AIMTo describe factors associated with treatment failure and frequency of resistance-associated substitutions （RAS）.METHODSHuman immunodefciency virus （HIV）/hepatitis C virus （HCV） coinfected patients starting a...AIMTo describe factors associated with treatment failure and frequency of resistance-associated substitutions （RAS）.METHODSHuman immunodefciency virus （HIV）/hepatitis C virus （HCV） coinfected patients starting a first direct-acting antiviral （DAA） regimen before February 2016 and included in the French ANRS CO13 HEPAVIH cohort were eligible. Failure was defned as： （1） non-response [HCV-RNA remained detectable during treatment, at end of treatment （EOT）]; and （2） relapse （HCV-RNA suppressed at EOT but detectable thereafter）. Sequencing analysis was performed to describe prevalence of drug class-specifc RAS. Factors associated with failure were determined using logistic regression models.RESULTSAmong 559 patients, 77% had suppressed plasmaHIV-RNA 〈 50 copies/mL at DAA treatment initiation41% were cirrhotic, and 68% were HCV treatmentexperienced. Virological treatment failures occurred in22 patients and were mainly relapses （17, 77%） thenundefined failures （3, 14%） and non-responses （29%）. Mean treatment duration was 16 wk overall. Posttreatment NS3, NS5A or NS5B RAS were detected in10/14 patients with samples available for sequencinganalysis. After adjustment for age, sex, ribavirin useHCV genotype and treatment duration, low platelecount was the only factor signifcantly associated with ahigher risk of failure （OR： 6.5; 95%CI： 1.8-22.6）. CONCLUSIONOnly 3.9% HIV-HCV coinfected patients failed DAAregimens and RAS were found in 70% of those failingLow platelet count was independently associated withvirological failure.展开更多
AIM： To evaluate the results of sub total colectomy withI cecorectal anastomosis （STC-CRA） for isolated colonicinertia （CI）. METHODS： Fourteen patients （mean age 57.5±16.5 year） underwent surgery for isol...AIM： To evaluate the results of sub total colectomy withI cecorectal anastomosis （STC-CRA） for isolated colonicinertia （CI）. METHODS： Fourteen patients （mean age 57.5±16.5 year） underwent surgery for isolated CI between January 1986 and December 2002. The mean frequency of bowel motions with the aid of laxatives was 1.2±0.6 per week. All subjects underwent colonoscopy, anorectal manometry, cinedefaecography and colonic transit time （CTF）. CI was defined as diffuse markers delay on CTF without evidence of pelvic floor dysfunction. All patients underwent STC-CRA. Long-term follow-up was obtained prospectively by clinical visits between October 2005 and February 2006 at a mean of 10.5 ＋ 3.6 years （range 5-16 years） during which we considered the number of stool emissions, the presence of abdominal pain or digitations, the use of pain killers, laxatives and/or fibers. Patients were also asked if they were satisfied with the surgery. RESULTS： There was no postoperative mortality Postoperative complications occurred in 21.4% （3/14）. At the end of follow-up, bowel frequency was significantly （P〈0.05）increased to a mean of 4.8±7.5 per day （range 1-30）. One patient reported disabling diarrhea. Two patients used laxatives less than three times per month without complaining of what they called constipation Overall, 78.5% of patients would have chosen surgery again if necessary. CONCLUSION： STC-CRA is feasible and safe in patients with CI achieving 79% of success at a mean follow-up of 10.5 years. A prospective controlled evaluation is warranted to verify the advantages of this surgical approach in patients with CI.展开更多
The incidence of obesity is steadily rising, and it has been estimated that 40% of the US population will be obese by the year 2025 if the current trend continues. In recent years there has been renewed interest in th...The incidence of obesity is steadily rising, and it has been estimated that 40% of the US population will be obese by the year 2025 if the current trend continues. In recent years there has been renewed interest in the surgical treatment of morbid obesity in concomitance with the epidemic of obesity. Bariatric surgery proved effective in providing weight loss of large magnitude, correction of comorbidities and excellent short-term and long-term outcomes, decreasing overall mortality and providing a marked survival advantage. The Laparoscopic Sleeve Gastrectomy (LSG) has increased in popularity and is currently very "trendy" among laparoscopic surgeons involved in bariatric surgery. As LSG proved to be effective in achieving considerable weight loss in the short-term, it has been proposed by some as a sole bariatric procedure. This editorial focuses on the particular advantages of LSG in the treatment of morbid obesity.展开更多
Ingestion of a foreign body is a frequent and wellknown medical problem with several diagnostic and therapeutic approaches.Usually,ingested foreign bodies pass through the alimentary tract without incident.In some cas...Ingestion of a foreign body is a frequent and wellknown medical problem with several diagnostic and therapeutic approaches.Usually,ingested foreign bodies pass through the alimentary tract without incident.In some cases,they can be lodged in the appendix and may cause appendicitis.We report a case of a 29-year old woman,suffering from mental illness,with a safety pin lodged in the appendix.Initially,the patient consulted for abdominal pain.After a period of waiting,during which time the foreign body did not move,a colonoscopy was performed but failed to see the safety pin.Then,the patient underwent a laparoscopic appendectomy.Pathological examination showed an ulcerative appendicitis.展开更多
Background: Kounis syndrome is a typically life threatening but very rare clinical entity that is characterized by coronary artery vasospasm and myocardial damage in the setting of allergic reactions including those c...Background: Kounis syndrome is a typically life threatening but very rare clinical entity that is characterized by coronary artery vasospasm and myocardial damage in the setting of allergic reactions including those caused by environmental stimuli. While jellyfish stings are familiar with provoking local allergic reactions, systemic encroachment including Kounis syndrome is extremely rare. Case Presentation: A 53-year-old male, apparently healthy and a regular swimmer reported to clinic with hypotension, increased troponin levels, and mild transient chest pain, after a sting from a jellyfish while swimming. The patient had a previous reaction to a jellyfish sting but no history of CAD, coronary artery disease. The first steps in managing the case were providing corticosteroids to stabilize the patient as well as antiplatelet therapy administration. Coronary angiography done later did not show any significant coronary artery stenosis making it clear that the patient had Kounis syndrome, Type I where products of an allergic reaction were leading and not coronary artery disease. Conclusion: The present case demonstrates the occurrence of Kounis syndrome after envenomation by jellyfish, emphasizing the possibility of allergy in patients with cardiovascular and allergic complaints. If the condition is recognized at an early stage and there is proper administration of steroids and or antiplatelets then the results are good. More studies are required for understanding how Kounis syndrome occurs and instead of recurrent allergic reactions on heart.展开更多
Objectives To our best knowledge,no study in France has comprehensively investigated the prehospital history of patients admitted for severe cases of COVID-19.‘Patients’voice is an excellent means to capture data on...Objectives To our best knowledge,no study in France has comprehensively investigated the prehospital history of patients admitted for severe cases of COVID-19.‘Patients’voice is an excellent means to capture data on primary care pathways.We aimed to identify clusters of COVID-19 hospitalised patients with similar prehospital symptom sequences,and to test whether these clusters were associated with a higher risk of poor clinical outcomes.Design Cross-sectional online survey using life-event calendars.Setting All patients hospitalised for COVID-19 between September 2020 and May 2021 in the Infectious Disease Departments in Nice and in Marseilles in France.Participants 312 patients responded to the survey.Main outcome measures From the day of symptom onset to the day of hospitalisation,we defined a symptom sequence as the time-ordered vector of the successive symptom grades(grade 1,grade 2,grade 3).State sequence analysis with optimal matching was used to identify clusters of patients with similar symptom sequences.Multivariate logistic regressions were performed to test whether these clusters were associated with admission to intensive care unit(ICU)and COVID-19 sequelae after hospitalisation.Results Three clusters of symptom sequences were identified among 312 complete prehospital pathways.A specific group of patients(29%)experienced extended symptoms of severe COVID-19,persisting for an average duration of 7.5 days before hospitalisation.This group had a significantly higher probability of being admitted to ICU(adjusted OR 2.01).They were less likely to know a loved one who was a healthcare worker,and more likely to have a lower level of education.Similarly,this group of patients,who were more likely to have previously visited the emergency room without exhibiting severe symptoms at that time,may have been inclined to postpone reassessment when their health worsened.Their relatives played a decisive role in their hospitalisation.Conclusion and relevance This study highlights the negative impact of delayed hospitalisation on the health outcomes of French patients with severe COVID-19 symptoms during the first wave and underscores the influence of socioeconomic factors,such as lower education levels and limited connections to the medical field,on patients’experiences.展开更多
基金Supported by Inserm-ANRS(French National Institute for Health and Medical Research-ANRS/France REcherche Nord and Sud Sida-hiv Hépatites)
文摘AIMTo describe factors associated with treatment failure and frequency of resistance-associated substitutions （RAS）.METHODSHuman immunodefciency virus （HIV）/hepatitis C virus （HCV） coinfected patients starting a first direct-acting antiviral （DAA） regimen before February 2016 and included in the French ANRS CO13 HEPAVIH cohort were eligible. Failure was defned as： （1） non-response [HCV-RNA remained detectable during treatment, at end of treatment （EOT）]; and （2） relapse （HCV-RNA suppressed at EOT but detectable thereafter）. Sequencing analysis was performed to describe prevalence of drug class-specifc RAS. Factors associated with failure were determined using logistic regression models.RESULTSAmong 559 patients, 77% had suppressed plasmaHIV-RNA 〈 50 copies/mL at DAA treatment initiation41% were cirrhotic, and 68% were HCV treatmentexperienced. Virological treatment failures occurred in22 patients and were mainly relapses （17, 77%） thenundefined failures （3, 14%） and non-responses （29%）. Mean treatment duration was 16 wk overall. Posttreatment NS3, NS5A or NS5B RAS were detected in10/14 patients with samples available for sequencinganalysis. After adjustment for age, sex, ribavirin useHCV genotype and treatment duration, low platelecount was the only factor signifcantly associated with ahigher risk of failure （OR： 6.5; 95%CI： 1.8-22.6）. CONCLUSIONOnly 3.9% HIV-HCV coinfected patients failed DAAregimens and RAS were found in 70% of those failingLow platelet count was independently associated withvirological failure.
文摘AIM： To evaluate the results of sub total colectomy withI cecorectal anastomosis （STC-CRA） for isolated colonicinertia （CI）. METHODS： Fourteen patients （mean age 57.5±16.5 year） underwent surgery for isolated CI between January 1986 and December 2002. The mean frequency of bowel motions with the aid of laxatives was 1.2±0.6 per week. All subjects underwent colonoscopy, anorectal manometry, cinedefaecography and colonic transit time （CTF）. CI was defined as diffuse markers delay on CTF without evidence of pelvic floor dysfunction. All patients underwent STC-CRA. Long-term follow-up was obtained prospectively by clinical visits between October 2005 and February 2006 at a mean of 10.5 ＋ 3.6 years （range 5-16 years） during which we considered the number of stool emissions, the presence of abdominal pain or digitations, the use of pain killers, laxatives and/or fibers. Patients were also asked if they were satisfied with the surgery. RESULTS： There was no postoperative mortality Postoperative complications occurred in 21.4% （3/14）. At the end of follow-up, bowel frequency was significantly （P〈0.05）increased to a mean of 4.8±7.5 per day （range 1-30）. One patient reported disabling diarrhea. Two patients used laxatives less than three times per month without complaining of what they called constipation Overall, 78.5% of patients would have chosen surgery again if necessary. CONCLUSION： STC-CRA is feasible and safe in patients with CI achieving 79% of success at a mean follow-up of 10.5 years. A prospective controlled evaluation is warranted to verify the advantages of this surgical approach in patients with CI.
文摘The incidence of obesity is steadily rising, and it has been estimated that 40% of the US population will be obese by the year 2025 if the current trend continues. In recent years there has been renewed interest in the surgical treatment of morbid obesity in concomitance with the epidemic of obesity. Bariatric surgery proved effective in providing weight loss of large magnitude, correction of comorbidities and excellent short-term and long-term outcomes, decreasing overall mortality and providing a marked survival advantage. The Laparoscopic Sleeve Gastrectomy (LSG) has increased in popularity and is currently very "trendy" among laparoscopic surgeons involved in bariatric surgery. As LSG proved to be effective in achieving considerable weight loss in the short-term, it has been proposed by some as a sole bariatric procedure. This editorial focuses on the particular advantages of LSG in the treatment of morbid obesity.
文摘Ingestion of a foreign body is a frequent and wellknown medical problem with several diagnostic and therapeutic approaches.Usually,ingested foreign bodies pass through the alimentary tract without incident.In some cases,they can be lodged in the appendix and may cause appendicitis.We report a case of a 29-year old woman,suffering from mental illness,with a safety pin lodged in the appendix.Initially,the patient consulted for abdominal pain.After a period of waiting,during which time the foreign body did not move,a colonoscopy was performed but failed to see the safety pin.Then,the patient underwent a laparoscopic appendectomy.Pathological examination showed an ulcerative appendicitis.
文摘Background: Kounis syndrome is a typically life threatening but very rare clinical entity that is characterized by coronary artery vasospasm and myocardial damage in the setting of allergic reactions including those caused by environmental stimuli. While jellyfish stings are familiar with provoking local allergic reactions, systemic encroachment including Kounis syndrome is extremely rare. Case Presentation: A 53-year-old male, apparently healthy and a regular swimmer reported to clinic with hypotension, increased troponin levels, and mild transient chest pain, after a sting from a jellyfish while swimming. The patient had a previous reaction to a jellyfish sting but no history of CAD, coronary artery disease. The first steps in managing the case were providing corticosteroids to stabilize the patient as well as antiplatelet therapy administration. Coronary angiography done later did not show any significant coronary artery stenosis making it clear that the patient had Kounis syndrome, Type I where products of an allergic reaction were leading and not coronary artery disease. Conclusion: The present case demonstrates the occurrence of Kounis syndrome after envenomation by jellyfish, emphasizing the possibility of allergy in patients with cardiovascular and allergic complaints. If the condition is recognized at an early stage and there is proper administration of steroids and or antiplatelets then the results are good. More studies are required for understanding how Kounis syndrome occurs and instead of recurrent allergic reactions on heart.
基金funded by Agence Nationale de la Recherche'Résilience Covid-19'(ANR-21-COVR 0043).
文摘Objectives To our best knowledge,no study in France has comprehensively investigated the prehospital history of patients admitted for severe cases of COVID-19.‘Patients’voice is an excellent means to capture data on primary care pathways.We aimed to identify clusters of COVID-19 hospitalised patients with similar prehospital symptom sequences,and to test whether these clusters were associated with a higher risk of poor clinical outcomes.Design Cross-sectional online survey using life-event calendars.Setting All patients hospitalised for COVID-19 between September 2020 and May 2021 in the Infectious Disease Departments in Nice and in Marseilles in France.Participants 312 patients responded to the survey.Main outcome measures From the day of symptom onset to the day of hospitalisation,we defined a symptom sequence as the time-ordered vector of the successive symptom grades(grade 1,grade 2,grade 3).State sequence analysis with optimal matching was used to identify clusters of patients with similar symptom sequences.Multivariate logistic regressions were performed to test whether these clusters were associated with admission to intensive care unit(ICU)and COVID-19 sequelae after hospitalisation.Results Three clusters of symptom sequences were identified among 312 complete prehospital pathways.A specific group of patients(29%)experienced extended symptoms of severe COVID-19,persisting for an average duration of 7.5 days before hospitalisation.This group had a significantly higher probability of being admitted to ICU(adjusted OR 2.01).They were less likely to know a loved one who was a healthcare worker,and more likely to have a lower level of education.Similarly,this group of patients,who were more likely to have previously visited the emergency room without exhibiting severe symptoms at that time,may have been inclined to postpone reassessment when their health worsened.Their relatives played a decisive role in their hospitalisation.Conclusion and relevance This study highlights the negative impact of delayed hospitalisation on the health outcomes of French patients with severe COVID-19 symptoms during the first wave and underscores the influence of socioeconomic factors,such as lower education levels and limited connections to the medical field,on patients’experiences.
