Patients with HIV and hepatitis C virus (HCV) coinfection have more severe hepatitis-related disease than do patients with HCV infection alone. Highly active antiretroviral therapy (HAART) with protease inhibitor appears to restore pathogen-specific immune responses, especially in patients with persistent undetectable HIV viral load. To evaluate the potent impact of immune restoration induced by HAART on the course of HCVrelated disease, HCV viremia and levels of transaminases were compared between two groups of patients: 10 HIV/HCV-coinfected patients with persistently undetectable HIV viremia (group A) and 12 HIV/HCV-coinfected patients with persistent detectable HIV viremia. No difference was detected in HCV viral load in either group. An increase in transaminases was found only in patients with persistent undetectable HIV viral load, which was correlated with the increase in CD8+ T cells. This may suggest that the restoration of CD8+ T cell cytotoxicity could lead to an enhancement of hepatitis C-related disease in HCV/HIV-coinfected patients receiving HAART.

OBJECTIVES Perform a retrospective analysis of care in a hospital "isolation unit" for patients infected with multirestant bacteria (MRB), i.e. meticillin-resistant staphylococcus aureus (SAMR), broad spectrum beta-lactamase secreting enterobacteria. (BLSE). PATIENTS AND METHODS Forty-nine patients infected with MRB were cared for in our hospital isolation unit between January 1, 1996 and January 1, 1997. Each patient was in a separate room equipped with a sink and soap distributor, single-use towels, and individual material for patient care (stethoscope, mobile equipment, writing material, etc.). The personnel were given special training in the prevention of nosocomial infections. At admission, and in all patients, bacteriological samples to search for SAMR were acquired from nasal discharge, urine, perineal swabs, wounds and bed sores. Wound, urine and fecal samples were also taken to search for BLSE. Search for other sites of infection depended on the clinical situation. The management protocol in the isolation unit included: isolation, daily antiseptic baths, topical application of antibiotics or antiseptics on all bacteriologically proven sites of SAMR infection, selective decontamination of the digestive tract for patients with BLSE positive stools. Systemic antibiotics were given case by case. RESULTS Mean duration of stay in the isolation unit was 17 days for SAMR infections and 14 days for BLSE infections. Mean delay to sterilization of the infected sites varied depending on the localization: 2.3 days for blood and 19.4 days for stools. Seven patients died. After leaving the isolation unit, the bacteriological course was followed in 23 patients: there were 7 cases of recurrence at least one site within a mean delay of 34.5 days. CONCLUSION Use of isolation units provides an interesting solution for health care centers to control spread of multiresistant bacteria. Considering the endemic state of multiresistant bacteria infections in French hospitals, each health care unit should have correctly equipped facilities for isolating infected patients.

Hemolysis is a rare complication of cytomegalovirus infection in the immunocompetent adult, and the mechanisms responsible for it remain obscure. Guidelines for treatment have yet to be established, and the effectiveness of antiviral therapy has not been proven. In this report, an unusual case of primary cytomegalovirus infection manifested by severe hemolysis in an immunocompetent adult is presented. Treatment with ganciclovir (5 mg/kg b.i.d.) for 10 days and prednisolone (2 mg/kg/day) for more than 3 months suggests that both virological and immunological mechanisms are probably responsible for the hemolysis.

The objective of this study was to evaluate the impact of the interaction between body dissatisfaction and gender on eating disorders (restrained eating, binge eating, orthorexia nervosa, and emotional eating) among a sample of Lebanese adults.This cross-sectional study, conducted between January and May 2018, enrolled 811 participants selected randomly from all Lebanese Mohafazat. The mean age of the participants was 27.6 ± 11.8 years. The majority were females (66.5%), had a high level of education (73.2%), and low income (77.9%). This study used the following scales: body dissatisfaction subscale of the Eating Disorder Inventory-second version, binge eating scale, Dutch restrained eating scale, orthorexia nervosa scale (ORTHO-15 scale), emotional eating scale, perceived stress scale, Hamilton Anxiety Rating Scale, and Hamilton Depression Rating Scale.Body dissatisfaction was positively correlated to restrained eating (r = 0.293, P < 0.001), emotional eating (r = 0.073, P = 0.042) and binge eating (r = 0.250, P < 0.001). The interaction between body dissatisfaction and gender was significantly associated with more restrained eating (Beta = 0.01, P < 0.001) and orthorexia nervosa (Beta = −0.09, P < 0.001), but not with emotional (Beta = −0.43, P = 0.103) and binge eating (Beta = −0.08, P = 0.358). When stratifying the analysis by gender, the results revealed that higher body dissatisfaction was significantly associated with more restrained eating in both genders, but particularly among women. Body dissatisfaction was significantly associated with higher emotional eating in men only and with higher orthorexia nervosa tendencies and behaviors in females only.The interaction between body dissatisfaction and gender was significantly associated with orthorexia nervosa and restrained eating but not with binge or emotional eating. Higher body dissatisfaction was significantly associated with higher restrained eating, more pronounced in women, while it was significantly associated with higher orthorexia tendencies (lower ORTO-15 scores) in women only. Body dissatisfaction was associated with emotional eating in men only.L'objectif de cette étude était d'évaluer les différences dans l'association entre l'insatisfaction corporelle et les troubles alimentaires selon le sexe (restriction alimentaire, hyperphagie boulimique, orthorexie nerveuse et alimentation émotionnelle) dans un échantillon d'adultes libanais.Une étude transversale a été menée entre janvier et mai 2018 et a recruté 811 participants sélectionnés aléatoirement dans les régions libanaises. L'âge moyen des participants était de 27,6 ± 11,8 ans. La majorité étaient des femmes (66,5 %), avaient un niveau d'éducation élevé (73,2 %) et un faible revenu (77,9 %). Les échelles suivantes ont été utilisées: la sous-échelle d'insatisfaction corporelle de la deuxième version de l'inventaire des troubles de l'alimentation, l'échelle de consommation excessive, l'échelle de restriction alimentaire, l'échelle d'orthorexie, l'échelle d'alimentation émotionnelle, l'échelle de stress, l'échelle d'évaluation de l'anxiété et l'échelle d'évaluation de la dépression.L'insatisfaction corporelle était positivement corrélée à une alimentation restreinte (r = 0,293, p < 0,001), une alimentation émotionnelle (r = 0,073, p = 0,042) et à l'hyperphagie boulimique (r = 0,250, p < 0,001). L'interaction entre l'insatisfaction corporelle et le sexe était significativement associée à une alimentation plus restreinte (Beta = 0,01, p < 0,001) et à l'orthorexie (Beta = −0,09, p < 0,001), mais n'était pas associée à une alimentation émotionnelle (Beta = −0,43, p = 0,111) ni à l'hyperphagie boulimique (Beta = −0,08, p = 0,358). L'analyse stratifiée en fonction du sexe a montré qu'une insatisfaction corporelle plus élevée était significativement associée à une alimentation plus restreinte dans les deux sexes, particulièrement chez les femmes. L'insatisfaction corporelle était significativement associée à une alimentation émotionnelle plus élevée chez les hommes seulement, tandis qu'elle était associée de manière significative à plus de tendances et de comportements orthorexiques chez les femmes uniquement.L'interaction entre l'insatisfaction corporelle et le sexe était associée de manière significative à l'orthorexie nerveuse et à une alimentation restreinte, mais pas à une hyperphagie boulimique ou à une alimentation émotionnelle. L'analyse stratifiée par sexe a montré qu'une insatisfaction corporelle plus élevée était significativement associée à une alimentation plus restreinte, plus prononcée chez les femmes, alors qu'elle était significativement associée à des tendances à l'orthorexie plus élevées chez les femmes uniquement. L'insatisfaction corporelle était associée à l'alimentation émotionnelle chez les hommes uniquement.

BACKGROUND:Extrapulmonary localizations are observed in 20% of tuberculosis cases, mainly in immunosuppressed patients. Prognosis is poor in case of relatively uncommon cerebral localizations and miliary dissemination, especially if treatment is initiated in late stages. We report a case of disseminated tuberculosis associated with cerebral and pulmonary localizations in an immunocompetent patient. THe disease progressed despite adapted treatment. CASE REPORT:A young immunocompetent man with an uneventful history developed miliary tuberculosis with pulmonary localizations visualized on the computed tomography (CT) of the thorax. Brain CT was normal, but magnetic resonance imaging revealed several intracranial lesions. The disease course was marked by development of neurological symptoms and progression of the cerebral lesions after one month of treatment. No evidence of therapeutic failure (insufficient dosing, non-compliance, primary resistance) could be identified. DISCUSSION:Magnetic resonance imaging provides a more precise evaluation of tuberculosis lesions in the brain. Early antituberculosis therapy associated with corticosteroids can improve prognosis. Clinicians should be aware that cerebral lesions may continue to progress despite appropriate treatment, a course which is not satisfactorily explained by any current pathogenic hypothesis.

The authors reviewed the influencing factors of staff compliance with hand washing in various studies, so as to update policies on this practice necessary for the prevention of nosocomial infections. 38 studies were selected; despite the fact that it was not always easy to compare the results, some converging factors appeared. The level of compliance was most of the time inferior to 50 %, especially among physicians. The number of sinks available was important for compliance but motivation and assessment played a more important role. The impact of training was positive if the training itself was carried out on an active basis by analysising of mistakes and care given, and if it was supported by regular assessment together with a return of the data to the assessed departments. Knowing about the patient's infection status: generally improved compliance with hygiene, going against universal caution, still badly observed in most hospitals. Some points needed to be more thoroughly studied so as to evaluate the improvement of compliance with hydro-alcoholic solutions, to integrate hand washing in work; load studies, and to better define hand washing instructions according to the nature of contact and to the wearing of gloves. The studies illustrated the complexity and multifactorial character of hand washing. The staffs (especially physicians) motivation, must be stimulated by integrating it within the dynamics of care quality and ergonomy. The methods to be used still remain to be determined but it seems that traditional methods such as posters or theoretical lectures must be abandoned for more modern techniques of communication and assessment. The staff's representation of contagious diseases needs to be better assessed in order to obtain suitable and rational behaviors.

Cytomegalovirus (CMV) is the leading cause of viral congenital infections. In children, the consequences may be severe, especially in case of maternal primary infection during pregnancy. A prospective study was carried out in the department of Isère, in 1,018 pregnant women, in order to establish the seroprevalence of CMV, the frequency of primary infections during pregnancy and the associated risk factors. The overall seroprevalence was 51.5%; it increased significantly with age, parity, and low socioeconomic status. It was higher in women born in the South of France (51.6%) than in those born in the North (37.4%). Among a total of 878 women with serological follow-up, 7 primary infection cases (0.8%) were observed. Seventeen women (1.9%) presented border IgM values in the first serum, and these values were not related to recent infection. Extrapolation of the results to the whole department of Isère, suggests that each year about 100 pregnant women would be concerned by CMV primary infection, with 2 or 3 cases of death or severe sequelae in children. In light of these results, the interest of serological screening is discussed.

HIV infection accelerates natural course of HCV infection, but impact of antiretroviral treatment on HCV infection is not well known. The aim of this study is to compare the change of HCV viral load in patients on combination of 2 nucleoside analogues and in patients on combination of 2 nucleoside analogues and protease inhibitor. HCV and HIV viral load, lymphocyte CD4 counts, alanine aminotransferase (ALT) and aspartate amino transferase (AST) were measured before and 3 months after starting treatment in 2 groups: Group 1 (n = 15) treated with 2 nucleoside analogues and Group 2 (n = 15) treated with 2 nucleoside analogues and a protease inhibitor. Results show a significant increase in lymphocyte and a significant decrease in HIV viral load in the both group but no significant change in HCV viral load and in ALT and AST. In conclusion efficiency of anti-HIV therapy (combination of 2 nucleoside analogues with or without a protease inhibitor) doesn't seem to have any impact on the course of HCV viremia in HIV-coinfected patients.

Infection with Hepatitis C virus is a significant public health problem that has important clinical and financial consequences. Understanding of the epidemiology of HCV is needed to help define future therapeutic and preventive strategies. So far, the importance and characteristics of the epidemics have been best appreciated in specialist units dealing with liver disease. The purpose of our study was to survey the number and characteristics of hepatitis C antibody positive patients in Departments of Internal Medicine and Infectious Diseases. We conducted a multicentre national prospective analysis of all positive HCV-antibody patients, either inpatient or outpatient, reported over a period of one month across France. Two thousand and two cases were identified. Epidemiological, clinical and therapeutic characteristics are described. Risk factors were identified in 86%. For 10% of the patients, hepatitis C seropositivity was discovered during the period of survey. At the time of first diagnosis, 47% of patients presented with no clinical or biological abnormality. Coinfection with HIV was frequent (59%). Only 20.3% of the patients had received or were receiving a treatment with interferon. Within the limits of the methodology used, this study shows that Hepatitis C infection is a substantial clinical problem in French Departments of Internal Medicine and Infectious Diseases. Our findings may help the public health authorities in better appreciating the impact of hepatitis C and making policy decisions.

HIV infection accelerates natural course of HCV infection, but impact of antiretroviral treatment on HCV infection is not well known. The aim of this study is to compare the change of HCV viral load in patients on combination of 2 nucleoside analogues and in patients on combination of 2 nucleoside analogues and protease inhibitor. HCV and HIV viral load, lymphocyte CD4 counts, alanine aminotransferase (ALT) and aspartate amino transferase (AST) were measured before and 3 months after starting treatment in 2 groups: Group 1 (n = 15) treated with 2 nucleoside analogues and Group 2 (n = 15) treated with 2 nucleoside analogues and a protease inhibitor. Results show a significant increase in lymphocyte and a significant decrease in HIV viral load in the both group but no significant change in HCV viral load and in ALT and AST. In conclusion efficiency of anti-HIV therapy (combination of 2 nucleoside analogues with or without a protease inhibitor) doesn't seem to have any impact on the course of HCV viremia in HIV-coinfected patients.

In this study, we focus on the recognition and characterization of the different phases present in a (Zr,Sn)TiO4 ceramic (with some amounts of La2O3 and NiO as sintering aids). Our work deals with the study of segmentation techniques that automatically extract each of the phases (ZST, TiO2, La2/3TiO3,…) from a scanning electronic microscope image of a polished section of the ceramic. The main difficulty encountered at this stage of the work is that their properties in terms of gray levels are very close together, thus, imposing the combination of simple image processing operators (such as thresholding) with advanced methods based on region growing processes.