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Biomedical subjects

M Carles

Publications and source records attributed to M Carles.

At least 37 records · Page 2Linked to original sources
PubMed1996

Liver biopsy is not useful in the diagnosis of mycobacterial infections in patients who are infected with human immunodeficiency virus.

Liver biopsy (LB) has been advocated for the detection of mycobacterial infections in patients infected with human immunodeficiency virus (HIV). To determine the effect of the use of this procedure on survival, we compared it terms of yield with histological findings and noninvasive microbiological procedures. We reviewed the cases of 98 patients who underwent 106 LBs as part of the diagnostic screening for fever of unknown origin. LB revealed 17 cases of mycobacterial infection. For all but one patient, the results of at least one noninvasive procedure were positive. In 85 cases where infections were not diagnosed by LB, 17 had infections documented by other procedures. When all culture results are considered, the mean (+/- SD) incubation time to the first positive culture was 15 +/- 5 days, whereas the mean (+/- SD) incubation time to the first positive culture of an LB specimen was 28 +/- 9 days. The survival time was not significantly increased for patients who underwent LB and had positive Ziehl-Neelsen-stained smears; these patients survived a mean (+/- SD) of 12 +/- 11 months, whereas patients with negative smears survived a mean (+/- SD) of 9 +/- 10 months. Noninvasive studies are preferable to LB for the diagnosis of mycobacterial infections in HIV-infected patients.

AIDS-Related Opportunistic Infections↗
PubMed1996

Dilated cardiomyopathy in turkeys: an animal model for the study of human heart failure.

Many animal models of heart failure developed to date do not mimic pathophysiologic changes recently described in the failing human myocardium. In human endstage heart failure, abnormalities in morphology, electromechanical coupling, and myocardial energetics have been described. However, studies of human myocardium are limited by lack of appropriate controls, the fact that all patients have endstage heart failure, and exposure of patients to different therapeutic regimens. In contrast to many animal models, the myopathic turkey heart (i.e., idiopathic dilated cardiomyopathy or furazolidone-induced cardiomyopathy) is similar to the myopathic human heart in terms of gross morphology, myocardial energetics, muscle physiology myofilament properties, Ca2+ metabolism, and the beta-receptor-adenylyl cyclase signaling system.

Actin Cytoskeleton↗
PubMed1995

[Persistent diarrhea in HIV infected patients: role of Enterocytozoon bieneusi].

OBJECTIVES: To determine the epidemiologic, clinical and aetiologic features of chronic diarrhoea in patients with human immunodeficiency virus (HIV) infection. METHODS: Between January 1992 and April 1993, all HIV positive patients with chronic diarrhoea were enrolled in a prospective study. There were 46 patients in the study group including 33 (22 homosexuals) in stage C according to the 1993 Centers for Disease Control classification. RESULTS: Thirty-four pathogenic agents were isolated in 26 of the patients (57%). Enterocytozoon bieneusi was the most frequently found pathogen (11 patients, 24%) followed by Cryptosporidium sp (8 patients). Enterocytozoon bieneusi was found in association with other pathogens in 7 patients. All patients with microsporidiosis were in stage C (p = 0.04) and had a longer duration of diarrhoea (19.6 vs 9.8 weeks, p = 0.03), greater weight loss (9.6 vs 2.1 kg, p = 0.0003) and a lower Karnofsky index (48% vs 67%, p = 0.01). Prophylaxy with dapsone or pyrimethamine during the 3 months prior to inclusion had been more frequent (p = 0.04 and p = 0.05 respectively) in patients without microsporidiosis. CONCLUSION: Microsporidiosis should be suspected as a probable cause of chronic diarrhoea in HIV positive patients with a CD4 count < 100/mm3. Multiple infections may be a factor leading to treatment failure. Microsporidiosis seems to be linked to homosexual intercourse.

AIDS-Related Opportunistic Infections↗
PubMed1995

Prevention of Pneumocystis carinii pneumonia and of cerebral toxoplasmosis by roxithromycin in HIV-infected patients.

The prevention of cerebral toxoplasmosis and of Pneumocystis carinii pneumonia is an essential objective in the management of patients infected with HIV. Given that roxithromycin is active in vitro against Toxoplasma gondii and that in 1989 Dolermann reported the effective treatment of P. carinii respiratory infections with erythromycin, a randomized pilot study was undertaken in 52 patients infected with HIV. Patients were treated with either: a monthly dose of pentamidine aerosol (300 mg); roxithromycin once a week (300 mg t.i.d.); or a combination of pentamidine aerosol and roxithromycin. Intention to treat analysis was applied to these 52 patients, all of whom received at least one treatment dose. Five out of 18 patients treated with pentamidine aerosol, 1/17 patients treated with pentamidine aerosol + roxithromycin and none of the 17 patients treated with roxithromycin developed cerebral toxoplasmosis (p = 0.038). P. carinii pneumonia was diagnosed in one patient in the pentamidine aerosol-treated group, in one patient treated with roxithromycin and in none of the patients treated with pentamidine aerosol + roxithromycin (non-significant difference). Four cases of Mycobacterium tuberculosis and Mycobacterium avium-intracellulare infection were seen in the pentamidine aerosol-treated group (p = 0.028) and none in the roxithromycin groups. Adverse events leading to the discontinuation of treatment occurred in 5/34 (14.7%) patients treated with roxithromycin. Nausea, abdominal pain and raised transaminases occurred in four patients and a skin allergy in the final patient. Roxithromycin appears to be effective in the prevention of pulmonary pneumocystis infection and of cerebral toxoplasmosis in HIV-infected patients. However, these results require confirmation in a larger study.

AIDS-Related Opportunistic Infections↗
PubMed1995

Atypical leishmaniasis in a patient infected with human immunodeficiency virus.

Visceral leishmaniasis is an anthropozoonosis endemic in the south of France. Its occurrence among patients infected with human immunodeficiency virus (HIV), in whom it presents with uncommon clinical, biological, and evolutionary signs, is being reported more and more often. We describe a case of leishmaniasis in an HIV-seropositive man that we believe is unique with respect to the cutaneous and then visceral location of the disease and the discovery at necropsy of an adrenal and myocardial leishmanial infiltrate.

AIDS-Related Opportunistic Infections↗
PubMed1995

SR-Ca2+ ATPase as an autoimmunogen in experimental myocarditis.

The concept of autoimmunity in the pathogenesis of myocarditis or dilated cardiomyopathy is gaining impetus. Since systolic functional impairment and subsequent recovery are frequently observed in myocarditis, we reasoned that the development of autoimmunity to cardiac sarcoplasmic reticulum calcium ATPase (SR-Ca2+ ATPase), which could interfere with intracellular calcium regulation and therefore affect myocardial contractility, should lead to immune-mediated myocarditis in experimental animals. Murine monoclonal antibody 4C11-20.21 (IgM class) generated against canine cardiac SR-Ca2+ ATPase inhibits the cardiac but not the skeletal ATPase activity. Immunization of CAF1/J mice with 4C11-20.21-affinity-column-purified cardiac SR-ATPase produced a time-dependent induction of myocardial injury consistent with the diagnosis of myocarditis. Furthermore, the antibody 4C11-20.21 alone can induce myo-necrosis in severe combined immunodeficiency (SCID) mice indicating a mechanism of cardiomyopathy independent of the cytotoxic T-cell mediated autoimmunopathy. Administration of 4C11-20.21 into immunocompetent CAF1/J mice resulted in minimal myocardial abnormality (40% with perivascular and/or interstitial mononuclear lymphoplasmacytoid aggregates, 10% with borderline myocarditis and 10% with lesions consistent with focal myocarditis). All control animals had normal hearts. Immunoperoxidase electron microscopic examination of the involved cardiac tissues showed antibody localization in the subsarcolemmal myotubular system and focal staining of the immediately adjacent sarcolemma in mice injected with 4C11-20.21 but not with 2C12.1B5. The time-dependent association between cardiac SR-Ca2+ ATPase administration and development of myocardial lesions, as well as potentiated induction of myonecrosis with anti-cardiac SR-Ca2+ ATPase antibody in SCID relative to immunocompetent mice, suggest a potential autoimmunopathogenic role of cardiac SR-Ca2+ ATPase in experimental myocarditis.

Animals↗
PubMed1995

[Muscular involvement in the course of AIDS. Anatomo-clinical study of 17 cases].

We report 17 patients seropositive for the human immunodeficiency virus, with muscle tissue involvement in different stages of the disease. Some patients are treated with azidothymidine (AZT). Others have no opportunistic infections. In all cases, there are some muscular symptoms such as progressive symetric and proximal muscular weakness with myalgias, elevated serum muscle enzymes, abnormal electromyogramma and very often a peripheral neuropathy. The muscle biopsy reveals the following features: rarely a focal muscular opportunistic infection in advanced stage of the disease is observed; a polymyositis is quite often the first clinical manifestation of the disease; a myopathy with mitochondrial involvement is observed in some of the AZT treated patients; some cachectic, under nourrished, bedridden patients present a type II muscle fiber atrophy. We conclude that a muscle biopsy could help us in our therapeutic planning directing us to a corticotherapy in the polymyositis, mitochondriopathies and wasting syndrome. Interruption alone of AZT or associated with a treatment by carnitine could allow remission of the muscular pathology.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Guillain-Barré syndrome associated with acute Q fever.

Several bacterial and viral agents have been implicated in the pathogenesis of the Guillain-Barré syndrome, an acquired immune-mediated disorder. A case of Guillain-Barré syndrome associated with acute Q fever is described. Coxiella burnetii should therefore be added to the list of microorganisms capable of inducing the Guillain-Barré syndrome.

Adult↗
PubMed1992

["Cholos de Coclé": determination of their racial mixture and genetic origins].

We have found, in this first genetic study of a supposedly admixed Panamanian population, that the cultural group known as "cholos of Coclé" constitute a trihybrid mixture, whose genetic pool has the following composition: 44% Amerindian, 38% Caucasoid and 18% Negroid. Similarly, we have detected Amerindian genes, such as LDHB--Gua and TFchi, in proportions that relate this population with the extant Ngawbé (Guaymí). Nevertheless, the very high frequency of variant PEPA--KUN seems to indicate the genetic contribution of Amerindian populations from Eastern Panama, possibly from the extinct indigenous group cueva. This variant is frequently found among the present-day Kuna, but has not been detected among Nagawbé and Buglé.

Humans↗
PubMed1989

[Value of fluconazole in the treatment of systemic yeast infection].

20 patients (18 men, 2 women), 10 of whom were HIV +, were given Fluconazole (F) for either systemic candidiasis (13 cases), histoplasmosis (1), or cryptococcosis (6). The localization of the Candida infections (12 C. albicans, 1 C. tropicalis), were: septicemic (2), urinary (7), bronchial (2), esophageal (5), uveal (1), soft tissue (2), and 1 undetermined localization but a positive serology (1). On day (d) 1, Candidiasis patients were given an initial dose of 400 mg (for septicemia) or 200 mg (other localizations) of FIV or PO, then 200 or 100 mg per d. The length of treatment lasted from 28 to 70 d. Evolution was favorable in all the patients. 4 relapses occurred after the end of treatment: at 10 d, a septicemic candidiasis (C. tropicalis) in 1 patient who had prosthetic endocarditis; and at 1 month, digestive candidiasis in 3 HIV + patients. For the patient, infected by Histoplasma capsulatum, despite a clinical improvement, urine were still positive at day 75. The patients with cryptococcosis (5 meningitidis in the AIDS patients) and renal (1) (kidney transplant) were given on the average 400 mg a d, IV or PO (mean length 8 weeks). Only 5 patients were evaluable. For 2 of the meningitis patients with other localizations, standard treatment was instituted due to the persistence of positive cultures. For the 2 other patients, the cerebrospinal fluid (1) and the urine (1) were sterilized by the 3d week. But they relapsed 1 month after the treatment stopped. For the 18 patients evaluable, clinical and biological tolerance was good except for 1 patient with transaminases rise for which fluconazole was probably the cause.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Liability for medical malpractice: an economic approach].

In recent years, changes in the organization of healthcare institutions and the increased number of medical malpractice claims have revealed the need to study the concept of medical responsibility and the repercussion of these changes on healthcare provision. To date, discussion has focussed on legal aspects and economic implications have been largely ignored.The present article reviews studies that have performed an economic analysis the subject. Firstly, we examine studies that gradually introduce the concepts of uncertainty, risk aversion and moral hazard. Secondly, in the healthcare environment, we pay particular attention to models that include new arguments on professionals' objective duties or to bargaining models when there is asymmetric information. Finally, we consider the medical malpractice insurance market and investigate how reputation and the possibilities of exercising defensive medicine influence healthcare provision. Our analysis suggests that, due to the characteristics of the healthcare market, the models proposed by the economy of information are very useful for performing economic analyses of liability in medical malpractice. However, alternative hypotheses also need to be formulated so that these models can be adapted to the specific characteristics of different health systems.

Health Care Sector↗