain the higher rate of major adverse cardiovascular events observed compared with non-diabetes patients, and it has recently been shown that aspirin resistance is mainly related to accelerated platelet turnover with persistent high platelet reactivity (HPR) 24h after last aspirin intake. The mechanism behind HPR is unknown. The aim of this study was to investigate the precise rate and mechanisms associated with HPR in a population of T2DM patients treated with aspirin.Methods: Included were 116 consecutive stable T2DM patients who had attended our hospital for their yearly check-up. HPR was assessed 24h after aspirin intake using light transmission aggregometry (LTA) with arachidonic acid (AA) and serum thromboxane B2 (TXB2) measurement. Its relationship with diabetes status, insulin resistance, inflammatory markers and coronary artery disease (CAD) severity, using calcium scores, were investigated.Results: Using LTA, HPR was found in 27 (23%) patients. There was no significant difference in mean age, gender ratio or cardiovascular risk factors in patients with or without HPR. HPR was significantly related to duration of diabetes and higher fasting glucose levels (but not consistently with HbA1c), and strongly related to all markers of insulin resistance, especially waist circumference, HOMA-IR, QUICKI and leptin. There was no association between HPR and thrombopoietin or inflammatory markers (IL-6, IL-10, indoleamine 2,3-dioxygenase activity, TNF-α, C-reactive protein), whereas HPR was associated with more severe CAD. Similar results were found with TXB2.Conclusion: Our results reveal that 'aspirin resistance' is frequently found in T2DM, and is strongly related to insulin resistance and severity of CAD, but weakly related to HbA1c and not at all to inflammatory parameters. This may help to identify those T2DM patients who might benefit from alternative antiplatelet treatments such as twice-daily aspirin and thienopyridines