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Biomedical subjects

M Danis

Publications and source records attributed to M Danis.

At least 55 records · Page 3Linked to original sources
PubMed1999

[Comparative study of artemether and quinine in severe Plasmodium falciparum malaria in adults and older children in Cameroon].

From June 1993 to June 1994, a study was carried out to compare artemether and quinine for management of severe falciparum malaria in adults and adolescents in Cameroon. Artemether was administered intramuscularly at a dose of 3.6 mg/kg on the first day and 1.6 mg/kg for the following 4 days. Quinine was administered intravenously at a dose of 1.6 mg/kg for the first 4 hours and 8 mg every 8 hours for the next 3 days. The files of 84 of the 95 patients recruited were validated for inclusion in the final study. There were 40 patients in the artemether group and 44 in the quinine group. The two groups were comparable with regard to all factors at the time of inclusion. Findings showed that artemether was more effective than quinine with regard to total clearance of parasitemia, 90 p. 100 clearance, and fever control and that it was as effective with regard to 50 p. 100 clearance and recovery of consciousness. In view of its good performance and of the simplicity of its administration by intramuscular injection, artemether would appear to be an excellent alternative for treatment of severe malaria and cerebral malaria in areas with poor medical facilities.

Adolescent↗
PubMed1999

[Immunoblot applied to the diagnosis of congenital toxoplasmosis].

Western blot was evaluated for the neonatal diagnosis of congenital toxoplasmosis based on a comparison of antibody profiles between serum samples obtained from the mother at delivery and from the neonate. Passively transferred antibodies can be distinguished from antibodies produced by the neonate, thus allowing early postdelivery diagnosis of congenital toxoplasmosis before the results of other tests are available. This method was developed at the Parasitology-Mycology laboratory of the Pitié-Salpêtrière Teaching Hospital, Paris, France, then evaluated in a retrospective study of 52 mother-infant pairs. The diagnosis of congenital toxoplasmosis was ruled out in 34 cases, confirmed in ten cases, and doubtful in 8 cases. Sensitivity was higher than with conventional serological tests. Antibody profile differences were found between mothers and affected infants; these differences usually involved IgGs (8 of 9 cases). Importantly, in two cases Western blot would have provided the diagnosis of congenital toxoplasmosis two months before the secondary elevation in IgM titers in one case and three weeks before the result of mouse placenta inoculation in another case. In conclusion, Western blot deserves to be used to complement established methods (serology and direct demonstration of the parasite by gene amplification, cell cultures, and mouse inoculations) as a means of rapidly (within 24 hours of receipt of the specimen) providing clinicians with information relevant to treatment decisions.

Antibodies↗
PubMed1998

[Malaria, a worldwide scourge].

Malaria, mostly caused by Plasmodium falciparum, continues to take its toll throughout the world's tropical zone. The last report of the World Health Organization indicates renewed activity of this endemic disease, with 300 to 500 million cases per year per 2.3 billion persons at risk, and 1.5 to 2.7 million death. Africa is the most affected, with an estimated incidence of 700 cases per 1000, while in South America and Asia, the incidence varies around 4 to 5 cases per 1000. Using treated mosquito nets will probably not lower transmission sufficiently to decrease mortality. Early treatment, particularly in the child, is as important and combating transmission.

Endemic Diseases↗
PubMed1998

The health insurance puzzle: a new approach to assessing patient coverage preferences.

Previous studies of preferences for health insurance benefits have required individuals to make a series of complex and repetitive decisions, and have assumed that all insured benefits are desirable. This study reports the development and testing of a simple, innovative instrument to measure preferences for health insurance benefits. The newly developed instrument (Puzzle) is designed to allow subjects to select health benefits in a way that underscores the trade-offs dictated by budgets and costs. A "puzzle-like" frame representing budget constraints and "puzzle piece" benefit cards proportionately sized to represent the premium price of a single year's coverage comprise the instrument. In a comparison procedure (Money Game), participants "purchase" individual benefits by exchanging "play" money for benefit tokens. The Puzzle's utility was assessed by examining the convergence of results from both instruments and the subject's ratings of and preference for the instruments. One hundred five elderly Medicare enrollees seen in the general Internal Medicine outpatient clinic of a major southeastern teaching hospital were interviewed. Subjects answered interviewer-administered questionnaires and completed both the Puzzle and the Money Game. Both McNemar's test and Kendall's tau-b indicated a high degree of concordance between benefit choices made using the two instruments. Descriptive statistics demonstrated that the Puzzle was clear, easy to use, understandable, and preferred to the Money Game. The results suggest that the Puzzle is a promising tool for assessing health insurance coverage preferences under circumstances of limited expenditures, which can be modified for use with various populations who face limited insurance benefits.

Aged↗
PubMed1998

Imported malaria in continental France in 1996.

Malaria ceased to be endemic in France in 1960, although sporadic cases were reported until 1970 in the department of Corse. No indigenous case of malaria have been reported since then. We report below the epidemiological data on imported malaria in 1996.

Journal Article↗
PubMed1998

Surveillance of malaria in European Union countries.

The European Union countries are outside the endemic area for malaria, but many cases of malaria contracted elsewhere are imported into Europe each year. Several countries have reported high and increasing numbers of imported cases in recent years (France

Journal Article↗
PubMed1998

Use of delipidized antigens of Taenia solium metacestodes in IgG-ELISA for detection of neurocysticercosis.

The development of IgG-ELISA for detecting neurocysticercosis is aimed at the routine laboratory, and requires a particular antigen preparation, an acceptable number of serum samples to be tested (both homologous and heterologous) and patients with a diversity of helminthic infections to rule out cross-reactions. This study characterizes IgG-antibodies from cases of neurocysticercosis by assaying the sera against ether-delipidized antigens (5 microg/ml) prepared from metacestodes of Taenia solium. The test had a sensitivity of 90% and a specificity of 83%. IgG-antibodies from heterologous serum samples elicited a number of false positives (25/147) from six different helminthic infections, ie paragonimiasis, echinococcosis, opisthorchiasis, ascariasis, taeniasis and fascioliasis. In additional tests to detect antibody levels to these stage-related antigens, one of three serum samples from T. solium-infected cases gave negative at OD value of 0.187 while the others yielded 0.472 and 0.576. Conversely, assays of all serum samples from neurocysticercosis cases reacted against antigens from Echinococcus granulosus cystic fluid, Paragonimus heterotremus and Opisthorchis viverrini adult worms. In comparison, the antigens from these three species yielded higher mean OD values when assayed against the corresponding infected serum samples. Furthermore, neurocysticercosis cases yielded OD values that are separate and distinct from those of paragonimiasis cases.

Adult↗
PubMed1998

Improving end-of-life care in the intensive care unit: what's to be learned from outcomes research?

Current recommendations about the care of dying patients advise that healthcare professionals understand and respect the goals, priorities, needs, and suffering of each dying patient and have command of the skills and resources required to address these concerns. Studies of important features of terminal illness, current use and outcome of intensive care for the terminally ill, and interventions designed to improve the outcome of care for patients who die in ICUs are reviewed to examine discrepancies between recommendations and the reality of ICU care for dying patients. Evidence indicates that it is difficult to predict the time of death or determine patient preferences about treatment prior to death. The utilization of intensive care prior to death varies widely across the United States and is a function of available resources more than individual patient need or choice. The pattern of withdrawal of life-sustaining treatment also varies widely and does not seem to follow guidelines. Families of deceased patients report that care could be improved by increased attention to analgesia and communication. The largest interventional study, the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT), which provided physicians with information about patient prognosis and preferences for care, did not alter outcomes of end-of-life care. Smaller but successful interventional studies have included examination of an alternative team that provides care tailored to the needs of dying patients, a service tailored to promote family contact with the dying patient, and proactive consultation to facilitate care planning and communication with families. Research suggests that clinicians should be cognizant of the difficulty of predicting death and anticipate the need to change the goals of care as therapeutic trials fail; anticipate and treat bothersome symptoms of dying patients; recognize that family support and contact between the dying patient and family facilitate decision-making and acceptance of death; and facilitate the coordination of care and the development of alternative care teams in order to optimize end-of-life care.

Advance Care Planning↗
PubMed1998

[Apropos of 1 case of hepatogastric fascioliasis in Cape Verde].

The authors report a case of Fascioliasis sp. distomiasis with a double hepatic and gastric location primitively associated with a gastric cancer metastazed to the liver. The parasitic origin of the lesions suspected from the histological specimen of the gastric biopsy (the presence of eggs) was confirmed by serology with the presence of the arc 2 specific to immunoelectrophoretic analysis, while the parasitological examination of the stools was always negative. The patient grew well after a day's cure of triclabendazole (375 mg x 2). Although the ectopic locations of Fascioliasis are classic, they are usually in the abdominal wall, less frequently in the gastric or colic wall. The fact that the contamination originated on the Cape Verde is indiscutable, since the patient had never left the island. It is the 5th case described in medical literature, thus confirming the presence of Fasciola hepatica (or gigantica) on the islands of the Cape Verde, whose population is of both Portuguese and African origin and has kept the eating habits of the former colonial power (Portugal is a zone of high endemicity for human fascioliasis). It would be interesting to look for Limnaea and contaminated bovine on the Cape Verde islands.

Africa, Western↗
PubMed1997

Can clinical interventions change care at the end of life?

PURPOSE: To review clinical interventions designed to change care at the end of life. DATA SOURCES: Published results of clinical trials identified by MEDLINE searches, review of abstracts from meetings, and selected bibliographies. STUDY SELECTION: Studies were included if data were presented on a clinical intervention designed to change medical care at the end of life. Studies done in nonclinical settings or outside the United States were excluded. DATA EXTRACTION: Interventions were classified as targeting patients, physicians, or both and were analyzed by their effect on four common clinical goals: increasing use of patient preferences, decreasing pain and suffering, reducing use of life-sustaining treatments, and reducing costs. Positive and negative trial results were compared for differences in intervention, target group, and strength of study methods. DATA SYNTHESIS: Educational interventions usually increased expression of patient treatment preferences. Success rates were higher when more severely ill patients were targeted and when written materials were combined with repeated discussions in clinical encounters. Educational interventions with physicians led to increased use of patient preferences, but sophisticated educational techniques were needed to motivate physicians to change their behavior. Three studies provided limited evidence that physician education reduced the use of life-sustaining treatments. No clinical intervention had an effect on pain, suffering, or cost of medical care. CONCLUSION: To change care at the end of life, intensive educational interventions for physicians and broad institutional programs seem more promising than advance directives. Future innovations should seek to change physician practices, reduce costs, and improve patient-centered outcomes, such as pain control and satisfaction.

Empirical Research↗
PubMed1997

Attitudes of the critically ill toward prolonging life: the role of social support.

Desires to prolong life were investigated in a hospitalized sample of 212 persons over age 50 whose illnesses were severe and who had an average life expectancy of six to twelve months. The importance of social support was emphasized in defining the context in which the stressors of unfinished business and fear of death prompted desires to prolong life. Interactions existed in predicting desires for prolonging life based on ethnicity and whether respondents did or did not have sustained family contact. Family contact and salience increased the desire to live longer for African Americans, but not for Whites.

Aged↗
PubMed1997

Older Medicare enrolees' choices for insured services.

OBJECTIVES: The Medicare Trust Fund is expected to be bankrupt in the next decade, thus threatening the viability of the Medicare Program. We have ascertained what Medicare enrollees' priorities for insured services would be, and why, if it were fiscally necessary to limit Medicare benefits to maintain the viability of the Program. DESIGN: A cross-sectional survey using anonymous, inperson interviews and an innovative instrument to elicit choices. SETTING: General Internal Medicine outpatient clinic at a university teaching hospital. PARTICIPANTS: One hundred five adults, 65 years of age and older, who had primary care physician visits between July and September 1995. MEASUREMENTS: Desire to personally select insurance benefits, insurance benefit choices, and the reasons for selection or rejection of benefits. RESULTS: Subjects of various educational and economic backgrounds were able to carry out the selection process with relative case, and four-fifths of respondents preferred to make their own choices about insured services. The most frequently selected services were hospitalization, outpatient care, prescription drugs, eye care, and home care, in descending order. Subjects selected 52 different combinations of services. Only 2% of respondents picked the current Medicare service package. The reasons given for selection varied by service; cost and current or anticipated need for a service were the most frequently cited forces driving the choices made. CONCLUSION: These data suggest that Medicare enrollees prefer some element of choice about their health insurance coverage. Their choices vary widely and differ from the current Medicare package.

Aged↗
PubMed1997

What is wrong with end-of-life care? Opinions of bereaved family members.

OBJECTIVE: To describe family perceptions of care at the end of life. METHODS: In a representative sample of older people who died from chronic diseases, family members were interviewed about satisfaction with treatment intensity, decision-making, and symptom relief in the last month of life, and gave suggestions to improve care. RESULTS: Interviews were completed with 461 family members, 80% of those contacted. They reported that 9% of decedents received CPR, 11% ventilator support, and 24% intensive care during their last month of life. Family members could not recall a discussion of treatment decisions in 23% of cases. Presence or absence of a living will did not affect the likelihood of no discussion (22% vs 24%, P = .85). Family informants desired more treatment to sustain life in 8% of deaths. They or the decedent wanted treatments doctors did not recommend in 6% of deaths but refused recommended therapies in 18% of deaths. They believed more care to relieve pain or other symptoms was indicated in 18% of deaths. Asked to make positive or negative comments about any aspect of terminal care, 91% of comments on hospice were positive. Nursing home care received the smallest proportion of positive comments (51%). Family members recommendations to improve end of life care emphasized better communication (44%), greater access to physicians' time (17%), and better pain management (10%). CONCLUSION: Bereaved family members are generally satisfied with life-sustaining treatment decisions. Their primary concerns are failures in communication and pain control. Discussions that focus on specific treatment decisions may not satisfy the real needs of dying patients and their families.

Aged↗