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C Strady

Publications and source records attributed to C Strady.

13 recordsLinked to original sources
PubMed2005

[Hantavirus infections].

Hantaviruses are cosmopolite anthropozoonosis considered as an emerging disease. Four pathogenic types for humans and part of the Bunyaviridae species are hosted by rodents and have been isolated: the Sin nombre virus responsible for the severe American respiratory form; the Hantaan and Seoul viruses responsible for hemorrhagic fevers with renal syndrome (HFRS) of severe to moderate expression in Asia and also in the Balkans; the Puumala virus responsible for HFRS of moderate expression or the socalled nephropathia epidemica in Europe. The Puumala virus is responsible for a minor form of the disease that is observed in areas of the Occidental sector of the ex-URSS, in Scandinavia and in the rest of Europe, notably in the North-East of France. The epidemic episodes occur every three years. They follow the proliferation of rodents, notably russet voles, the reservoir hosts, and their degree of infection. The concept of an occupation at risk in 20 to 49 year-old men (working in forests, agriculture, living near a forest, contact with wood) in an endemic area has not always been found. Its clinical form can vary greatly in its presentation. Basically it is a severe algic influenza syndrome accompanied by acute myopia in 38% of cases, but is nearly pathognomonic in the context. Respiratory involvement is frequent but benign. The initial syndrome can suggest an abdominal or urological surgical emergency, which is source of diagnostic and therapeutic errors. Early biological examination reveals thrombopenia and proteinuria. Then more or less severe acute kidney failure appears in slightly more than 50% of cases. Although it usually regresses with symptomatic treatment, after effects remain in some patients. The environmental changes, the geographical distribution depending on the biotope, the dynamics and behaviour of rodents and the viral circulation between them and its transmission to human beings and its risk factors must continue to be studied in order to gain further knowledge on the epidemiology of this anthropozoonosis.

Animals↗
PubMed2005

Rabies in Europe in 2005.

Rabies is still present in Europe in 2005. Its incidence in humans remains limited (fewer than 5 human cases per year) through the application of strict prophylactic measures (anti-rabies treatment) and by means of veterinary rabies control measures in the domesticated and wild animal populations. The main indigenous animal reservoirs are: the dog in eastern European countries and on the borders with the Middle East; the fox in central and eastern Europe; the racoon dog in northeastern Europe; and the insectivorous bat throughout the entire territory. Finally, each year, cases of animals with rabies imported from enzootic areas are reported, showing the permeability of borders and traveller's lack of consideration of the rabies risk. These importations constantly threaten the rabies-free status of terrestrial animals in western European countries and complicate the therapeutic decisions taken by physicians in the absence of information regarding the biting animal.

Animal Diseases↗
PubMed2004

[Predictive factors of virological response to primary antiretroviral treatment].

OBJECTIVES: During 1999, first-line antiretroviral combinations for the treatment of HIV infections have diversified. The aim of our study was two-fold: define the factors associated with initial success and define the factors associated with virological rebound in patients in whom a primary antiretroviral therapy (ARV) had been initiated between 1999 and 2000. METHOD: We conducted a retrospective multicenter study regrouping 6 HIV clinics in the North-East of France. Data were Issued from the patients medical files. Primary success was defined as plasma HIV RNA viral load (VL<200 copies/ml within 6 Months of therapy and two consecutive VL<200 copies/ml. Virological rebound was defined as two consecutive VL>1000 copies/ml after primary success. Predictors of success were determined using multivariate logistic regression and SAS 8.2 software. RESULTS: Analysis concerned 123 patients, with 19% stage C when ARV was initiated. Their median CD4 and PVL values at baseline were 233/mm3 and 73,000 copies/ml respectively. The median duration of follow-up was of 20.7 Months [(mean (STD): 20.6 (6.7)]. Initial treatments were distributed as follows: 2 NRTI + 1NNRTI, n=66 (54%); 2 NRTI+1PI, n=44 (36%); 3 NRTI, n=13 (10%). Primary success was obtained in 100 (81,3%) patients. Among these, 6 (6%) developed secondary virologic failure. The absence of change in initial ARV treatment within first 4 Months, and good compliance to treatment were statistically associated with primary success in univariate (p values respectively: 0.004 and 0.04) and in multivariate analysis (p respectively: 0.009 and 0.03). The proportion of failure was higher in the patients with lower baseline CD4 levels lesser than 200/mm3 (p=0.09). CONCLUSION: In this cohort of patients, tolerance and compliance to the first regimen were associated to primary success. These results emphasize the role of compliance in primary success and reinforces need to work on compliance in such patients.

Adult↗
PubMed2002

Five years of follow-up after elemental mercury self-poisoning.

A case of attempted suicide by injection of elemental mercury is described. Radiographs demonstrated the presence of widespread opacities of metallic mercury in both the lungs and the abdomen. During a 5-year follow-up, even though the patient had high concentrations of mercury in the urine and blood, only mild clinical symptoms and moderate carbon monoxide diffusing capacity reduction appeared. No biochemical evidence of damage to any organ was found.

Adult↗
PubMed2001

Pre-exposure rabies vaccination: strategies and cost-minimization study.

An alternative strategy for pre-exposure rabies vaccination to the institutional recommendations of the World Health Organization and the Centers for Disease Control and Prevention is proposed based on recent long-term follow-up of post-vaccinal seroconversion rates. The alternative strategy uses the same primary series (i.e. vaccination in the deltoid area on D0, D7, and D28), but is completed by a scheduled booster vaccination at D365. The frequency of recommended subsequent booster injections depends on the serological test results obtained by a RFFIT on D379 and 3 years later. The objective of this study was to compare the efficiency of the two pre-exposure strategies. A cost-minimization analysis was carried out to compare the two rabies pre-exposure vaccination and serological test strategies based on the data from two published studies on the long-term evolution of the immunity achieved using the different recommendations. For a theoretically equivalent immunogenicity, the cost of the alternative strategy ranged from 1.7 to 5.2 times lower than that of the institutional recommendations. A sensitivity analysis confirmed the robustness of the results. The alternative strategy should be validated externally under field conditions. This approach would compare its real efficiency to the institutional recommendations.

Antibodies, Viral↗
PubMed2001

[Current antiretroviral therapy].

INTRODUCTION: Advances in HIV/AIDS therapy have been rapid and profound. CURRENT KNOWLEDGE AND KEY POINTS: In developed countries the epidemic infection has stabilized and there are dramatic decreases in morbidity and mortality resulting from the use of intensive but expensive therapies. HIV patients who have detectable viral loads and/or evidence of immunologic dysfunction should be treated with a potent combination antiretroviral regimen. Currently, this consists of two nucleoside reverse transcriptase inhibitors with at least one protease inhibitor, or a non-nucleoside reverse transcriptase inhibitor, or another combination with adequate potency. Current therapies do have limitations, including side effects, cross-resistance, adherence challenges, and drug interactions. FUTURE PROSPECTS AND PROJECTS: Drug resistance is a major factor contributing to the failure of antiretroviral therapy: the ability to predict clinical response to therapy on the basis of genotype and/or phenotype depends on knowledge of appropriate data for defining drug resistance. Moreover, careful selection and monitoring of combination drug therapy along with individualized rather than standard dosage regimens may minimize the pharmacological problems and help ensure optimum antiviral activity. Further developments include new drugs, vaccine, cytokine-, and gene therapy-based treatment strategies.

Anti-HIV Agents↗
PubMed2001

[Laparoscopic diagnosis of stenosing eosinophilic jejuno-ileitis].

INTRODUCTION: Eosinophilic gastroenteritis of unknown origin could be isolated or integrated in idiopathic hypereosinophilic syndrome. Clinical expression is variable since the lesion may affect any area of the gastrointestinal tract and any layer of the wall. EXEGESIS: A 25-year-old male patient had digestive symptoms such as peritoneal, obstructive and diarrheal signs, associated with blood eosinophilia, giving evidence for eosinophilic jejuno-ileitis. Computer tomography revealed an extensive obstruction of the jejuno-ileum and thickening of the intestinal wall. The diagnosis was obtained using laparoscopy and controlled wedge biopsy, which showed a predominantly external infiltration of the intestinal wall by eosinophils. The disease evolution was favorable with corticosteroid therapy. CONCLUSION: Worrying and persistent digestive symptomatology, associated with blood eosinophilia, particularly when intestinal wall infiltration is revealed by computer tomography, should lead one to perform a laparoscopy to guide a surgical biopsy of the intestinal wall.

Adrenal Cortex Hormones↗
PubMed2001

[Should NSAID/corticoids be considered when treating erysipelas?].

Using non-steroidal anti-inflammatory drugs (NSAID) in association with a suitable antibiotherapy in the treatment of erysipelas, is still being largely discussed in medical publications. When compared to other fields of medicine, here their use might be justified by their ability to reduce local inflammation processes, to relieve patients more quickly, and to prevent potential sequels due to an inflammatory process. Numerous reports have suggested an association between the use of NSAID and the progression of an invasive streptococcal infection, particularly necrotizing fasciitis. The exact mechanism is still unclear. No controlled survey (NSAID versus placebo) checking the efficiency and the safety of these treatments is currently available. Only one comparative study showed a gain of one single day for prednisolone The prednisolone-treated patients had a shorter median length of hospital stay (5 days vs. 6) than the placebo-treated ones. The median treatment time with intravenous antibiotics, in the placebo group, was 1 day longer than in the prednisolone group. The occurrence of side effects was not higher in the prednisolone group. If this currently available data is not sufficient to establish a relationship between severe infectious complications and the use of NSAID, one should be cautious when using them to treat erysipelas, since their efficiency has not been positively proved.

Adrenal Cortex Hormones↗
PubMed2000

Predictive factors for the neutralizing antibody response following pre-exposure rabies immunization: validation of a new booster dose strategy.

A prospective cohort of 312 subjects who received pre-exposure rabies immunization and who were monitored serologically with a 10-year follow-up was assessed using multivariate analysis. The aim was to propose a new booster dose strategy by identifying predictive factors for the durability of the neutralizing antibody response. Evaluation bore on several factors relating to: (1) demographic characteristics: age, gender; (2) vaccines: type of vaccine (HDCV or PVRV), injection regimen (D0-D28-D365 or D0-D7-D28-D365) and vaccine lots' antigenic potency; and (3) resulting antibody titers. Logistic regression analysis enabled the authors to establish a predictive model for immunized subjects' serological status at ten years' follow-up expressed as a P probability for seroreversion (antibody titer <0.5 IU/ml). Highly significant factors were the immunization regimen, the type of vaccine used and the antibody titer at D379. A P value <0.4 identified subjects as "good" responders who were sure to be have satisfactory antibody titers at 10 years and who required a single booster dose every 10 years. A P value >/=0.4 identified subjects as "poor" responders in whom a specific follow-up and booster dose strategy is proposed. This new immunization strategy could at least be applied to subjects with a frequent risk of exposure, as defined by institutional recommendations. This new immunization strategy should nevertheless undergo an external validation and a cost-effectiveness evaluation.

Adolescent↗
PubMed2000

[Rabies in France: an update].

INTRODUCTION: In 1996, rabies was responsible for more than 35,000 deaths worldwide. Three cases of human rabies that had been contracted abroad were diagnosed in France during the same year. Cases notified in 1997 followed exposure outside the country. Fox, bat, and dog rabies are reviewed on the basis of the latest epidemiological data obtained in France. CURRENT KNOWLEDGE AND KEY POINTS: Two cases of fox rabies diagnosed in 1998 occurred at the border between France and Germany, thus preventing five French departments bordering Germany from being officially declared rabies-free in 1999. The campaigns for oral immunization of foxes that are led since 1986 are responsible for the decrease in rabies incidence. Though not well known, bat rabies is a reality in France, involving either European virus strains (five cases all over the country) or African virus strains that are carried along by imported tropical bats. Dogs rabies is also today an imported disease. FUTURE PROSPECTS AND PROJECTS: The decrease in risk for rabies has resulted from the conjunction of multiple efforts: extensive programs aimed at oral vaccination of foxes in France and its neighboring countries, efficient epidemiological survey, sanitary controls at borders, ban on importing tropical bats. Furthermore, recommendations for preventive pre-exposure immunization have recently been changed, leading to modifications of the French licensing form.

Animals↗
PubMedDate not supplied

Carcinomatous meningitis and solid tumours.

This retrospective study concerning patients with a carcinomatous meningitis (CM) associated with solid tumour aimed at identifying risk markers of CM which could be used in the future in order to prevent from this neurological complication. From 1976 to 1996, the patients whose CSF sampling was positive cytologically, were registered recording baseline clinical data, tumour histology with grade, tumour dissemination, treatments and follow-up. Simultaneously to the recruitment of the patients the incidence of CM was derived at each 5-year period. The variables were analysed by uni- and multivariate statistics. Among the 41 cases, the first three sites of the primary were breast, lung, essentially small cell lung cancer, and urinary tumours. At their initial presentation, 22 patients revealed an M1 dissemination and 22 tumours were undifferentiated. Over the 20 years, the incidence of CM has significantly increased for urinary cancers, decreased for breast cancer while the administration of neoadjuvant chemotherapy was increasing, and remained unchanged for lung cancer. M1 and/or undifferentiated tumours shortened the time-to-CM whereas bone metastases, that were the most frequent site for secondary deposits, did not. Breast, lung and urinary cancers produced 80% of the CM in the series. Neoadjuvant chemotherapy possibly could save patients from the meningeal dissemination. M1 and undifferentiated tumours appeared to be independent risk factors, as well as osseous metastases. Other risk factors of CM should be identified in prospective trials.

Adult↗