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Biomedical subjects

M Maignan

Publications and source records attributed to M Maignan.

17 recordsLinked to original sources
PubMed1998

Randomised comparison of thalidomide versus placebo in toxic epidermal necrolysis.

BACKGROUND: Toxic epidermal necrolysis (TEN) is associated with a 30% death rate. Tumour necrosis factor alpha (TNF-alpha) has been implicated in the pathogenesis of TEN. Thalidomide is a potent inhibitor of TNF-alpha action. We did a double-blind, randomised, placebo-controlled study of thalidomide in TEN. METHODS: The patients received a 5-day course of thalidomide 400 mg daily or placebo. The main endpoint was the progression of skin detachment after day 7. Secondary endpoints were the severity of the disease, evaluated with the simplified acute physiology score (SAPS), and the mortality. TNF-alpha and interleukin 6 were measured. FINDINGS: The study was stopped because there was excess mortality in the thalidomide group--ten of 12 patients died compared with three of ten in the placebo group (Fisher's exact test with Katz's approximation, relative risk=2.78, p=0.03). After adjustment for SAPS, mortality remained significantly higher in the thalidomide group than in the placebo group (exact logistic regression mid-p=0.007; 95% CI for odds ratio 2.7 to infinity). Plasma TNF-alpha concentration was higher in the thalidomide group than the placebo group on day 2, though the difference was not significant (Wilcoxon rank-sum test p=0.07). INTERPRETATION: Even though few patients were included, our data suggest that thalidomide is detrimental in TEN, possibly because of a paradoxical enhancement of TNF-alpha production.

Adult↗
PubMed1997

Clinical and bacteriological characteristics of infective endocarditis in the elderly.

OBJECTIVE: To determine the clinical and bacteriological features of infective endocarditis in the elderly. DESIGN: Prospective case series. SETTING: A university hospital that is both a referral and a primary care centre. PATIENTS: 114 consecutive patients treated for infective endocarditis from November 1990 to December 1993: 25 were > 70 years of age (group 1) and 89 were < 70 years old (group 2). RESULTS: Location of infective endocarditis, clinical signs, and symptoms were similar in the two groups, except for a lower occurrence of embolic episodes in the elderly (group 1:8%, group 2: 28%; P < 0.04). A higher rate of infective endocarditis on intracardiac prosthetic devices was noted in group 1 (group 1: 52%, group 2: 25%; P < 0.05). The distribution of causative micro-organisms showed a higher proportion of bacteria from the gastrointestinal tract in the elderly (group D streptococci and enterococci: 48% in group 1 v 20% in group 2) and the presumed portal of entry was more often digestive (group 1: 50%, group 2: 17%; P = 0.01). Elderly patients were less often operated on (group 1: 24%, group 2: 43%; P = 0.07) and their mortality rate was higher (group 1: 28%, group 2: 13%; P = 0.08). CONCLUSIONS: Infective endocarditis in patients over 70 often occurs in those with intracardiac prosthetic devices and is more often due to bacteria from the gastrointestinal tract. Its prognosis appears to be worse than in younger subjects.

Adult↗
PubMed1996

[Prognostic factors of Pneumocystis carinii pneumonia in AIDS].

OBJECTIVES: Identify prognosis factors in Pneumocystis carinii pneumonia at diagnosis and construct a model to predict mortality according to these prognosis factors. METHODS: Seventy-seven consecutive cases of proven AIDS-related Pneumocystis carinii pneumonia (67 men, 10 women, mean age 37.2 years) were reviewed to determine the most accurate initial prognostic factors and estimate an individual prediction of death. A stepwise logistic regression analysis was performed. Three kinds of data were entered into the logistic model: historical data, clinical and laboratory data obtained within the first 24 hours of diagnosis, and specific data related to chest X-ray and bronchoalveolar lavage results. RESULTS: The sum of arterial partial pressure of oxygen and carbon dioxide (PaO2 + PaCO2) and serum albumin level best predicted a fatal outcome in multivariate analysis. CONCLUSION: The logistic equation provided by the model might be used to accurately and quickly identify the patients with severe Pneumocystis carinii pneumonia who might benefit from supportive intensive care.

AIDS-Related Opportunistic Infections↗
PubMed1996

[Malnutrition and HIV infection].

The wasting syndrome is well known in HIV infected patients. Predominant free fatty mass deletion is achieved. The weight loss results from decrease of food intake, from gut disorders due to HIV or opportunistic infections. Metabolic disorders are reported too. Breakdown of carbohydrates and proteins presents energy source. Raised free fatty acid turn over and hypertriglyceridemia are reported. Polyunsatured fatty acid level is raised inducing free radicals increase. Free radicals delete immune functions (apoptosis). Vitamin and trace element decrease worsen negative effects of free radicals.

HIV Infections↗
PubMed1994

Pain in hospitalized patients with AIDS: analgesic and psychotropic medications.

OBJECTIVE: We undertook this study to evaluate the use of analgesic and psychotropic medication in acquired immunodeficiency syndrome (AIDS) patients with pain and to determine whether our previous findings of a high prevalence of pain in patients with AIDS who were hospitalized could be replicated. Additional factors related to pain were evaluated, such as death during hospital stay, i.v. drug abuse, and length of hospital stay. DESIGN: One hundred thirty-nine medical charts randomly selected from 1 year of hospital admissions of patients with AIDS were reviewed in a systematic manner for pain, prescription of analgesic and psychotropic medication, patient demographics, and disease characteristics. RESULTS: Sixty-one percent of the charts reviewed had at least one note of nonprocedural pain. Sixty-eight percent of pain patients were prescribed a nonnarcotic (most commonly acetaminophen), and 44% a narcotic. Sixty-two percent of pain patients were prescribed a psychotropic medication. Patients with pain were significantly more likely to receive an analgesic as well as psychotropic medication, particularly a sedative-hypnotic, than patients without pain. Having pain was not significantly related to other factors such as i.v. drug abuse except for length of hospital stay. Most of the previous study findings were replicated with the notable exception of the rate of prescription of psychotropics as well as acetaminophen, which increased substantially in this study. CONCLUSIONS: Although pain is a prevalent problem in hospitalized AIDS patients, narcotics as well as antidepressants appear to be underutilized. It is suggested that medical education regarding pain management in AIDS patients is an important first step in a more aggressive approach.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Self-limited primary cytomegalovirus colitis in an immunocompetent individual.

Cytomegalovirus colitis in immunocompetent patients has rarely been reported without another severe illness. The prognosis is usually bad, leading to toxic megacolon or death due to multi-organ system failure. We report a case of a self-limited cytomegalovirus colitis in a young patient with no risk factor for CMV infection or associated disease. This suggests that self-limiting CMV colitis may be more frequent than is usually believed, and its prognosis may be better in young patients with normal immune functions. Therefore it should be sought systematically even in immunocompetent young patients.

Adult↗