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Biomedical subjects

Jean Beytout

Publications and source records attributed to Jean Beytout.

10 recordsLinked to original sources
PubMed2005

Whole body leucine flux in HIV-infected patients treated with or without protease inhibitors.

The present study was carried out to assess the effects of protease inhibitor (PI) therapy on basal whole body protein metabolism and its response to acute amino acid-glucose infusion in 14 human immunodeficiency virus (HIV)-infected patients. Patients treated with PIs (PI+, 7 patients) or without PIs (PI-, 7 patients) were studied after an overnight fast during a 180-min basal period followed by a 140-min period of amino acid-glucose infusion. Protein metabolism was investigated by a primed constant infusion of l-[1-(13)C]leucine. Dual-energy X-ray absorptiometry for determination of fat-free mass (FFM) and body fat mass measured body composition. In the postabsorptive state, whole body leucine balance was 2.5 times (P < 0.05) less negative in the PI+ than in the PI- group. In HIV-infected patients treated with PIs, the oxidative leucine disposal during an acute amino acid-glucose infusion was lower (0.58 +/- 0.09 vs. 0.81 +/- 0.07 micromol x kg FFM(-1) x min(-1) using plasma [(13)C]leucine enrichment, P = 0.06; or 0.70 +/- 0.10 vs. 0.99 +/- 0.08 micromol x kg FFM(-1) x min(-1) using plasma [(13)C]ketoisocaproic acid enrichment, P = 0.04 in PI+ and PI- groups, respectively) than in patients treated without PIs. Consequently, whole body nonoxidative leucine disposal (an index of protein synthesis) and leucine balance (0.50 +/- 0.10 vs. 0.18 +/- 0.06 micromol x kg FFM x (-1) x min(-1) in PI+ and PI- groups respectively, P < 0.05) were significantly improved during amino acid-glucose infusion in patients treated with PIs. However, whereas the response of whole body protein anabolism to an amino acid-glucose infusion was increased in HIV-infected patients treated with PIs, any improvement in lean body mass was detected.

Absorptiometry, Photon↗
PubMed2005

[Propionibacterium acnes adenitis].

INTRODUCTION: Propionibacterium acnes is a gram-positive pleomorphic rod-shaped anaerobic saprophyte of the skin, mouth and upper respiratory tract. Although associated with acne vulgaris, it is otherwise reported as a human pathogen only rarely, in various infections, notably cutaneous and osteoarticular, and in endocarditis. We report here a case of bilateral P. acnes-abscessed adenitis of the inguinal folds. CASE: A 32 year-old man presented with inguinal lymph nodes that had progressively and bilaterally reddened and become painful, with fistulation of the skin and pus. Culture of a surgical sample identified P. acnes. DISCUSSION: Although this strain has been associated with lymph node granuloma, especially in sarcoidosis, abscessed lymph node infection as seen in our patient has never been reported.

Adult↗
PubMed2005

Pseudotumor presentation of intracerebral tuberculomas.

Diagnosis of tuberculoma is difficult because of its tumorlike aspects. This report describes the case of a male who displayed a hemiplegia revealing an intracranial mass. Neuroimaging was consistent with a glioblastoma; however, the definite diagnosis was a tuberculoma. Clinical features of tuberculomas are nonspecific. Even though the neuroimaging features are sensitive, they are much less specific, with variability related to the tuberculoma course. Investigations leading to the diagnosis are histologic analysis showing a granuloma with or without caseating necrosis, and the microbiologic identification of Mycobacterium tuberculosis. Every intracranial tumor with malignant radiologic and clinical appearance must evoke a suspicion for tuberculoma.

Brain Neoplasms↗
PubMed2004

[Adult immunization in France: an update].

French immunisation schedule recommends tetanus and poliomyelitis vaccine every 10 years and influenza every year after the age of 65. Several other vaccinations related to occupational health are implemented. Travellers or immunocompromised people who could be exposed to infections need some other vaccinations, too. Pneumoccocal vaccine coverage is insufficient. Reinforcing diphteria immunization is considered, using a recently licensed combined vaccine. Maintenance of immunity against "childhood infectious diseases" preventable with vaccinations is a new challenge; measles, rubella and pertussis occur now quite often in adults: the risk of complications is higher in these ages (measles), or expose to specific risk (rubella in pregnant women); adults may even become the source of the contamination of younger people (many infants affected with whooping cough have contracted the disease from their own parents). The immunisation against these diseases should be prosecuted in adults. Related with the development of more efficacious new vaccines, the indications of pneumococcus, meningococcus or varicella vaccines should be defined in some populations of adults. Immunization policy of adults should be revised in order to continue the vaccination program of childhood. Some infections that may affect adults should be prevented by improving vaccine application. A real adult immunisation schedule and recommendations should be set up towards populations at risk of preventable infections. The implementation of these recommendations should be reinforced.

Adult↗
PubMed2003

Frequency, risk factors, and outcome of hyperlactatemia in HIV-positive persons: implications for the management of treated patients.

BACKGROUND: The nucleoside reverse transcriptase inhibitors used for the treatment of HIV-positive persons are now clearly associated with metabolic disorders. We determined the prevalence of and risk factors for hyperlactatemia in HIV-positive persons to assess the relevance of lactate venous blood concentrations during antiretroviral therapy. METHODS: We conducted a prospective cross-sectional study of venous lactate determinations with 282 consecutive HIV-positive persons who, in addition to a physical examination, had blood samples taken every 3-4 months for routine biochemical, immunologic, and viral assessment. The frequencies of hyperlactatemia and lactic acidosis were determined, and the risk factors were analyzed by a multivariate logistic regression model. The effect of modification of antiretroviral therapy in patients with moderate hyperlactatemia was also assessed. RESULTS: From 782 blood lactate determinations, we identified 65 (23%) patients with moderate hyperlactatemia and 5 (1.8%) with lactate concentrations >5 mmol/L (2 with severe lactic acidosis; 0.7%). Older age, drug regimens containing stavudine [adjusted odds ratio (OR) = 2.5] or a combination of stavudine-didanosine (adjusted OR = 3.1), and the use of buprenorphine (adjusted OR = 14.7) were independent predictors of hyperlactatemia. Among 65 patients with moderate hyperlactatemia, 39 did not have their treatments changed, and 26 had a new combination therapy that was associated with a clinical improvement and a more pronounced decrease in lactate (-1.66 vs -0.99 mmol/L; P <0.05). CONCLUSIONS: Chronic compensated and moderate hyperlactatemia was common in our population study. Measurement of lactate, under standardized conditions, may be useful in optimizing management of HIV-positive persons on antiretroviral therapy.

Acidosis, Lactic↗
PubMed2003

[Adult immunization].

Adults receive several vaccinations related to occupational health. Travellers or immunocompromised people who are exposed to infections need some other vaccinations, too. People older than 65 receive influenza vaccine every year. Tetanus and poliomyelitis immunity should be maintained with a decennial injection following adult immunisation schedule but the application of this vaccine remains rather erratic. Diphtheria valence included in a recently licensed combined vaccine could be done together. Maintenance of immunity against "childhood infectious diseases" preventable with vaccinations is a new challenge; measles, rubella and pertussis occur now quite often in adults: the risk of complications is higher in these ages. Adults may even become the source of the contamination of youngers: many infants affected with whooping cough have contracted the disease from their own parents. The immunisation against these diseases should be prosecuted in adults. Related with the development of more efficacious new vaccines, the indications of pneumococcus, meningococcus or varicella vaccines should be defined in some populations of adults. Immunization policy of adults should be revised in order to continue the vaccination program of childhood. Some infections that may affect adults should be prevented by improving vaccine application. A real adult immunisation schedule and recommendations for populations at risk of preventable infections should be set up and their application reinforced.

Adult↗
PubMed2002

Spotless rickettsiosis caused by Rickettsia slovaca and associated with Dermacentor ticks.

The pathogenic role of Rickettsia slovaca was first demonstrated in 1997 in a patient who presented with a single inoculation lesion of the scalp and enlarged cervical lymph nodes after receiving a bite from a Dermacentor tick. Subsequently, we evaluated the occurrence of R. slovaca infections among patients living in France and Hungary who presented with these symptoms. R. slovaca infections were confirmed by polymerase chain reaction (PCR) in 17 of 67 enrolled patients. Infections were most likely to occur in patients aged <10 years and in patients who were bitten during the colder months of the year. The median duration of incubation for the disease was 7 days. Fever was present in only 2 patients, and only 1 patient developed a rash. Sequelae included persistent asthenia (3 cases) and localized alopecia (4 cases). Immunofluorescence and/or Western blot analysis detected antibodies in 50% of tested patients. Three Dermacentor ticks obtained from patients revealed R. slovaca by PCR.

Animals↗
PubMedDate not supplied

[Vancomycin-resistant Enterococcus in an epidemic situation: screening at admission for patients at risk of carriage].

OBJECTIVES: To evaluate a strategy based on screening and isolation at admission to a department of infectious diseases during an epidemic of vancomycin-resistant Enterococcus (VRE) at the University Hospital of Clermont-Ferrand. METHODS: Systematic screening for VRE by anal swabs began on November 15, 2004. Patients were isolated on admission if (a) they had been hospitalized more than 24 h in an at-risk department of our hospital or (b) they had received a course of wide-spectrum antimicrobial therapy for longer than 48 h in the three months preceding admission. Patients hospitalized in our department were screened weekly if they were treated with wide-spectrum antibiotics, had a urinary catheter left in place for one week, or were neutropenic. RESULTS: Through May 15, 2005, 12 (3.5%) of 341 swabs were found to be positive for VRE: eight were detected on admission and four during hospitalization. In all, 81 patients were isolated on admission. A case-control study confirmed that the criteria for patient isolation were indeed risk factors for VRE. Isolation was well accepted when it was clearly explained. No new case has been detected since March 2005. CONCLUSION: An isolation strategy based on known risk factors for VRE with systematic screening on admission appears to be an effective way to control an outbreak of VRE, perhaps in part because it helps to keep the medical staff alert to this problem. Isolation is well tolerated as long as it is explained clearly.

Aged↗
PubMedDate not supplied

Effect of medroxyprogesterone acetate on the efficiency of an oral protein-rich nutritional support in HIV-infected patients.

We have examined the effect of a medroxyprogesterone therapy in HIV-infected patients under appropriate nutrition for anabolism. The experiments were performed on 12 men (mean age 40 y), HIV seropositive but free of any clinically active opportunistic infection for at least one month. The patients underwent a 2-week baseline diet period (1.2 g protein x kg(-1) body weight (BW) x d(-1)) and then a 5-week experimental period with again the baseline diet in conjunction with supplements including Tonexis HP (0.7 g protein x kg(-1) BW) x d(-1)), L-threonine (0.018 g x kg(-1) BW x d(-1)) and L-methionine (0.013 g x kg(-1) BW x d(-1)). Indeed HIV-infected patients showed deficiencies in these amino acids. They were randomly divided into groups I and II under double-blinded condition. Group II was given medroxyprogesterone acetate (0.4 g x d(-1)) during the last 3 weeks whereas group I received a placebo. All the patients significantly increased their body weight (P < 0.05) during the experimental periods. Those under medroxyprogesterone tended to show a higher but not significant weight gain (+3.1 +/- 1.0 kg in group II and +1.9 +/- 0.3 kg in group I). Blood free amino acids were used as rough indicators of amino acid utilization and were analyzed prior and during acute 150 min intravenous infusion of a complete glucose-amino acid mixture. This test was done before and at the end of the experimental periods. Basal essential blood free amino acids were similar in the two groups and did not change during the experimental period. Most essential amino acids increased following glucose-amino acid infusions. The incremental increase was of less magnitude after the experimental period than before when medroxyprogesterone was present (P < 0.05 for valine, leucine, lysine, threonine and methionine). This was not the case in the absence of the hormone. We concluded that medroxyprogesterone might improve the efficacy of an oral protein-rich nutritional support in HIV-infected patients.

Adult↗