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Lars Åke Persson and colleagues conduct a cluster randomised control in northern Vietnam to analyze the effect of the activity of local community-based maternal-and-newborn stakeholder groups on neonatal mortality. Please see later in the article for the Editors' Summary [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Disseminated non-tuberculosis mycobacterial infections are associated with a defect of the cellular immune response. They have been mainly reported in AIDS patients. Cases related to the presence of anti-interferon-γ autoantibodies are rare. Case report: We report a non HIV-infected 45-year-old Thai woman, with a past medical history of Graves’ disease. She presented with recurrent disseminated and severe non-tuberculous mycobacterial infections that were related to the production of anti-interferon-γ autoantibody. The diagnosis was suspected in the presence of a negative interferon-γ release assay (IGRA) including with the positive control, and evidenced by the identification of specific antibodies. Conclusion: Anti-interferon-γ autoantibody production is a rare cause of non tuberculous mycobacterial infection. Such a mechanism should be suspected in non HIV-infected patients and especially in those having an Asiatic ethnicity or an associated immune disorder. A negative IGRA (including with the positive control) is a reliable diagnostic tool and should be completed with the identification of specific autoantibodies. [Copyright &y& Elsevier]

Abstract: Aim: The authors wanted to identify the factors associated with prescription or non-prescription of antibiotics by general practitioners (GPs), for three frequent infectious diseases: tonsillitis, acute bronchitis (AB) and exacerbations of chronic bronchitis (ECB). Patients and methods: A cross-sectional study included 574 patients followed by 58 randomly selected GPs in Eastern France. Data on physicians, patients (clinical, social and environmental) and antibiotic treatment (type, motivations) was collected during the consultation via a standardized questionnaire. Results: Official recommendations for tonsillitis, AB and ECB were known by GPs in 100, 96 and 91% of the cases, respectively. An antibiotic was administered in 61% of tonsillitis cases, 64% of AB and 84% of ECB. The correlation between prescribing or not antibiotics and official recommendations was variable (tonsillitis: 81.3%, ECB 89.6%, AB: 36.5%). Clinical criteria were the main factors influencing antibiotic prescription. A rapid antigen detection test for streptococcus A was performed in 65% of tonsillitis cases (positive in 55%) increased conformity with recommendations to 93.7%. A second consultation, poor tolerance and patient demand were also significantly associated with a higher rate of antibiotic prescription. Conclusions: Recommendations were known, but semiologic definitions and nosologic limits varied from one physician to another. Recommendations must be based on routine medical practice surveys to include factors influencing prescription, even if non significant. Paraclinical tests help in therapeutic decision making and in the non-prescription of antibiotics but such tests need to be more commonly used. [Copyright &y& Elsevier]

: Background The combination of one non-nucleoside reverse transcriptase inhibitor (NNRTI) with two nucleoside reverse transcriptase inhibitors is a validated first-line antiretroviral (ARV) therapy. The once-daily combination of lamivudine, tenofovirDF and nevirapine has not been evaluated in a clinical trial. : Methods Randomized, open-label, multicentre, non-inferiority trial comparing lamivudine, tenofovirDF and nevirapine once daily (Group 2) with zidovudine/lamivudine and nevirapine twice daily (Group 1), in naive HIV-1-infected patients with a CD4 count <350/mm3. We planned to enrol 250 patients. : Results As of May 2006, 71 patients had been enrolled (35 in Group 1 and 36 in Group 2) and an unplanned interim analysis was done. The groups were comparable at baseline: median CD4 count was 195 and 191/mm3 and median plasma viral load was 4.9 log10 and 5.01 log10, respectively, in Groups 1 and 2. Eight early non-responses (22.2%) were observed, all in Group 2, while two later viral rebounds occurred. Resistance genotypes for the nine Group 2 failing patients showed the mutations M184V/I (n = 3), K65R (n = 6), one or more NNRTI resistance mutations in all cases. At baseline, the nine Group 2 patients who failed had higher median plasma viral load (5.4 log10) and lower median CD4 count (110/mm3) than the other Group 2 patients (4.7 log10, P = 0.002 and 223/mm3, P = 0.004). Nevirapine trough concentrations were not different between the two groups, nor between patients with full viral suppression or those who failed in Group 2. Due to slow recruitment, and those results, the steering committee decided to stop the trial at 12 months. : Conclusions In ARV-naive HIV-1-infected patients, the once-daily lamivudine, tenofovirDF and nevirapine regimen resulted in a high rate of early virological failures. The reasons for the failures remain unclear. [ABSTRACT FROM AUTHOR]

Background The world-wide AIDS epidemic is reflected in Western Europe in an increasing number of HIV-infected persons who originate from Africa. We describe the characteristics and response to antiretroviral therapy (ART) of HIV-infected patients born in Africa and living in France. Methods Analysis of data from the (Anti PROtéase COhorte APROCO) cohort study of HIV-infected patients initiating ART was carried out. Included in the study were 90 patients born in sub-Saharan Africa, 53 in North Africa and 771 in metropolitan France. Results At baseline, there was a higher proportion of women and of the heterosexual transmission route of infection among patients born in sub-Saharan Africa, a higher proportion of injecting drug users among patients born in North Africa and a higher frequency of unemployment and of unstable housing conditions among patients born in both sub-Saharan and North Africa as compared with patients born in France. The median CD4 cell count was lower in patients born in both sub-Saharan and North Africa (sub-Saharan Africa: 197 cells/μL; North Africa: 222 cells/μL) than in patients born in France (307 cells/μL). Median HIV-1 viral loads were similar. After a median follow-up time of 36 months (2506 patient-years), the Kaplan–Meier estimations of probability of survival without new AIDS-defining events were not different. After 36 months of ART, in multivariate analysis, median CD4 cell count, CD4/CD8 ratio and viral load were not statistically different according to birthplace, but the median CD4 percentage was lower in patients born in both sub-Saharan and North Africa. The adherence profiles were similar. Conclusions Although clinical response and adherence to ART did not appear to differ in patients according to their birthplace, the reasons for the more advanced HIV infection observed at ART initiation among patients born in Africa should be further investigated. [ABSTRACT FROM AUTHOR]

Backgrounds Atrophy of corpus callosum (CC), a white matter structure linking the two hemispheres, is commonly observed in multiple sclerosis (MS). However, the occurrence and processes leading to this alteration are not yet determined. Goal and methods To better characterize the onset and progression of CC atrophy from the early stage of MS, we performed a two-year follow-up magnetic resonance imaging/magnetic resonance spectroscopic imaging (MRI/MRSI) exploration of CC in 24 patients with clinically isolated syndrome. These patients were explored using the same protocol at month (M)6, M12 and M24. MRI/MRSI techniques were applied to measure CC volume, and relative concentrations of N-acetylaspartate (NAA), creatine/phosphocreatine (Cr) and choline-containing compounds (Cho). A group of matched controls was also explored. Results Atrophy of CC, not present at baseline, was observed at M12 and progressed over the second year (M24). At baseline, a decrease in relative NAA level was observed in the anterior and posterior body of CC, with normalization during the follow-up period. In the anterior body, an increase in relative Cho level was observed, with normalization at M6. Normal relative Cr levels were observed at all time points in all sub-regions. The rate of CC atrophy was correlated with the change in the Expanded Disability Status Scale (EDSS) during the follow-up period. Conclusion These results suggest that CC atrophy appears over a period of one year after the first acute inflammatory episode, and that this atrophy is accompanied, especially in the anterior body of CC, by a normalization of the relative Cho levels, marker of acute inflammation, and NAA levels, marker of neuronal dysfunction and/or loss. [ABSTRACT FROM AUTHOR]

Background The predominance of T-helper type 2 (Th2) lymphocytes is thought to underlie the pathogenesis of asthma. Allergen inhalation challenge in atopic asthmatic subjects is associated with decreased interferon-γ (IFN-γ) positive CD4+ and CD8+ lymphocytes in peripheral blood and induced sputum. Objective This study examined the effects of an inhaled corticosteroid on these previously described allergen-induced changes in circulating Th1 and Th2 lymphocytes. Methods Subjects were randomized to 7 days of placebo, 40 or 80 μg ciclesonide in a crossover study. Airway responses and peripheral blood were measured before and after treatment, and 24 h after allergen challenge. Results Ciclesonide 40 and 80 μg significantly attenuated the late response and sputum eosinophils at 8 h post-allergen ( P<0.05). Circulating IFN-γ positive CD4+ lymphocytes decreased after allergen challenge with placebo ( P<0.05), and this was inhibited by 40 μg ciclesonide treatment ( P<0.05). There was no effect of allergen inhalation or ciclesonide on IL-4-positive CD4+ lymphocytes or IFN-γ and IL-4-positive CD8high lymphocytes. The allergen-induced change of IFN-γ/IL-4 ratio on CD4+ cells correlated with the allergen-induced change of peripheral blood eosinophils. Conclusions The results of this study suggest that attenuation of allergen-induced airway responses by ciclesonide may be mediated through regulation of IFN-γ-positive CD4+ cells. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Psoas abscess is a rare disease in developed countries. Its diagnosis is difficult and any delay could lead to a worsen prognosis. The aim of this study is to determine the best diagnostic and therapeutic practices. Methods: A retrospective study of psoas abscess that occurred during six months was performed. Results: Six cases of secondary psoas abscess are reported. They were associated with spondylodiscitis in three cases, arthritis and gynaecologic infection in the three remaining cases. Anatomic diagnosis was performed by tomodensitometry. Microbiologic diagnosis was obtained by blood culture or direct puncture of the abscess. Antibiotics were associated with percutaneous drainage in two cases, with simple puncture in one case, and with surgery in one case. A local improvement w observed in all cases. The oldest patients presented the worst complications which were not directly caused by the abscess. Conclusion: ● Physicians must be aware of psoas abscess because of their increasing incidence. ● Despite the fact that digestive pathologies are the main cause of secondary psoas abscess, bone infections, particularly spine infections, should be taken into consideration. ● Tomodensitometry guided puncture or percutaneous drainage are of diagnostic and therapeutic interest. ● Infectious samples must be taken before starting antibiotics, which have to be efficient against Gram negative bacillus, anaerobes and Staphylococcus aureus. ● Surgery must be quickly performed when the primary infection localisation need it, in case of voluminous abscess or when antibiotics and drainage are inefficient. [Copyright &y& Elsevier]

To compare the efficacy, ease of use and safety of intermittent vancomycin infusion (IVI) and continuous vancomycin infusion (CVI) in high-dose therapy of osteomyelitis. Forty-four patients with an osteomyelitis requiring vancomycin for more than 4 weeks were prospectively included, 21 receiving IVI and 23, CVI. The target serum concentration of vancomycin was 20–25 mg/L. Pharmacokinetics, adverse effects, and clinical efficacy were recorded. The mean daily vancomycin dosing was the same in the two groups, but the serum vancomycin concentrations (trough or plateau) were lower in the IVI group than the CVI group (21·7 ± 9·3 and 26·0 ± 6·1 mg/L, respectively; P < 0·0001). The target concentrations were achieved quicker with CVI, and daily dosing was changed more frequently in the IVI group. After reaching the target, variability of vancomycin serum concentration (trough or plateau concentrations) was higher in the IVI group than in CVI group (standard deviation 7·9 mg/L vs. 5·6 mg/L, respectively; P = 0·001). CVI did not show clinical superiority, but adverse drug effects were more frequent in the IVI group as compared with the CVI group, 9 (42·9%) and 2 (8·7%), respectively ( P = 0·03). Survival multiple regression using Cox's proportional hazard model showed that IVI (RR = 5·9, P = 0·03) and osteomyelitis of the foot (RR = 5·2, P = 0·01) were the only factors associated with adverse drug reactions leading to treatment termination. CVI is practical and effective, and may be a good alternative for patients requiring prolonged treatment with high vancomycin serum levels. [ABSTRACT FROM AUTHOR]

Presents an X-ray absorption spectroscopy study of the structures of Gd(DTPA)2- and Gd(DOTA)- complexes in the crystalline state and in aqueous solutions. Reconstruction of the Gd3+ local environment; Chemicals and solutions used in the study; Analysis of experimental data; Discussion on the results of the study.

The UK herpes zoster (HZ) national immunisation programme currently covers individuals aged 70-79 years-old. The study describes the disease burden of HZ and post-herpetic neuralgia (PHN) in the immunocompetent unvaccinated UK population aged >=80 years. From this the HZ and PHN incidence rates were calculated per 1,000 person-years and stratified by age groups (80-84, 85-90 and >=90 years). [Extracted from the article]

Introduction Le suivi thérapeutique pharmacologique (STP) est un des outils du suivi des personnes vivant avec le VIH (PVVIH). L’objectif de cette étude est d’évaluer en pratique courante l’utilisation du STP, ainsi que les situations dans lesquelles il apporte un bénéfice thérapeutique. Matériels et méthodes Toutes les PVVIH ayant bénéficié d’au moins un STP entre le 1 er janvier 2009 et le 31 décembre 2012 ont été rétrospectivement incluses. Chaque fois qu’un STP a été réalisé, nous avons analysé sa conformité aux recommandations françaises, les concentrations plasmatiques des molécules antirétrovirales, les modifications thérapeutiques consécutives, et l’évolution virologique 6 mois après le premier STP. Résultats Sur 571 PVVIH incluses, 248 (43,4 %) ont bénéficié d’au moins un STP de leur traitement antirétroviral. Le STP était conforme aux recommandations chez 120 patients (48 %). Les STP réalisés conformément aux recommandations mettaient plus fréquemment en évidence des concentrations en dehors de l’intervalle thérapeutique (107 [28,4 %] vs. 74 [19,6 %] p = 0,03), en particulier lorsque motivés par un échec virologique (156 [41,5 %] vs. 110 [29,2 %] p = 0,09). Au total, 56 patients (22,6 %) ont bénéficié d’une modification de leur traitement antirétroviral, consécutive au STP. Les inhibiteurs de protéase, les inhibiteurs non nucléotidiques de la transcriptase inverse et le raltégravir étaient consécutivement plus souvent modifiés lorsque la concentration plasmatique était en dehors de l’intervalle thérapeutique ( p = 0,008, p = 0,05 et p = 0,02, respectivement). Au final, seuls 44 STP (11,7 %) ont mis en évidence une concentration en dehors de l’intervalle thérapeutique motivant une modification du traitement avec un contrôle virologique VIH confirmé 6 mois après. Conclusion Si le bénéfice global du STP en pratique courante peut apparaître modéré lorsqu’il est pratiqué largement, il est d’un intérêt lorsqu’il est réalisé dans le cadre défini par les recommandations. Il n’est pas, à l’échelon individuel, un outil de décision en soi, mais un outil utile lorsqu’intégré à une approche globale incluant le contexte clinique et virologique. [ABSTRACT FROM AUTHOR]

A longitudinal study found that the incidence of gynecomastia in HIV-infected male patients treated with highly active antiretroviral therapy was 0.8/100 patient-years, with a prevalence of 2.8% in those treated for ≥ 2 y. Even though the physiopathology remains unclear, this study suggests that gynecomastia should be monitored in these patients. [ABSTRACT FROM AUTHOR]

Presents a study that determined the frequency of incomplete genotypic resistance to nonnucleoside reverse transcriptase inhibitors (NNRTI) among HIV-infected persons treated with nevirapine. Definition of incomplete genotypic resistance; Determination of full susceptibility and partial susceptibility of patients to NNRTI; Recommendations.

Background: Facilitation of local women's groups may reportedly reduce neonatal mortality. It is not known whether facilitation of groups composed of local health care staff and politicians can improve perinatal outcomes. We hypothesised that facilitation of local stakeholder groups would reduce neonatal mortality (primary outcome) and improve maternal, delivery, and newborn care indicators (secondary outcomes) in Quang Ninh province, Vietnam.Methods and Findings: In a cluster-randomized design 44 communes were allocated to intervention and 46 to control. Laywomen facilitated monthly meetings during 3 years in groups composed of health care staff and key persons in the communes. A problem-solving approach was employed. Births and neonatal deaths were monitored, and interviews were performed in households of neonatal deaths and of randomly selected surviving infants. A latent period before effect is expected in this type of intervention, but this timeframe was not pre-specified. Neonatal mortality rate (NMR) from July 2008 to June 2011 was 16.5/1,000 (195 deaths per 11,818 live births) in the intervention communes and 18.4/1,000 (194 per 10,559 live births) in control communes (adjusted odds ratio [OR] 0.96 [95% CI 0.73-1.25]). There was a significant downward time trend of NMR in intervention communes (p = 0.003) but not in control communes (p = 0.184). No significant difference in NMR was observed during the first two years (July 2008 to June 2010) while the third year (July 2010 to June 2011) had significantly lower NMR in intervention arm: adjusted OR 0.51 (95% CI 0.30-0.89). Women in intervention communes more frequently attended antenatal care (adjusted OR 2.27 [95% CI 1.07-4.8]).Conclusions: A randomized facilitation intervention with local stakeholder groups composed of primary care staff and local politicians working for three years with a perinatal problem-solving approach resulted in increased attendance to antenatal care and reduced neonatal mortality after a latent period. [ABSTRACT FROM AUTHOR]

Summary: We report three consecutive cases of tularemia occurring in Burgundy, France, a region previously considered not endemic for tularemia. The patients presented with varied and unspecific clinical manifestations. The epidemiological circumstances, especially the mode of contamination, were not particularly suggestive of tularemia. Serological diagnosis was delayed in two cases because of the lack of significant antibody titers at the time of admission. In contrast, a diagnosis could readily be obtained in all three cases by detection of Francisella tularensis DNA from clinical samples using PCR-based methods. These cases highlight the increased incidence and geographical spread of tularemia in France, and the usefulness of real-time PCR technology for the early diagnostic confirmation of tularemia. [Copyright &y& Elsevier]

Examines whether measuring levels of anti-HIV drugs in patients' hair might be useful for determining that patients are taking and absorbing the drugs appropriately. Measurement of indinavir levels in patients' hair; Blood levels of virus.