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Biomedical subjects

G Fournier

Publications and source records attributed to G Fournier.

At least 181 records · Page 10Linked to original sources
PubMedDate not supplied

Epidemiology of extended spectrum beta-lactamases.

Beta-lactamases play a major part in resistance, as recently redemonstrated by the emergence of extended spectrum beta-lactamases. Since its discovery in FR Germany, SHV-2 has been reported from four continents and CTX-1 (TEM-3) was established in at least 26 French hospitals. More than 12 other enzymes have been individualized. The newest aspect of resistance was probably underestimated because most strains of enterobacteria (mainly Klebsiella pneumoniae) appeared susceptible to oxyimino-beta-lactams as suggested by MICs or diameters of inhibition zone sizes. The double-disk synergy test between amoxicillin/clavulanic acid and oxyimino-beta-lactams was useful to easily detect two susceptibility patterns (CTX, CAZ). Extended spectrum beta-lactamases isolated among nosocomial isolates of enterobacteria (urines, blood, wound, sputum cultures) mostly from intensive care units have spread through hospitals. If outbreaks were described, numerous serotypes were identified in Klebsiella pneumoniae. In France the distribution of extended spectrum beta-lactamases showed that CTX-1 (TEM-3) was well distributed among ten species unlike SHV-type enzymes (SHV-2, SHV-3, SHV-4) preferentially detected in Klebsiella pneumoniae. A majority of strains produced CAZ-type enzymes in Escherichia coli. Some isolates produced two extended spectrum beta-lactamases. In Tunisia extended spectrum beta-lactamase producing strains were mainly identified among pediatric isolates of Klebsiella pneumoniae, Salmonella and Escherichia coli; SHV-2 was predominant but recently CTX-1 and two other types with an isoelectric point of 6.35 and 5.4 (phenotype CTX) were individualized. Because plasmid-encoded, this mechanism was spreading in France among enterobacteria with other resistance markers (e.g. netilmicin, amikacin) for CTX-1 unlike SHV-2.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacterial Infections↗
PubMedDate not supplied

Extended broad-spectrum beta-lactamases conferring transferable resistance to newer beta-lactam agents in Enterobacteriaceae: hospital prevalence and susceptibility patterns.

Before 1985 at the Pitié-Salpêtrière Hospital in Paris (2,400 beds), resistance to cefotaxime in clinical isolates of Enterobacteriaceae involved only species producing inducible class 1 beta-lactamase. Between November 1985 and April 1987, however, 62 isolates (57 of Klebsiella pneumoniae and five of Escherichia coli) showed decreased susceptibility to cefotaxime (mean MIC, 8-16 micrograms/mL). The transferability of cefotaxime resistance in E. coli K12 was demonstrated for 15 of 16 selected isolates. By isoelectric focusing using iodometric detection with 20 mg of ceftriaxone/100 mL and determination of substrate and inhibition profiles, three beta-lactamases mediating cefotaxime resistance were identified as SHV-2 (isoelectric point [pI] 7.6), CTX-1 (pI 6.3), and "SHV-2-type" or SHV-3 (pI 6.98). The three beta-lactamases hydrolyzed penicillins and cephalosporins (including cefotaxime and ceftriaxone) and were therefore designated "extended broad-spectrum beta-lactamases" (EBS-Bla). The enzymes conferred to derivatives a high level of resistance to amoxicillin, ticarcillin, piperacillin, and cephalothin and a decreased degree of susceptibility (i.e., MICs increased by 10- to 800-fold) to cefotaxime, ceftriaxone, ceftazidime, and aztreonam. These beta-lactamases did not affect the activity of cephamycins (cefoxitin, cefotetan, moxalactam) or imipenem. Synergy between clavulanate or sulbactam (2 micrograms/mL) and amoxicillin was greater against derivatives producing EBS-Bla than against those producing TEM-1, TEM-2, or SHV-1; this synergy was greater with clavulanate than with sulbactam against derivatives producing SHV-2 and the SHV-2-type enzyme but was similar with clavulanate and sulbactam against those producing CTX-1. A double-disk synergy test performed with cefotaxime and Augmentin disks (placed 30 mm apart, center to center) seemed a useful and specific test for the detection of strains producing EBS-Bla.

Anti-Bacterial Agents↗
PubMedDate not supplied

[The anti-implantation effects of various savine extracts on the pregnant rat].

Ether and ethyl acetate extracts obtained after savin essential oil extraction, were administered, on days 1 to 4, to pregnant rats by intragastric catheter, at doses of 0, 50 or 150 mg/Kg, to search for their possible effects on implantation. The ethyl acetate extract was not toxic. Inversely, the ether extract was responsible for a dose-dependent anti-implantation effect, thus showing that essential oil is not alone responsible for the abortive effect generally attributed to Savin.

Animals↗
PubMedDate not supplied

[Renal failure disclosing interstitial granulomatous nephropathy of sarcoidosis. 4 cases].

In patients with interstitial granulomatous sarcoid nephritis, renal failure often suggests the diagnosis, being rapidly progressive and isolated, i.e. without proteinuria and with few abnormalities of the urinary sediment. The extra-renal signs are usually discreet or absent, and the finding of a paradoxically high or normal calcaemia concomitant with renal failure should alert the clinician. When granulomatous lesions of the kidney are not too old, corticosteroids are remarkably effective in improving renal function.

Acute Kidney Injury↗
PubMedDate not supplied

[Indications of home assisted ventilation by tracheostomy for non-paralytic chronic respiratory insufficient patients (author's transl)].

Based on a 15-year study, the indication of assisted ventilation at home is discussed. It depends on the seriousness of the C.R.I. (dyspnea, repeated acute failures, PaCO2 greater than or equal to 55 Torr). The only possible course is ventilation by tracheostomy. The best indication is represented by pure restrictive syndromes. On the contrary, the indication should be considered with extreme caution in obstructive syndromes.

Airway Resistance↗
PubMedDate not supplied

[Results of home assisted ventilation of non-paralytic and tracheostomized chronic respiratory insufficient patients (author's transl)].

The following results have been obtained from a study of 118 tracheostomized patients ventilated at home: --Survival on the whole is generally prolonged. --The prognosis of tracheostomized subjects with restrictive syndrome is totally modified in length and quality when the patients are ventilated. --In the case of obstructive syndrome, the length and quality of survival are probably increased. However, it seems that assisted ventilation at home leads only to the disappearance of asphyxiating paroxysms and right cardiac failure. It does not seem to prevent the unrelenting evolution of the disease.

Adult↗
PubMedDate not supplied

[Training of community health aides in the subject of nutrition].

Struggling with nutritional diseases requires strategies to get through: the training of community health workers (C.H.W.) represents one among others. After strong arguments are made on whether or not these C.H.W. are relevant to support the community in an attempt to increase its nutritional status, some prerequisites are listed out according to certain criteria. In order to write down a complete training plan, an intervention model and a step by step approach are submitted. In developing technical and community organization skills, the C.H.W. is better off for being involved at the local level. Nevertheless information channel and the process of problem solving are keys important to consider for the C.H.W. in his social commitment, providing that concerned sectors and disciplines participate under health personnel initiatives.

Africa↗
PubMedDate not supplied

[Training in epidemiology at the Institute of Tropical Medicine of the Army Health Service. Experience over 4 years].

The authors described the training in epidemiology received by 185 Army medical doctors attached for instruction to the I.M.T.S.S.A. since 1981. Statistical methodology, basic epidemiology, and applied epidemiology are taught in such way that Army medical doctors are better capable of rationalizing and strengthening their action of prevention in their posting either in France or seconded to developing countries. Description of pedagogical targets is underlined as well as methodology of control and evaluation of progress towards these targets. The authors are also able to appreciate, in terms of the level of capacity of the personnel trained, the severity of the consequences either of a strengthening of the pedagogical targets or of a reduction. When the reform of medical education and training imposes very often such an alternative, the authors point out how the leading opinion of the ones who utilize the services of the personnel should be taken into full consideration prior to any decision.

Epidemiology↗