Background. Considering the remarkable efficacy of the strategies for preventing mother-to-child transmission of HIV infection (PMTCT), failures are rare in high-resource countries and deserve further investigation. Moreover, infants have been found to be at increased risk of viral failure. We analyzed the factors related to the children's environment, including maternal psychological factors that may be associated with viral failure in children diagnosed before the age of 1 year.Patients and methods. Retrospective study of all HIV-infected infants, born in France between July 2003 and July 2013, diagnosed before the age of 1 year, cared for in a single reference center, comparing the group of children in viral success to the group of children presenting at least one episode of viral failure, using data available in their medical, psychological and social files.Results. Out of 1061 infants included in the prospective PMTCT follow-up, eight infants were found HIV-positive and an additional six cases were referred from other centers before the age of 1 year, for a total of 14 children born to 13 mothers. Seven children presented durable optimal viral control (VL < 50 c/mL) whereas seven others did not reach or maintain optimal viral control over time. The main difference between the two groups was the presence among the mothers of children with viral failure of severe psychological disorders, leading to treatment adherence problems in the mothers who were aware of their HIV status before pregnancy, and difficulties in giving their children's treatments correctly.Conclusions. Although seroconversion during pregnancy is responsible for a significant proportion of residual transmission in high resource countries, severe psychological or psychiatric conditions in HIV-positive mothers play an important role on the risk of both MTC residual transmission and viral failure in their infants. (C) 2017 Elsevier Masson SAS. All rights reserved.

L'association de 2 inhibiteurs de la reverse transcriptase (INRT) et d'un inhibiteur de protéase (IP) boosté par le RTV est le traitement de référence des femmes enceintes infectées par le VIH. Cette étude rapporte notre expérience de l'utilisation de l'ATV sans RTV Étude rétrospective de 2004 à 2013 dans les Hôpitaux Universitaires de l'Est parisien (St-Antoine, Tenon et Trousseau) Trente-huit femmes infectées par le VIH ont été analysées : 32 (84 %) originaires d'Afrique sub saharienne, médiane d'âge 30,5 ans (18–39), stade CDC A chez 21 (55 %), B chez 13 (34 %), C chez 4 (11 %). En début de grossesse, la médiane des CD4 était de 411/mm3 (107–980), celle de la charge virale (CV) de 2 452 copies/ml (0–130 066). Dix-sept (45 %) patientes (ptes) ont débuté leur grossesse sous ATV (dont 6 avec RTV) ; chez 21, l'ATV sans RTV a été introduit à une médiane de 21,5 semaines d'aménorrhée (SA) (8–30). Les INRT associés à l'ATV étaient AZT+3TC (12 ptes, 38 %), FTC+Tenofovir (14 ptes, 37 %), 3TC+Abacavir (8 ptes, 21 %). Un boost par RTV a été introduit chez 4/31 ptes, une augmentation de la dose d'ATV à respectivement 400 et 600 mg a été nécessaire chez 2/31 ptes après résultats pharmacologiques et virologiques. À l'accouchement, la CV était < 40 copies/ml chez 33 ptes (87 %), 5 avaient une CV entre 40 et 250 copies/ml. Trente-trois patientes ont accouché à > 37SA, 3 entre 33 et 36SA et 2 < 25SA. Aucun cas de transmission mère-enfant n'a été observé chez les 37/38 nouveaux nés dont les données étaient disponibles Malgré l'absence d'AMM d'ATV sans RTV au cours de la grossesse de femmes infectées par le VIH notre étude suggère l'intérêt de cette stratégie sous réserve d'une surveillance par suivi pharmacologique et virologique

Objective. - The authors had for aim to describe the effectiveness and the safety of a saquinavir/ritonavir (SQV/r) regimen, 1000/100 mg twice daily, in HIV-infected pregnant patients.Patients and method. - We made a prospective and observational study of HIV positive female patients beginning or going on SQV/r antiretroviral treatment (ART) during pregnancy.Results. - Sixty-two patients were enrolled from July 2007 to June 2009 in 10 infectious diseases units in France. Thirty-six women (group 1) were ART naive on inclusion, 20 (group 2) had been previously treated and then switched to SQV/r, six (group 3) were treated with SQV/r before pregnancy. 58 patients delivered while on SQV/r regimen after a median pregnancy duration of 39 WA. Eighty percent had a viral load below 50 copies/mL and 93% below 400 copies/mL: respectively 77% and 93.5% in group 1, 83% and 89% in group 2, 83% and 100% in group 3. The median SQV minimum concentrations (C-min) measured at the third trimester and at delivery were adequate, respectively 0.91 mg/L and 0.86 mg/L. Most women (52%) had a vaginal delivery; 12 (21%) had an elective caesarean section, for obstetrics factors in eight cases. None of the newborns were HIV-infected at 6 months of age (n = 59, one death at day 3). Only one severe adverse event occurred due to saquinavir (maternal grade 3 hepatotoxicity).Conclusion. - SQV/r 1000/100 mg twice daily seems to be effective and safe in HIV-infected pregnant women with adequate saquinavir C-min. (c) 2012 Elsevier Masson SAS. All rights reserved.

Les peaux pigmentées présentent des variations physiologiques, structurelles et fonctionnelles, entraînant des maladies cutanées spécifiques qui nécessitent d'être connues. Les dermatoses usuelles ont souvent une présentation déroutante avec, en particulier, des problèmes de dyschromies, hyper- ou hypopigmentation, dont le retentissement esthétique et psychologique est important. Enfin, les maladies du cuir chevelu posent de nombreux problèmes particuliers à la peau noire.Pigmented skins present some variations in terms of physiology, structure, and function, that can be responsible for specific skin diseases, and which need to be identified. Frequently, common skin diseases have a disconcerting clinical presentation due to dyschromias such as hyper or hypo-pigmentation, with important aesthetical and psychological repercussion. Scalp diseases are also very peculiar for people with black skin.

Le but de notre travail est de faire une revue générale sur les différents aspects clinico-radiologiques et la prise en charge de la thrombose veineuse cérébrale (TVC) au sein de notre structure hospitalière et les comparer à ceux décrits dans la littérature.Notre série incluait 62 patients âgés de plus de 18 ans, colligés sur 7 ans (2009–2016) dans le service de radiologie du CHU Hassan II de Fès (Maroc), chez qui le diagnostic radiologique de TVC a été retenu. Nos patients ont bénéficié d’une TDM cérébrale et d’une IRM cérébrale. Les caractéristiques cliniques et radiologiques et l’évolution après traitement ont été relevées.La moyenne d’âge était de 35 ans avec une prédominance féminine ; sexe-ratio de 3,76 (49F/13H). La symptomatologie était non spécifique, faite essentiellement de céphalées, crises comitiales, troubles de conscience et signes focaux. Le sinus longitudinal supérieur était la topographie dominante. Les facteurs étiologiques étaient variés regroupant les causes infectieuses (sinusite, otite moyenne chronique, otomastoïdite, méningite bactérienne, septicémie), gynéco-obstétricales (la contraception orale, la grossesse, le post-partum), systémiques (la maladie de Behçet, la polyglobulie de Vaquez, les syndromes paranéoplasiques, le syndrome des antiphospholipides), locaux (les traumatismes crâniens), idiopathiques. La TDM mais surtout l’IRM cérébrale ont permis de poser le diagnostic mais également d’orienter vers l’étiologie.L’IRM cérébrale est actuellement le meilleur moyen d’imagerie dans le diagnostic de la TVC, permettant d’apprécier avec précision sa localisation, son étendue et le retentissement sur le parenchyme cérébral. De multiples affections sont responsables des TVC. La prise en charge thérapeutique repose sur l’héparinothérapie et le traitement étiologique.The work's purpose is to make a general review on the various clinical-radiological aspects and the management of cerebral venous thrombosis (CVT) in our hospital and compare them to those described in the literature.Our series included 62 patients aged over 18 years, collected over 7 years (2009–2016) in the radiology department of the CHU Hassan II of Fez (Morocco), in which the radiological diagnosis of TVC was retained. Our patients have benefited from a brain CT scan and brain MRI. Clinical and radiological characteristics and post-treatment progression were described.The average age was 35 years with a female predominance; sex ratio 3.76 (49F/13H). The symptomatology was non-specific, made mainly of headaches, comic crises, disturbances of consciousness and focal signs. The upper longitudinal sinus was dominant topography (51.61%). The etiological factors were varied: infectious (sinusitis, chronic otitis media, oto-mastoiditis, bacterial meningitis, and septicemia), gyneco-obstetrical (oral contraception, pregnancy, and postpartum), systemic (Behçet diseases, polycythemia of Vaquez, paraneoplastic syndrome, antiphospholipid syndrome), local (head trauma), undetermined etiological factors. The CT scan, but especially the cerebral MRI, made it possible to make the diagnosis but also to direct towards the etiology.Cerebral MRI is currently the best imaging in the diagnosis of CTV, allowing an accurate assessment of its location, extent and impact on the cerebral parenchyma. Multiple conditions are responsible for CTVs. Therapeutic management is based on heparinotherapy and etiological treatment.

patches on the face and neck. In 24 h, as the symptoms intensified, macular lesions increased in number and became confluent, involving the trunk, back and arms, while discrete macules were seen on both hands ( fig. 1 ). She was then hospitalized. On physical examination, KS were found bilaterally on the buccal mucosa, consisting of irregular and confluent small white spots, making diagnosis of measles most likely ( fig. 2 ). Immediate notification to health authorities was made, and epidemiological investigation for related cases was shortly undertaken. In this patient, the final diagnosis was confirmed by the presence of antimeasles IgM antibodies. She had received only 1 dose of measles-containing vaccine at the age of 2 years.

Solitary Peutz-Jeghers-type polyps of the stomach are extremely rare. They are defined as unique polyps that are not associated with Peutz-Jeghers syndrome (PJS).A 37-year-old woman presented at our hospital with anemia and epigastric discomfort. Esophagogastroduodenoscopy to determine the cause of anemia revealed a 5 × 6-cm pedunculated polypoid tumor at the greater curvature of the upper gastric body. Pathological examination of a biopsy specimen confirmed a Group 1 hyperplastic polyp. Computed tomography revealed neither lymph node swelling nor distant metastasis. A malignant component of the polypoid tumor was difficult to deny because of its size. The patient underwent local resection of the stomach. Her postoperative course was uneventful.A pathological examination of the surgical specimen revealed a Peutz-Jeghers-type, hamartomatous polyp containing an enlarged crypt with hyperplastic foveolar epithelium and smooth muscle proliferating into the lamina propria. No atypical cells were found in the overlying epithelium. Based on these findings, we performed colonoscopy and capsule endoscopy of the intestine. No polyps were found in the intestine or colon. She had no family history of any type of tumor and no mucocutaneous pigmentation.There were only 10 reports of solitary gastric Peutz-Jeghers polyps published to date. Although most of them did not have atypical cells, one case has proliferative component. A few reports have described relationship with malignant tumor.Solitary gastric PJ-type polyps are rare. Careful follow-up should be recommended and further studies are needed to evaluate cancer risk of solitary gastric PJ-type polyps.

Different cleaning and silanization methods have been applied to bioactive glasses with the aim of covalently bonding bone morphogenetic proteins (BMP-2) to the surface. Several glasses, with different bioactivity index, were cleaned with acidic, basic, or neutral aqueous media to investigate the role of pH in the formation of silanols on glass surfaces of different reactivity. The cleaned glasses were then functionalized using 3-aminopropyl-triethoxysilane (APTS). After the optimization of the silanization procedure, proteins of different complexity were immobilized on the functionalized glasses. To optimize the protein immobilization, a model protein (carnosine) was first used, and the procedure was then used to bind human BMP-2. The glass surfaces were characterized during each step of the treatment by water contact angles and X-ray photoelectron analyses. The APTS functionalization was then used to immobilize bone morphogenetic protein on the bioactive glasses. This result suggested that such a treatment could be successfully used as an efficient alternative to systemic administration of transforming growth factors for the development of local delivery vehicle implants.

We report the case of a 27-year-old man presenting with a hepatic abscess and hereditary hemorrhagic telangiectasia (HHT). The association between HHT and an infectious disease seemed to be induced by arteriovenous malformations and maybe also by a deficit of polymorphonuclear cells, a monocyte oxidative burst and phagocytosis. This diagnosis should be suggested in case of serious infections in young patients. Prevention is based on screening for and destroying infection, antibioprophylaxis and embolization of arteriovenous malformations. (C) 2009 Published by Elsevier Masson SAS.

La démarche diagnostique dans le syndrome de Cushing est relativement difficile. Il existe classiquement deux types d'hypercorticisme organique: les syndromes de Cushing adrenocorticotropin hormone (ACTH)-dépendants, représentés par l'adénome hypophysaire sécrétant de l'ACTH et les syndromes paranéoplasiques sécrétant de l'ACTH et du corticotropin releasing factor (CRF), et les syndromes de Cushing ACTH-indépendants représentés par l'adénome surrénalien bénin et le corticosurrénalome malin. Les hypercorticismes organiques ACTH-dépendants sont souvent associés à une hyperplasie bilatérale des surrénales. Il a récemment été mis en évidence un syndrome de Cushing en relation avec la prise alimentaire. Ce syndrome de Cushing alimentaire est un hypercorticisme ACTH-indépendant et se présente comme une hyperplasie multinodulaire bilatérale et primitive des surrénales. Sa physiopathogénie est une sensibilité particulière des cellules corticosurrénaliennes au gastric inhibitory peptid (GIP) secondaire à une présence illicite des récepteurs au GIP sur la corticosurrénale. Elle se traduit par une augmentation postprandiale pathologique du cortisol qu'il faut désormais rechercher dans la démarche étiologique d'un syndrome de Cushing ACTH-indépendant.Diagnosis of Cushing's syndrome is quite difficult in endocrinology. Spontaneous Cushing's syndrome is usually divided into two subgroups, one which is dependent on corticotropin (ACTH) and another one which is not. In the first class are Cushing's disease, the ectopic corticotropin syndrome and the rare ectopic corticotropin-releasing hormone (CRH) syndrome; these ACTH-dependent Cushing's syndrome have usually diffusely enlarged adrenal glands. In the second class are cortisol producing unilateral adrenocortical adenomas or carcinomas, and the recent Cushing's syndrome with food dependent periodic hormonogenesis. This food dependent Cushing's syndrome is an ACTH-independent Cushing's syndrome with multinodular enlargement of both adrenal glands. Pathogenesis is an aberrant adrenal sensitivity to physiologic secretion of gastric inhibitory peptide (GIP). Ectopic expression of GIP receptors on adrenal cells involve pathologic food induced cortisol secretion. Food dependent Cushing's syndrome is a new cause of Cushing's syndrome. Food induced cortisol secretion may have tobe explored in the ACTH-independent Cushing's syndrome.

Les syndromes de masse rétropéritonéale peuvent représenter un piège diagnostique et certaines étiologies rares et trompeuses méritent d’être rappelées. Un homme de 41 ans était hospitalisé pour une masse pseudo tumorale du psoas droit, sans image de spondylodiscite. Alors que ce patient n’avait jamais voyagé en zone endémique, l’enquête étiologique permettait d’identifier Brucella melitensis au sein de la masse dont la biopsie avait mis en évidence la nature granulomateuse et abcédée. L’évolution était favorable sous traitement adapté : drainage percutané et bi-antibiothérapie (rifampicine et doxycycline). Cette observation souligne la persistance de brucellose autochtone alors même qu’une éradication proche est espérée en France. La quasi totalité des cas de brucellose rencontrés en France sont en effet importés. Les abcès mélitococciques du psoas compliquent volontiers une spondylodiscite, mais notre observation rappelle la possibilité de formes isolées pouvant alors faire craindre un processus tumoral expansif.Despite their rarity, some causes of retroperitoneal granulomatous tumor must be kept in mind. We report a 41-year-old man who presented with a right psoas mass. No spondylitis was associated. The patient had never travelled. He had never eaten foreign exotic fresh aliments. Serology and specific PCR were positive for brucellosis. The course was favorable after a percutaneous drainage and a combined antibiotic therapy (rifampin and doxycycline). Brucellosis is close to be eradicated in France. The large majority of new French cases result from accidental laboratory contamination or from a journey abroad. This case report highlights the possibility of excessively rare native brucellosis cases in France.

The activities of HIV-specific cytotoxic T lymphocytes (CTLs) were evaluated in 10 HIV-infected children, born to infected mothers who did not receive AZT during pregnancy. CTL activities were present as early as 4 months of age. The five children that progressed to AIDS before 1 year of age had reduced in vivo and in vitro CTL activities, when compared with children who remained AIDS free after 1 year of age. The latter children had weak in vivo activated CTL responses but strong memory CTLs. No relation was found between viral load, lymphocyte populations, and CTL responses between birth and 6 months of age. Between 7 and 12 months old, children with broader in vitro activated CTLs had higher absolute numbers of CD4+ and CD8+ T lymphocytes and lower plasma viral load. These data support a beneficial role of CTLs in pediatric HIV infection.