Objectives
The aim of the study was to demonstrate the noninferiority of polyacrylamide hydrogel (PH) vs. polylactic acid (PLA) for the treatment of facial lipoatrophy in HIV‐infected adults.
Methods
...A randomized, blinded, multicentre, noninferiority 96‐week study was carried out. Patients with facial lipoatrophy were randomly assigned to receive intradermal injections with PH or PLA, and were blinded to the filler. The primary efficacy endpoint was patient satisfaction at week 48 assessed using a visual analogue scale score (VAS). Secondary efficacy end‐points included cheek thickness and skin‐fold, lipoatrophy grading and quality of life. Safety was assessed by the reporting of adverse events.
Results
A total of 148 patients were included in the study; 93% were men, the median age was 47 years, the median CD4 count was 528 cells/μL, and the median duration of antiretroviral therapy was 12 years. Mean VAS increased from 2.8 at baseline to 7.1 and 7.5 in the PLA and PH arms, respectively, at week 48 (P = 0.0002 for noninferiority) and was sustained at week 96 (6.7 and 7.9 in the PLA and PH arms, respectively; P = 0.003 for noninferiority). Cheek thickness and skin‐fold increases and lipoatrophy improvement were similar in the two arms. Quality of life remained unchanged or improved depending on the questionnaire used. In injected patients, subcutaneous nodules emerged in 28 (41%) and 26 (37%) patients in the PLA and PH arms, respectively (P = 0.73). Four patients in the PH arm developed severe inflammatory nodules, a median of 17 months after the last injection.
Conclusions
PH and PLA have similar efficacies in the treatment of facial lipoatrophy, but PH may be associated with more delayed inflammatory nodules.
Quinine was the main treatment for malaria between 1630 and the beginning of the XXth century. In the 1940s, the synthesis of chloroquine gave rise to the hope of eliminating this plague. Falciparum ...resistance to chloroquine, first observed in Asia then in sub-Saharan Africa, lead researchers to discover halofantrine, mefloquine, atovaquone-proguanil and artemisinin combined therapies. There is no ideal treatment for uncomplicated imported malaria in children. Medical teams have to develop a protocol according to available drugs and their personal experience, with a special attention to follow-up at days 3-4 and day 28. From now on, severe malaria must be treated with intravenous artesunate, a more effective therapy than quinine.
Among 36 cases of Escherichia coli native valve endocarditis (NVE) that met Duke criteria (31 cases in the literature between 1909 and 2002, and five cases seen in Paris, France), the urinary tract ...was the most common portal of entry. The majority (72.2%) of cases developed in elderly females. Overall, the proportion of patients aged > 70 years rose from 5.3% in 1982 to 22.9% in 2002. Persistent E. coli bacteraemia in the elderly in the absence of cardiac risk-factors may be a sign of NVE and should prompt an investigation by echocardiography.
Entre le XVIIe siècle et le début du XXe siècle, le traitement du paludisme en Occident était la quinine. Dans la première moitié du XXe siècle, la synthèse de la chloroquine suscite l’espoir, ...rapidement déçu, d’éradiquer ce fléau. La résistance de Plasmodium falciparum à la chloroquine, d’abord en Asie du Sud-est puis en Afrique sub-saharienne, suscite des recherches qui aboutissent à la découverte ou à la redécouverte de l’halofantrine, de la méfloquine, de l’atovaquone-proguanil et des dérivés de l’artémisinine. À l’heure actuelle, il n’existe pas de traitement idéal du paludisme simple d’importation de l’enfant ; chaque équipe doit établir son protocole en fonction des molécules disponibles et de son expérience, sans perdre de vue la nécessité d’un suivi rigoureux à j3 ou j4 et à j28. Le traitement de l’accès grave doit désormais faire appel à l’artésunate intraveineux, plus efficace que la quinine.
Quinine was the main treatment for malaria between 1630 and the beginning of the XXth century. In the 1940s, the synthesis of chloroquine gave rise to the hope of eliminating this plague. Falciparum resistance to chloroquine, first observed in Asia then in sub-Saharan Africa, lead researchers to discover halofantrine, mefloquine, atovaquone-proguanil and artemisinin combined therapies. There is no ideal treatment for uncomplicated imported malaria in children. Medical teams have to develop a protocol according to available drugs and their personal experience, with a special attention to follow-up at days 3–4 and day 28. From now on, severe malaria must be treated with intravenous artesunate, a more effective therapy than quinine.
Abstract Introduction There are insufficient data regarding the efficacy and safety of vaccination in patients with auto-immune disease (AID) and/or drug-related immune deficiency (DRID). The ...objective of this study was to obtain professional agreement on vaccine practices in these patients. Methods A Delphi survey was carried out with physicians recognised for their expertise in vaccinology and/or the caring for adult patients with AID and/or DRID. For each proposed vaccination practice, the experts’ opinion and level of agreement were evaluated. Results The proposals relating to patients with AID specified: the absence of risk of AID relapse following vaccination; the possibility of administering live virus vaccines (LVV) to patients not receiving immunosuppressants; the pertinence of determining protective antibody titre before vaccination; the absence of need for specific monitoring following the vaccination. The proposals relating to patients with DRID specified that a 3–6 month delay is needed between the end of these treatments and the vaccination with LVV. There is no contraindication to administering LVV in patients receiving systemic corticosteroids prescribed for less than two weeks, regardless of their dose, or at a daily dose not exceeding 10 mg of prednisone, if this involves prolonged treatment. Out of 14 proposals, the level of agreement between the experts was “very good” for eleven, and “good” for the remaining three. Conclusion Proposals for vaccine practices in patients with AID and/or DRID should aid with decision-making in daily medical practice and provide better vaccine coverage for these patients.
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