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Biomedical subjects

M Danis

Publications and source records attributed to M Danis.

At least 127 records · Page 7Linked to original sources
PubMed1990

[Current strategies for the prevention of malaria].

Two billion of persons live in regions where endemic malaria prevails or has reappeared. An estimated on hundred million infected individuals per year have been reported around the world. In front of this alarming situation, the diversity and even the incoherence of the currently proposed prophylactic regimens confuses the therapists and renders difficult the adoption of an efficacious strategy. The extension and gravity of drug resistance of P. falciparum and the withdrawal of anti-vectorial campaign constitute two reasons for the present recrudescence of malaria. The preventive strategies in 1990 are based on: rehabilitation of anti-vectorial campaign particularly against nocturnal mosquito bites, applicable to all, everywhere and at all times, by the means of individual and collective measures and mostly by impregnated nets; chemoprophylaxis for which two situations should be distinguished: the non immune traveler leaving for a short period (inferior or equal to 3 months) to an endemic area: individuals living permanently or for long periods in tropical regions. Prevention for short stays In low risk transmission zone (North Africa, Mexico, large cities of South East Asia) whatever the duration, suppression of chemoprophylaxis is acceptable. In high risk transmission zone, three strategies exist according to the intensity and frequency of drug resistance: zone 1 (P. vivax or drug sensitive P. falciparum): chloroquine at a dose of 100 mg/day for adults (1.5 mg/kg/day for children) 6 days out of 7, from the day of departure trough the whole stay and for one month after the return, is still efficacious; zone 2 (moderate frequency of drug resistance): protection is again ensured by chloroquine only, as in zone 1, or better than that by the association of chloroquine 300 mg once a week and proguanil 200 mg/day (3 mg/kg/day for children). The side effects of mefloquine and the risk of generation drug resistance argue against its general use in this zone particularly in West Africa. In one year, we have already observed three chemoprophylactic failures with mefloquine in individuals returning from this region; zone 3 (high frequency of drug resistance and multiresistance): mefloquine, if well tolerated is justified in weekly intake. In case of contraindications or intolerance to mefloquine, which are becoming more frequent, no substitution for that chemoprophylactic regimen is presently available. In view of these facts, indications, contraindications and posologies of mefloquine should be reviewed to better profit from the remarkable characteristics of this antimalarial. Mefloquine should only be prescribed (excluding curative treatment) for chemoprophylaxis of short stays in zone 3. Some contraindications of this drug should be maintained (pregnant women) or made relative (treatment with B-blockers and in the absence of pediatric studies, children weighing less than 15 kg).(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1990

[Cross resistance to mefloquine and halofantrine in a case of P. falciparum malaria contracted in Sierra Leone].

Malaria caused by P. falciparum occurred during prophylaxis with mefloquine upon return from Sierra Leone (zone II). A typical and not recognized, with negative results of initial hematological examinations. Diagnosed on D.26 with parasitemia of 0.2%. Successful treatment of clinical symptoms with halofantrine but increased anemia and positive parasitemia at D.7. Successful treatment with chloroquine. Chemosensitivity tests confirmed sensitivity to chloroquine, threshold sensitivity to quinine (IC50 = 297), resistance to mefloquine (IC50 = 76) despite high levels in bloods, and to halofantrine (IC50 = 7-laboratory normal value = 1). This cross-resistance of P. falciparum originating from Sierra Leone to mefloquine-halofantrine seems to be the first observation of this danger in Africa. Prescription of chloroquine is still imperative in zone 11 countries.

Adult↗
PubMed1990

[A case of tuberculoma of the orbit with sphenoidal origin].

We report the case of an orbital and sphenoidal tuberculosis observed in a young Indian man living in France. The orbital disease is presenting as an orbital mass with a radiologic bony lytic aspect, without systemic manifestation. A malignant process was suspected. The diagnosis was obtained by the culture for Mycobacterium tuberculosis of the biopsy specimen. Orbital involvement in tuberculosis is a rare manifestation in developed countries. Most cases reported in the literature were reported from Asia and Africa. Orbital tuberculosis may become established in one of two ways: primarily by heamatogenous spread to cause a periostitis or a tuberculoma of the orbital tissues, or secondarily by direct extension from neighbouring structures. It occurs in patients with or without associated pulmonary tuberculosis. Mycobacterium tuberculosis should be considered in the differential diagnosis of inflammatory orbital diseases. This diagnosis is based on clinical feature, positive tuberculin skin test and positive culture in resected tissues. The complete resolution of the disease with the specific antituberculous drugs emphasizes the point that tuberculosis must be evocated.

Adolescent↗
PubMed1990

[Failure of prevention of malaria by mefloquine in West Africa].

Mefloquine (Lariam) is extensively prescribed for the prevention of malaria in chloroquine-resistant areas. However, in west Africa, most of the strains of Plasmodium falciparum are still sensitive to chloroquine. In addition, a few of these strains are inherently resistant to mefloquine. Under these conditions, we must expect to see the failure of mefloquine prophylaxis in travellers returning from west Africa. We report here 5 such failures. The in vitro susceptibility of Plasmodium falciparum isolates from 4 of these patients was evaluated and showed that all 4 had normal sensitivity to chloroquine and quinine, 3 were resistant to mefloquine and one had reduced susceptibility to mefloquine. Mefloquine blood levels (measured 3 times) were within the normal protective range. These case reports indicate that mefloquine should be used cautiously for malaria prevention in west Africa. They also point out that, regardless of the prophylactic method used, fever in a traveller returning from endemic malaria regions always dictates the analysis of a thick blood smear to rule out the diagnosis of malaria.

Adult↗
PubMed1989

Foscarnet nephrotoxicity: mechanism, incidence and prevention.

Foscarnet is a pyrophosphate analogue that has been successfully used in severe cytomegalovirus (CMV) infections. Little is known of the incidence and mechanisms of foscarnet-induced nephrotoxicity as most data comes from recipients of renal allografts or from patients with severe underlying disease or with other nephrotoxic drugs. We have retrospectively analyzed the evolution of renal function after 56 courses of foscarnet. In addition, we have prospectively studied the protective effects of hydration on foscarnet nephrotoxicity (2.5 liters of saline/day during the night before the foscarnet therapy and throughout the course of treatment). Foscarnet-induced acute renal failure was defined as a rise in serum creatinine of at least 25% from the basal value. An increase in serum creatinine occurred in 37 cases out of the 56 courses of foscarnet (66%). The mean serum creatinine prior to foscarnet was 80.5 +/- 3.3 mumol/l and the mean increase was 190 +/- 28.3 mumol/l (range 80-1,000). Peak serum creatinine was higher than 200 and 300 mumol/l in 16 and 13 patients, respectively. Kidney obtained at autopsy from a 30-year-old male with AIDS, CMV pneumonitis and acute renal failure secondary to foscarnet administration showed an extensive tubular necrosis. In the group which was prospectively hydrated only 1 patient had an acute renal failure. The mean serum creatinine at the peak (96 +/- 4 mumol/l) and at the end of the treatment (83 +/- 4 mumol/l) was significantly lower (p less than 0.05) than in non hydrated patients. In conclusion, foscarnet is a highly nephrotoxic drug which induces acute tubular necrosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗
PubMed1988

Patients' and families' preferences for medical intensive care.

Medical ethics suggest that life-sustaining treatment decisions should be made with consideration for patients' preferences and quality of life. Patients were interviewed who were at least 55 years old and had experienced medical intensive care at a university hospital during a one-year period to determine their preferences regarding intensive care; family members were interviewed if the patient had died (n = 160). Seventy percent of patients and families were 100% willing to undergo intensive care again to achieve even one month of survival; 8% were completely unwilling to undergo intensive care to achieve any prolongation of survival. Preferences were poorly correlated with functional status or quality of life and were not altered by life expectancy for 82% of respondents. Age, severity of critical illness, length of stay, and charges for intensive care did not influence willingness to undergo intensive care. These data suggest that personal preferences may conflict with any health policy that limits the allocation of intensive care based on age, function, or quality of life.

Age Factors↗
PubMed1988

The effect of cimetidine dose timing on oral propranolol kinetics in adults.

Ten healthy male volunteers completed a study to determine the effect of cimetidine dose timing on the oral clearance of propranolol. Propranolol HCl 160 mg as tablets, was administered daily at 8 AM for 4 consecutive days on three occasions. In addition, cimetidine HCl 800 mg as tablets, was administered either simultaneously in the morning with propranolol (8 AM), at bedtime (10 PM), or not at all (control). Each treatment was separated by at least a 3-day washout. Propranolol and cimetidine serum samples were measured over the 24-hour dosing interval after the last propranolol dose. Cimetidine administration at 8 AM and 10 PM was associated with significant mean increases in the propranolol area under the serum concentration-time curve of 26% and 41%, respectively (P less than .002). The mean elimination half-life of propranolol was 6.3 hours during all three treatments. There was no significant difference in area under cimetidine serum concentration time curve between 8 AM and 10 PM dosing. Dosing cimetidine at bedtime 10 hours before propranolol does not diminish the magnitude of interaction.

Administration, Oral↗
PubMed1988

Epidemiology of toxoplasmosis among pregnant women in the Paris area.

A survey was performed using a sample of pregnant women selected at one of the biggest test centres in the Paris area. These women were serologically screened for toxoplasmosis between October 1981 and September 1983 (according to the prevention protocol for congenital toxoplasmosis established by the French health ministry). The prevalence rate of specific antibodies for toxoplasmosis was estimated from the 1074 women who were tested for the first time during the study. The prevalence rate among pregnant women in the Paris area was derived by direct standardization according to age and geographical origin. A standardized prevalence rate of 71% +/- 4% among French women, of 51.4% +/- 5% among immigrant women and a global adjusted prevalence rate of 67.3% +/- 3% for pregnant women in the Paris area was found. An incidence rate of 1.6% was estimated for the 2216 non-immune pregnant women included in the sample. There is no significant difference between the probabilities of seroconversion among French and immigrant women (2.3% +/- 1% and 1.6% +/- 0.8% respectively). Comparison of the data with previous study results show a decrease in the prevalence rate of specific antibodies for toxoplasmosis in the Paris area over the last 20 years that cannot be explained by changes in age and geographical origin. No data were available to support an aetiological hypothesis for a decrease in toxoplasma transmission to humans. Since immigration and a decrease in toxoplasma transmission to humans has led to a larger population of women at risk of infection during pregnancy in France, it is therefore important to perform studies to investigate risk factors and markers of acquired toxoplasmosis during pregnancy in order to improve the prevention of congenital toxoplasmosis.

Adolescent↗
PubMed1988

A comparison of patient, family, and physician assessments of the value of medical intensive care.

Medical ethics suggest that physicians incorporate patient preferences when making life-sustaining treatment decisions. This study therefore examines how closely physicians' assessments of the usefulness of intensive care agree with their patients' willingness to receive intensive care. Former intensive care patients, at least 55 yr old (or family members of nonsurviving patients), and their physicians were interviewed (n = 76 pairs of interviews) to determine how valuable each believe intensive care would be to the patient (on a scale of 0 to 100%) under actual and ideal life circumstances. Little correlation was found between individual patient or family member and physician responses (Kendall's Tau ranged from -.14 to .22 depending on how long life was prolonged). Physicians' evaluations of intensive care for patients under ideal life circumstances were strongly correlated with physicians' personal preferences for intensive care (Kendall's Tau, .41 to .65, p less than .02). Because physicians and patients may not agree regarding the value of intensive care, physicians must explicitly discuss patients' preferences in order to reconcile wishes and justifiable needs for critical care.

Aged↗
PubMed1988

[Low levels of chloroquine resistance of Plasmodium falciparum in the province of Zou in Benin].

An in vivo test using the WHO protocol (chloroquine 25 mg/kg within 3 days, trial over 7 days) was performed in 72 children in the province of Zou, Benin, in July-August 1987. The blood concentration of chloroquine was dosed before, during and after treatment by a sensitive method. This study showed a low rate of drug resistance (4.2%), even though surveys in Cotonou exhibited a high level of chloroquine resistance.

Animals↗
PubMed1988

[Serodiagnosis of toxoplasmosis developing during pregnancy and of congenital toxoplasmosis].

During the first prenatal serodiagnosis of toxoplasmosis, the test must permit to differentiate between immunized and non-immunized patients and to screen recently contracted toxoplasmosis. In a group of 33 women affected with toxoplasmosis during pregnancy a critical study of serodiagnosis criteria is carried out by comparing the theoretical protocol of the evolution of the serology during acquired toxoplasmosis with the situations observed under usual prenatal monitoring. Seroconversion was noted in 26 women and the variability of the results emphasizes the difficulties in determining the date of the contamination when an evolutive form of toxoplasmosis is suspected at the first examination, which is the case in 7 other patients. In children, 11 congenital toxoplasmosis were diagnosed, all on laboratory examinations. It must be emphasized that 16 children were prematurely lost to follow-up. It should be necessary to devote our energies to screening and information in order to validate the protocol of prevention of congenital toxoplasmosis.

Agglutination Tests↗