Search

Abstract: Establishment of an effective prophylaxis against oral candidiasis by local treatment is essential for immunocompromised patients. The aim of the study is to assess effectiveness and stability of antifungal suspensions for mouthrinses. The assessed suspensions are compounded by one solvent among sterile water, spring water or sodium bicarbonate associated with amphotericin B (Fungizone®) or nystatine (Mycostatine®). Two others mixes are assessed: Mycostatine®-bicarbonate and Mycostatine®-Hextril®-bicarbonate as well as the two straight antifungal. In vitro activity is tested on five Candida species (C. albicans, C. glabrata, C. krusei, C. parapsilosis, C. tropicalis) after a five minutes contact between yeasts and the assessed suspension. A galenic study is realized during 3 days. Mixes associating a polyene with sodium bicarbonate have no effectiveness on Candida albicans, others mixes shows intermediate effectiveness (the percentage of yeast growth inhibition lies between 35% and 68%). Effectiveness results of Hextril®-based mixes are not explainable because of alcohol in its composition. Spring water-based mixes must be evicted due to microbiologic contaminations after 48hours. Mycostatine®-Hextril®-bicarbonate mix is not stable during 3 days. All those mouthrinses, poorly effective, excepted on C. glabrata, should be avoided. Straight Mycostatine® shows a good antifungal effectiveness excepted on C. krusei and its use should be recommended. [Copyright &y& Elsevier]

Introduction Les staphylocoques à coagulase négative (SCN) sont des bactéries commensales de la peau et des muqueuses faiblement pathogènes mais responsables de 30 % des bactériémies liées au cathéter (BLC). Le but de ce travail était de caractériser la pathogénicité d’une population de SCN issus de BLC puis d’étudier l’effet de l’exposition aux antibiotiques sur leur résistance et leur virulence. Matériels et méthodes Les SCN ont été isolées dans 3 centres du 01/01/15 au 31/12/15. Après une étude de clonalité par Rep-PCR et par MLST, la virulence a été caractérisée à la fois par la recherche des 14 principaux gènes de virulence (PCR), par l’utilisation du modèle de virulence in vivo C. elegans (courbe de survie), et par la détermination de la formation du biofilm par la technique biofilm Ring Test ® . Cinq souches représentatives du panel ont été sélectionnées et exposées 15 jours à un antibiotique (ceftobiprole, daptomycine, linézolide ou vancomycine). La résistance aux antibiotiques (concentration minimale inhibitrice (CMI)) et la formation de biofilm étaient évaluées après exposition. Les capacités de 5 antibiotiques à inhiber la formation de biofilm a été étudiée sur ces souches par la technique de l’antibiofilmogram ® (biofilm Control). Résultats Parmi les 36 souches de SCN isolées, une majorité portait les principaux gènes de virulence connus dans ces bactéries et toutes produisaient du biofilm en moins de 5 heures. Toutefois, seulement 39 % étaient virulentes chez C. elegans . Les 5 isolats de S. epidermidis sélectionnés soumis à une pression antibiotique pendant 15 jours augmentaient leur CMI de ce même antibiotique. Il existait une résistance croisée entre la vancomycine et la daptomycine. Les souches de S. epidermidis exposées à la daptomycine augmentaient leur capacité d’adhésion et de formation de biofilm S. epidermidis . La daptomycine et le ceftobiprole étaient inefficaces pour inhiber le biofilm. Le test de l’antibiofilmogram ® permettait de mettre en évidence que la rifampicine et le linézolide étaient les médicaments les plus efficaces pour inhiber l’initiation de la formation de biofilm alors que la ceftobibrole et la daptomycine étaient inefficaces. Même en présence d’autres antibiotiques, les souches exposées à la daptomycine maintenaient leur capacité exacerbée de formation de biofilm. Conclusion Les SCN sont capables de modifier leur phénotype de résistance et de virulence sous pression antibiotique. Dans cette étude, S. epidermidis augmentait ses capacités de formation de biofilm après une exposition prolongée à la daptomycine. Par ailleurs seuls le linézolide et la rifampicine semblent avoir une activité permettant de limiter l’adhésion bactérienne chez S. epidermidis . [ABSTRACT FROM AUTHOR]

Micro-inflammation has been recognized as a major factor associated with the poor prognosis of patients with chronic kidney disease. Those patients have an increased rate of pro-inflammatory markers like interleukin 6, C-Reactive protein, Tumor Necrosis Factor α and fibrinogen. Among multiple and complex causes of micro-inflammation the gut microbiota could be an important actor considering the dysbiosis in chronic kidney disease which would enhance the synthesis of uremic toxins with cardiovascular toxicity and the bacterial translocation. This review details the role of the gut microbiota in human pathology and in chronic kidney disease focusing on the bacterial translocation that could occur because of an impaired digestive permeability. This bacterial translocation could induce a chronic immune response and could take part in the raise of pro-inflammatory markers in chronic kidney disease. New therapeutic strategies aiming at preventing metabolic and cardiovascular complications could emerge from the understanding of the relationships between gut microbiota and host in this particular pathology., (Copyright © 2017 Société francophone de néphrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.)

Mrs. A, a 62 year old patient with a history of hypertension, polyuria and polydipsia is hospitalized after a malaise. A severe hypokalemia, which is the cause of the polyuria and polydipsia, is discovered. The presence of hypertension and hypokalemia arises suspicion of a primary hyperaldosteronism and the plasma levels of renin and aldosterone are measured. Elevated aldosterone levels are combined with high plasma renin concentrations which permits to rule out primary hyperaldosteronism. Further explorations reveal a subocclusive ostial stenosis of the right renal artery. A treatment by sartan is instaured, which allows arterial pressure control and kalemia normalization. Chronic hypokalemia can be the cause of tubular nephropathy manifested by nephrogenic diabetes insipidus.

A patient, born in 1961, is hospitalised for pubic abdominal pain with irradiation to the right and left sides. She has a Turner's syndrome. At first evaluation, an abdominal tomography demonstrates a right pyelonephritis. The patient is treated with quinolones and she evolves favourably, except that she continues to present some abdominal pain. She leaves the hospital, but because of permanent abdominal pain, a new abdominal tomography is performed: an aortic dissection type B for (Stanford), or III anterograde for (De Bakey), is diagnosed. Cardiovascular anomalies are frequent in Turner's syndrome. Aortic dissection is a rare complication. Histological analysis shows a cystic medial necrosis. Medical and cardiological follow-up is needed.

A large number of factors have to be taken into consideration to evaluate the severity of intractable partial epilepsy. These inter-related factors change with compliance and with the frequency of seizures as well as the psycho-social context. We discuss here the different factors which are directly or indirectly related with epilepsy. In clinical practice, only some of these factors are used as criteria of severity. The only truly effective method of determining the real consequences of epilepsy are quality of life could measurements.

Although rare in non immunodeficient patients, the correct diagnosis of brain abscess is essential in order to initiate urgent medical and surgical treatment. We describe the imaging features including spectroscopy and diffusion MRI.

The treatment of drug addiction by methadone is questioned: there is a shift from "all of abstinence" to "all for risk limitation". There is a modification of the clinical relationship, due to specific resources allocated for methadone treatment, modifying also the connections between medicine, Public Health and Public Security.

Objectives: Repeated hypoglycaemia has been reported to impair recognition of subsequent hypoglycaemia with a high risk of severe hypoglycaemia. This intensified insulin therapy may be dangerous in insulin-dependent diabetes mellitus (IDDM) patients with unawareness of hypoglycaemia., Methods: We assessed the incidence of nocturnal hypoglycaemia and the benefit of an additional bedtime snack in IDDM patients treated by 2 or 3 daily injections. Capillary blood glucose was measured by finger strip at 10 p.m. and plasma venous glycaemia was determined at 0, 2, 4 and 8 a.m., Results: The study was composed of two phases. In the first phase, patients (n = 93) did not receive any snack at bedtime. Blood glucose fell to 2.75 mmol/l or less in 33%. Among the 40 patients with a 10 p.m. glycaemia of 9 mmol/l or less, 57.5% experienced nocturnal hypoglycaemia vs 15% of the 53 others. The second phase concerned 106 IDD patients. An additional bedtime snack was given when 10 p.m. blood glucose was 9 mmol/l or less. The incidence of hypoglycaemia fell to 32% (14 of 44 IDDM) i.e. a significant benefit of 44% (p < 0.01). However patients who received this additional bedtime snack had a slightly higher 8 a.m. glycaemia than those with 10 p.m. glycaemia at 9 mmol/l or less during the first phase (9.61 +/- 5.67 mmol/l vs 7.75 +/- 4.30 mmol/l) but this result is not significant., Conclusion: Prevention of nocturnal hypoglycaemia may be achieved in IDDM patients by bedtime glucose determination and an additional snack when glycaemia is 9 mmol/l or less.

A multicentre open therapeutic trial comparing carbamazepine with slow-release carbamazepine was conducted in 114 epileptic patients older than 12 years. The patients received the two products successively during two periods of 1 month each. With slow-release carbamazepine the number of doses could be reduced to 2 per day without decrease in effectiveness and with less side-effects. The twice-a-day dosage should result in better compliance and consequently in a better quality of treatment in the long term.

The leukocyte adherence was employed to detect patients with auto-immunity against the retina, in three series of retinal detachments associated with peripheral vitreo-retinal retraction. The first serie of 14 patients received no medical treatment; the second serie of 19 patients was submitted an antiprostaglandins drug (tiaprofenic acid); the third serie of 16 patients received systemic corticoids. The leukocyte adherence test was performed before surgery and 10 days after surgery in all patients. It showed that auto-immunity against the retina after surgery was half as frequent in those patients submitted to anti-inflammatory drugs than in those patients who received no medical treatment. Moreover, the results of the present study suggest that: 1) Auto-immunity against the retina after surgery is twice as frequent in retinal detachments with associated massive vitreo-retinal retraction than in those which are surgical successes with good visual results (no macular pucker). 2) Auto-immunity against the retina 10 days after surgery is more frequent in those retinal detachments needing more than 20 cryo-applications than in those needing less than 20 cryo-applications.