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P Sudre

Publications and source records attributed to P Sudre.

At least 19 recordsLinked to original sources
PubMed2002

Molecular epidemiology of predominant clones and sporadic strains of methicillin resistant Staphylococcus aureus in Switzerland and comparison with European epidemic clones.

OBJECTIVE: To assess the molecular epidemiology and risk factors of predominant clones and sporadic strains of methicillin-resistant Staphylococcus aureus (MRSA) in Swiss hospitals and to compare them with European strains of epidemic clones. MATERIAL AND METHODS: One-year national survey of MRSA cases. Analysis of epidemiological and molecular typing data (PFGE) of MRSA strains. RESULTS: In 1997, 385 cases of MRSA were recorded in the five Swiss university hospitals and in 47 community hospitals. Half of the cases were found in Geneva hospitals where MRSA was already known to be endemic. Molecular typing of 288 isolates (one per case) showed that 186 (65%) belong to four predominant clones, three of which were mostly present in Geneva hospitals. In contrast, the fourth clone (85 cases) was found in 23 hospitals (in one to 16 cases per hospital). The remaining 35% of the strains were clustered into 62 pulsed field gel electrophoresis types. They accounted for one to five patients per hospital and were defined as sporadic. Multivariate analysis revealed no independent risk factors for harboring a predominant versus a sporadic strain, except that transfer from a foreign hospital increases the risk of harboring a sporadic strain (OR, 42; 95% CI, 5-360). CONCLUSION: While cases with predominant clones were due to the local spread of these clones, most sporadic cases appear to be due to the continuous introduction of new strains into the country. With the exception of a transfer from a hospital outside Switzerland, no difference in the clinical or epidemiological characteristics was observed between patients harboring a predominant clone and those with a sporadic strain.

Anti-Bacterial Agents↗
PubMed2001

Hyperlactatemia and antiretroviral therapy: the Swiss HIV Cohort Study.

The prevalence, clinical presentation, and risk factors for hyperlactatemia among patients receiving antiretroviral therapy was determined during a 1-month period for patients in the Swiss HIV Cohort Study. Overall, 73 (8.3%) of 880 patients presented an increase in serum lactate of >1.1 times the upper normal limit (UNL). For 9 patients (1%), lactate elevation was moderate or severe (>2.2 times the UNL). Patients who presented with hyperlactatemia were more likely to be receiving stavudine with or without didanosine (odds ratio, 2.7; 95% confidence interval, 1.5-4.8), as compared with patients who received zidovudine-based regimens. The risk increased with increasing time receiving stavudine with or without didanosine. The association between hyperlactatemia and stavudine with or without didanosine was not biased by these medications being more recently available and, therefore, being given preferentially to patients who had prolonged use of nucleoside analog reverse-transcriptase inhibitors. Hyperlactatemia was associated with lipoatrophy, hyperlipidemia, and hyperglycemia. Age, sex, or stage of infection with human immunodeficiency virus were not predictive of hyperlactatemia. Determination of lactate levels may prove useful in the screening for mitochondrial toxicity.

Acidosis, Lactic↗
PubMed2001

Prophylaxis failure is associated with a specific Pneumocystis carinii genotype.

To investigate the possible association between Pneumocystis carinii types and various clinical and demographic parameters, we used molecular typing to analyze 93 bronchoalveolar lavage specimens from patients with P. carinii pneumonia (PCP). Multivariate regression analysis revealed an association between being infected with a specific P. carinii genotype and receiving anti-PCP prophylaxis (odds ratio, 4.4; 95% confidence interval, 1.0-18.6; P=.05), although no association with a specific drug was detected.

Adult↗
PubMed2001

Antiretroviral prophylaxis for community exposure to the human immunodeficiency virus in Switzerland, 1997-2000.

OBJECTIVE: To analyse the data from Swiss nationwide voluntary reporting on non-occupational HIV-postexposure prophylaxis (HIV-PEP) by prescribing physicians. METHODS: One hundred and seventy-six persons, who received antiretroviral prophylaxis for community exposure to HIV between December 1997 and March 2000, were included in this prospective cohort study with standardised data collection. Information on the source, the exposed person, type of exposure, treatment, and outcome was reported by physicians on a voluntary basis to three co-ordinating centers. RESULTS: HIV-PEP was prescribed predominantly following sexual exposure (69%). Needle injury was the second most common type of exposure (19% of all exposures), mostly occurring in a non-healthcare related "professional" setting (i.e., housekeepers, concierges [caretakers], and policemen). Needle sharing accounted for only 4% of all cases of exposure. The HIV status of the source often remained unknown (56%). Most patients received a combination of three antiretroviral drugs (zidovudine/lamivudine/nelfinavir in 34.1%; zidovudine/lamivudine/indinavir in 22.8%; zidovudine/lamivudine/nevirapine in 18.6%; various triple combinations in 13.8%). Follow-up information was available for 86 patients. In this group 78 (91%) completed at least one week of prophylaxis. Side-effects were common (70.9%), particularly diarrhoea (29.6%) and nausea (20.9%). Two patients experienced severe side effects, nephrolithiasis with sepsis, and toxic hepatitis, respectively. CONCLUSIONS: In most of the cases where HIV-PEP was prescribed the indication was questionable, with the HIV status of the source unknown. The role of HIV-PEP as part of HIV prevention programs should be well defined in view of the cost and potential for causing severe side-effects.

Adolescent↗
PubMed2001

Genetic diversity of Pneumocystis carinii in HIV-positive and -negative patients as revealed by PCR-SSCP typing.

OBJECTIVE: To describe the epidemiology of severe Pneumocystis carinii pneumonia (PCP) in HIV-infected and non HIV-infected patients. METHODS: Bronchoalveolar lavage specimens from 212 European patients with PCP were typed using PCR--single strand conformation polymorphism analysis of four genomic regions of P. carinii f. sp. hominis. Demographic and clinical information was obtained from all patients. RESULTS: Twenty-three per cent of the patients were presumably infected with a single P. c. hominis type. The other patients presented with two (50%) or more (27%) types. Thirty-five genetically stable and ubiquitous P. c. hominis types were found. Their frequency ranged from 0.4% to 10% of all isolates, and up to 15% of those from a given hospital. There was no significant association between the P. c. hominis type or number of co-infecting types per patient and geographical location, year of collection, sex, age, or HIV status. No more than three patients infected with the same type were observed in the same hospital within the same 6 month period, and no epidemiological link between the cases was found. CONCLUSIONS: The broad diversity of types observed seems to indicate that multiple sources of the pathogen co-exist. There was no evidence that in our study population inter-human transmission played a significant role in the epidemiology of P. carinii.

Bronchoalveolar Lavage↗
PubMed2001

Premature atherosclerosis in HIV-infected individuals--focus on protease inhibitor therapy.

OBJECTIVE: Lipid disorders associated with the use of protease inhibitors may contribute to the premature development of atherosclerosis. The purpose of the present study was to determine whether the administration of a protease inhibitor-containing regimen to middle-aged (30-50 years) HIV-infected individuals for 6 months or longer is associated with an increased prevalence of atherosclerosis. METHODS: High-resolution B-mode ultrasound imaging was used to visualize the femoral and carotid arteries of 68 HIV-negative and 168 HIV-infected individuals, including 136 patients who had received protease inhibitors for 26.8 +/- 8.9 months (mean +/- SD). Atherogenic plaques were defined as a thickening of the intima-media > or = 1200 mm. RESULTS: The proportion of participants with one or more plaques was higher in the HIV-infected group in comparison with the HIV-negative group (55 versus 38%; P = 0.02), and so was the prevalence of cigarette smoking (61 versus 46%; P = 0.03) and hyperlipidaemia (56 versus 24%; P < 0.001). The presence of plaque was independently associated with age, male gender, plasma low-density lipoprotein cholesterol levels and smoking. In univariate logistic regression analysis, an association was also found with HIV infection. Among HIV-infected subjects protease inhibitor therapy was not associated with the presence of plaque. CONCLUSIONS: A large proportion of the middle-aged HIV-infected individuals examined during this study had one or more atherosclerotic plaques within the femoral or carotid arteries. The presence of peripheral atherosclerosis within this population is not associated with the use of protease inhibitors, but rather with 'classic' cardiovascular risk factors such as smoking and hyperlipidaemia, which are amenable to interventions.

Adult↗
PubMed2001

Kashin-Beck disease: from etiology to prevention or from prevention to etiology?

The aetiology of Kashin-Beck disease (KBD) remains elusive. Four factors have been convincingly associated with the disease: selenium deficiency, iodine deficiency, grain contamination with mycotoxin-producing fungi, and water pollution with organic material and fulvic acid. The most credible studies from a scientific standpoint, i.e. randomised placebo controlled trials and observational cohort studies have either not been conducted or did not provide unequivocal demonstration in favour of any of these hypotheses. Many studies such as case-control, cross-sectional, "before-after", and even more so, ecological studies have been conducted. They merely produced weak evidence and fail to support any single factor to the exclusion of the others. The most scientifically sound studies have included animal models, laboratory experiments and pathology studies; however, these have only provided indirect evidence. Although none of the competing theories prevails when they are compared using a predefined and standard set of causality criteria (temporality, strength of the association, biological gradient, experimental evidence, biological plausibility, coherence, specificity and analogy), none should be discounted. This is an indication that a comprehensive and unifying theory is most likely to be multifactorial. Because the ultimate goal of those who are compelled by the challenge of KBD is to prevent its occurrence, a perfect understanding of its mechanisms is not indispensable for action. Well-conducted randomised intervention should be the priority of researchers as well as public health professionals to demonstrate what works and what does not.

Causality↗
PubMed2001

Determinants of transfusion-associated bacterial contamination: results of the French BACTHEM Case-Control Study.

BACKGROUND: Transfusion-associated bacterial contamination (TABC), probably the most frequent transfusion-transmitted infection, may induce serious adverse events. Systematic information and documentation on determinants are lacking. STUDY DESIGN AND METHODS: The BACTHEM Study is a French matched case-control study assessing TABC determinants. Included were cases of TABC reported in France in a 2-year period, as determined from uniform definitions. Information on recipient-, blood component-, and donor-related potential determinants was collected on site. ORs were estimated by conditional logistic regression. RESULTS: Of the 158 cases of suspected TABC reported, 41 that involved transfusion with 25 RBCs and 16 platelet concentrates were included. Gram-negative rods accounted for nearly half of the bacteria species involved and for all six deaths. In comparison with the risk of TABC for patients receiving RBCs for anemia, the risk was higher for patients receiving RBCs for pancytopenia (OR, 7.3; 95% CI, 1.3-41.0) and for those receiving platelets for thrombocytopenia (OR, 5.3; 95% CI, 1.2-24.1). Other potential determinants were platelet transfusion for pancytopenia (OR, 4.5; 95% CI, 0.5-40.0), immunosuppressive treatment (OR, 2.8; 95% CI, 0.7-10.6), shelf-life of more than 1 day for platelets or 8 days for RBCs (OR, 2.6; 95% CI, 0.7-9.6), and more than 20 previous donations by donors (OR, 1.9; 95% CI, 0.7-5.3). CONCLUSION: This first comparative study revealed TABC determinants that suggest approaches for prevention.

Adult↗
PubMed2001

Predictors of participation and attendance in a new asthma patient self-management education program.

BACKGROUND: Low participation limits the effectiveness of patient education interventions. In this study, the characteristics of patients who agreed to participate in a clinical trial of disease self-management education for asthma were compared to the characteristics of those who declined, and among the former group patients who actually attended were compared to those who did not. METHODS: The education program, implemented at the Geneva University Hospitals between 1996 and 1998, consisted of three interactive sessions spread over 3 weeks. Only 131 of 253 eligible patients (52%) agreed to participate in the trial, and only 83 patients (63%) attended two to three educational sessions. All eligible patients filled out baseline questionnaires and were interviewed by a trained physiotherapist. RESULTS: Lower confidence in the patient's own current treatment regimen and a more severe baseline asthma attack were independently associated with participation in the trial. Among those who agreed to participate in the study, a university education, longer asthma duration, older age, and a higher level of asthma management knowledge were associated with higher attendance. Quality-of-life scores were not associated with higher course attendance. Among all eligible participants, persons with lower knowledge of asthma management (which was assessed by what to do during an asthma attack and knowledge of the correct use of a peak expiratory flowmeter and inhalers) were less likely to enroll in the trial and to attend the educational training sessions. CONCLUSIONS: Strategies need to be developed to motivate patients with lower disease self-management knowledge to participate in asthma education programs.

Asthma↗
PubMed2000

[Early application of CPAP in newborns with gestational age below 34 weeks lowers intubation rate and shortens oxygen therapy without altering mortality and morbidity].

OBJECTIVE: The aim of this study was to test the following hypotheses: the application of early CPAP in the treatment of RDS decreases both the intubation rate and the incidence of bronchopulmonary dysplasia. DESIGN: This retrospective study compares the ventilatory management of premature infants between two periods of 12 months. The first period (July 1996-June 1997) precedes the application of early CPAP, the second (July 1998-June 1999) follows the systematic introduction of early CPAP. POPULATION: All inborn infants, < 34 weeks gestational age and admitted in the Division of Neonatology, CHUV, Lausanne, are included. RESULTS: The intubation rate was reduced significantly from 63.6% in the first period to 23.8% in the second and, if we only consider infants < or = 1500 g, from 72.1 to 30.8% (p < 0.01). The incidence of bronchopulmonary dysplasia, defined as the persistence of oxygen needs at 28 days of life, decreases from 10% in the first period to 4.8% in the second period and, if we only consider infants < or = 1500 g, from 14.7 to 7.7%. These differences are not significant. However we noticed a significant decrease in the duration of O2 therapy from 8.8 days in the first period to 4.6 days in the second (p = 0.04). If we only consider infants < or = 1500 g, the O2 therapy lasted 12.1 days for the first period and 6.8 days for the second. This decrease is not significant. Mortality is identical for both periods: survival rate is 90% in the first period and 90.5% in the second, and 85% and 86.2% respectively if we only consider infants < or = 1500 g. We noticed no significant differences in the morbidity rate (intraventricular haemorrhage, leucomalacia, retinopathy of prematurity and patent ductus arteriosus), except that for infants < or = 1500 g the incidence of pneumothorax was higher in the second period. CONCLUSION: The application of early CPAP significantly reduces the intubation rate without increasing mortality. A decrease in the incidence of bronchopulmonary dysplasia was observed but this finding was not statistically significant.

Bronchopulmonary Dysplasia↗
PubMed2000

Clinical epidemiology and research on HIV infection in Switzerland: the Swiss HIV Cohort Study 1988-2000.

BACKGROUND AND OBJECTIVES: The Swiss HIV Cohort Study (SHCS) was initiated in 1988 and represented the main scientific component of the comprehensive response to the AIDS epidemic in Switzerland. It brought together physicians and scientists from five university hospitals (Basel, Berne, Geneva, Lausanne and Zurich) and two Cantonal hospitals (Lugano and St. Gallen). The objective of SHCS was, and still is, to produce rapid, high quality patient-oriented medical research in the field of HIV infection. METHODS: SHCS is a prospective population-based cohort study. Any HIV-infected person aged > or = 16 years is eligible to participate. Data collection and study procedures are standardised. Data quality and protocol monitoring are conducted at the coordination and data centre in Lausanne. Detailed information on demographics, income, mode of HIV acquisition, risk behaviours, clinical events, laboratory results, treatment and treatment tolerance is collected at registration and at 6-monthly intervals. RESULTS: Since 1996, 10,600 persons have been enrolled and the SHCS study population is considered fairly representative of the HIV-infected population in Switzerland, at least in terms of gender and mode of HIV acquisition. In 1999, 4600 patients were actively followed up and more than 70% of patients were receiving highly active antiretroviral therapy (HAART). As a consequence, mortality and the incidence of HIV-related opportunistic infections have decreased significantly in the recent past. Between 1996 and 2000, 91 original manuscripts have been published by SHCS scientists and physicians, almost exclusively in peer-reviewed journals. A wide range of scientific questions have been addressed, including HIV primary infection, the natural history of HIV infection, the clinical and biological impact of HAART, drug resistance, risk factors for disease evolution including the timing of treatment initiation, the role of CD4 receptors, the validity of HIV surveillance reports, determinants of treatment access and tolerance, clinical trials of new drug combinations, the interruption of prophylaxis following a favourable response to HAART and issues relating to quality of life and interaction between income, social level and disease evolution. CONCLUSION: The SHCS has had, and continues to have, a significant impact on medical practice, public health and research in Switzerland and beyond. It represents a network of excellence which has brought together and fostered intensive collaboration between physicians and institutions throughout this country and beyond. This was possible thanks to the support of the Federal Office of Public Health and the commitment of primary care physicians, researchers and patients. This project may be model for focused and prioritised multicentre and transdisciplinary research programmes.

AIDS-Related Opportunistic Infections↗
PubMed2000

Polymorphism of HIV type 1 gag p7/p1 and p1/p6 cleavage sites: clinical significance and implications for resistance to protease inhibitors.

Amino acid substitutions at HIV-1 Gag p7/p1 and p1/p6 cleavage sites may be selected under antiretroviral pressure or represent natural polymorphisms. Whether changes are associated with specific protease (PR) mutation patterns and different clinical evolution has not been investigated. p7/p1 and p1/p6 cleavage site sequences from sera from 110 patients infected with HIV-1 were compared by regression analysis, using clinical, laboratory, and sequence variables, and the evolution of CD4(+) cell counts and viral load over time. Sixteen of 35 (46%) individuals naive to PR inhibitors (PIs), and 49 of 75 (65%) receiving PI-containing regimens had a p7/p1 and/or p1/p6 cleavage site polymorphism (p = 0.06). A431V and/or L449F were present exclusively among individuals failing PI treatment (17 of 75 [23%] and 3 of 75 [3%], respectively). There was a significant association between A431V and PR M46I,L (OR 13.7; 95% CI 4.2-44.3) and V82A,F,T (OR 8.8; 95% CI 2.7-27.8). Natural polymorphism P453L was strongly associated with the selection of PR I84V (OR 49.5; 95% CI 12-212) and selected against V82 mutation (OR 0.15; 95% CI 0.02-1. 2). After a median followup of 15 months, no polymorphism was associated with parameters of disease progression among individuals failing treatment. Only a limited set of amino acid substitutions can be tolerated at p7/p1 and p1/p6 cleavage sites. A431V is selected in association with specific PR inhibitor mutations. Natural polymorphism P453L might direct the PR resistance pathway through I84V instead of V82 mutation. No short-term clinical impact of cleavage site substitutions was documented.

Capsid↗
PubMed2000

Comparison of the psychometric properties of the Asthma Quality of life Questionnaire (AQLQ) among 115 asthmatic adults assessed during acute hospitalization and as outpatients.

Health status instruments designed for outpatient settings may not perform as intended when applied to hospitalized patients. In this study, we assessed similarities and differences between the psychometric properties of the Asthma Quality of Life Questionnaire (AQLQ) in-hospital and during an outpatient visit 6 months later, in a cohort of 115 patients. No ceiling or floor effects were present at either visit. At both visits, all scales except for 'environment' had internal consistency coefficients > 0.7 (ENVIRONMENT: 0.69--hospitalization; 0.68--outpatient). On both occasions, over 75% of item-scale correlation scores were > 0.4 and over 80% correlated to a greater degree with their own scale total than with the other three scales. However, at both visits, the AQLQ standard activity items had a higher correlation with the environment scale than with respondent-defined activity items; this finding re-occurred during exploratory factor analysis. Finally, the AQLQ performed similarly in construct validity tests in the two settings. In conclusion, this study provides evidence that the AQLQ has similar psychometric properties during an acute hospitalization and subsequently in an outpatient setting.

Adolescent↗
PubMed2000

Causes of macrocytosis in HIV-infected patients not treated with zidovudine. Swiss HIV Cohort Study.

OBJECTIVE: Zidovudine is a well known cause of macrocytosis. However, many HIV-infected patients develop macrocytosis even though they do not receive zidovudine. The aim of this case-control study was to evaluate other causes of high mean corpuscular volumes (MCV) in HIV infected patients. METHODS: Thirty patients with a MCV > or = 100 fl (cases) were compared to 60 randomly selected controls with MCV A< or = 99 fl, none of them receiving zidovudine. RESULTS: Sex ratio, age, mean CD4, prevalence of alcohol abuse and liver disease were similar in both groups. Vitamin B12 or folic acid levels were not decreased in patients with macrocytosis. In contrast, there was an association between macrocytosis and use of stavudine alone or in combination with another antiviral drug (28/30 cases, 15/60 controls, odds ratio 40.6 (95% confidence interval 5.1-325.2), P< 0.001). The haemoglobin concentration among cases (mean 13.5 g/dl) was similar to that of controls (mean 13.0 g/dl). CONCLUSIONS: Stavudine use increase the risk of macrocytosis more than 40-fold in HIV-infected patients who do not receive zidovudine. None of the stavudine-treated patients, however, developed anaemia or had to interrupt treatment because of this side effect.

Adult↗
PubMed2000

Infections with Mycobacterium tuberculosis and Mycobacterium avium among HIV-infected patients after the introduction of highly active antiretroviral therapy. EuroSIDA Study Group JD.

The impact of highly active antiretroviral therapy (HAART) among human immunodeficiency virus (HIV)-infected patients on the incidences of mycobacterial infections has not been studied in detail. We assessed incidences of mycobacterial diseases among HIV- infected patients following the introduction of HAART, using data from the EuroSIDA study, a European, multicenter observational cohort of more than 7,000 patients. Overall incidences of Mycobacterium tuberculosis (TB) and Mycobacterium avium complex (MAC) were 0.8 and 1.4 cases/100 person-years of follow-up (PYF), decreasing from 1.8 (TB) and 3.5 cases/100 PYF (MAC) before September 1995 to 0.3 and 0.2 cases/100 PYF after March 1997. After adjustment for changes in CD4 cell count and use of antiretroviral treatment in Cox proportional hazards models, the risk of MAC decreased with increasing calendar time (hazard ratio per calendar year; HR = 0.58 [95% confidence intervals: 0.45-0.74], whereas this was not the case for TB; 0.95 [0.74-1.22]). In conclusion, we documented marked decreases in the incidence of TB and to an even larger extent of MAC among HIV-infected patients from 1994 to 1999. The decrease in TB was associated with the introduction of HAART and changes in CD4 cell count. These factors could also explain some of the decrease in MAC over time, though there remained a significantly lower risk of MAC than expected.

AIDS-Related Opportunistic Infections↗
PubMed2000

Pulmonary tuberculosis in prisons of the ex-USSR state Georgia: results of a nation-wide prevalence survey among sentenced inmates.

SETTING: The penitentiary system of the ex-USSR state of Georgia. OBJECTIVES: To measure the prevalence of active pulmonary tuberculosis and drug-resistant disease among prisoners. To identify factors associated with active tuberculosis and multidrug resistance (MDR). DESIGN: A comprehensive multiphasic screening survey for tuberculosis. RESULTS: The prevalence of smear- or culture-positive tuberculosis was 5995 per 100,000 prisoners (n = 448 cases among 7473 inmates). Of all the strains, 215 (77.9%) were resistant to at least one drug and 37 (13.0%) were MDR. Independent risk markers associated smear- or culture-positive tuberculosis with included prison stay of 2 years or more, body mass index <20 kg/m2, accommodation in a large size prison, previous anti-tuberculosis treatment, cough of 2 weeks or more and loss of appetite. Risk markers associated with MDR were a prison stay of less than 2 years and being over 25 years of age. CONCLUSIONS: In Georgia, the excess risk for tuberculosis among prisoners is unprecedented, suggesting that prisons represent a significant reservoir of tuberculosis. Only a comprehensive strategy for tuberculosis control in prisons, including prison reform, control of anti-tuberculosis drugs, and prompt and efficient diagnosis and treatment of patients can have an impact on the tuberculosis burden in the prison system.

Adult↗