Frédéric Lombard

Hepatitis C virus (HCV) genotypes in the Caribbean island of Martinique: evidence for a large radiation of HCV-2 and for a recent introduction from Europe of HCV-4.

ABSTRACT Molecular epidemiological studies of hepatitis C virus (HCV) in the Caribbean may help to specify the origin and spread of HCV infection. Indeed, the Caribbean population is intermixed from European and African origins and geographically close to the American continent. We characterized HCV genotypes in the Caribbean island of Martinique. HCV genotypes were analyzed by sequencing or reverse hybridization in the 5′ noncoding region (5′NC) in 250 HCV-monoinfected and 85 HCV-human immunodeficiency virus (HIV)-coinfected patients. In addition, sequencing in the nonstructural 5B (NS5B) gene was required to determine the subtype or to perform phylogenetic analysis in selected samples. Genotypes 1 to 6 were found, respectively, in 84.4, 6.8, 5.2, 2.8, 0.4, and 0.4% of 250 HCV-monoinfected patients and in 71.7, 7.1, 15.3, 5.9, 0, and 0% of 85 HCV-HIV-coinfected patients. HCV-1b was found in 66.4% of the HCV-monoinfected patients and was associated with blood transfusion, whereas HCV-1a was detected in 41.2% of the HCV-HIV-coinfected patients and was associated with intravenous drug use (IVDU). The HCV-3 strains belonged to subtype 3a and were linked to IVDU. Phylogenetic analyses were focused on HCV-2 and HCV-4, which are common in Africa. Two opposite patterns were evidenced. NS5B sequences from 19 HCV-2 isolates were affiliated with many different subtypes described either in Europe or in West Africa, suggesting an ancient radiation. In contrast, seven of the nine HCV-4 NS5B sequences ranged within HCV-4a and HCV-4d clusters spreading in continental France by the IVDU route. Epidemiological data demonstrate the recent introduction of HCV-4a and -4d subtypes into the Caribbean.

Téléassistance en hospitalisation à domicile: Le programme ViSaDom

OBJECTIVE The purpose of this project was to study the clinical feasibility of videophone-based communication between patients in their homes, and the care teams who work in the Home Hospitalization department (HH). METHODS This pilot study of videophone users compared them with a group of control patients also in HH. They came from either the adult, maternity or pediatric departments. Patients who met the inclusion criteria and consented to participate in the study were randomly assigned to one of two groups: those who had a videophone installed in their homes (telemedicine group), and those who received the standard HH care (control group). Sixteen patients in the telemedicine group were matched with 16 from the control group, according to age, Karnofsky Index score, and the reason for HH admission. RESULTS The mean videophone call lasted six minutes, and patients averaged 23 calls each over the study period (0.7 calls per patient per working day). The videophone enabled better follow-up of wounds: for example, the nurse could transmit photos from the patients home for real-time coordination. It was also useful for following patients suffering from pain, for technical nursing care, and for educating patients and their caregivers. Anxiety (measured with the Hospital Anxiety and Depression Scale) diminished during the study period for the telemedicine patients, compared with the control group (p=0.048). Within the telemedicine group, all patients and their families were very satisfied or satisfied with their care and with the communication (15/15), although the staffs level of satisfaction was slightly lower (14/16); there were no significant differences between groups. CONCLUSION The ViSaDom program indicates that videophone communication is feasible and acceptable and could be a useful tool for improving the quality, efficiency and effectiveness of care.Resume Objectif Evaluer la faisabilite clinique de la communication visiophonique, entre un malade a son domicile et les equipes soignantes d’un reseau d’Hospitalisation a domicile (HAD). Methodes Etude cas-temoins, concernant les secteurs adulte, maternite et pediatrie du reseau HAD. Apres accord de participation, les patients qui remplissaient les criteres d’inclusion ont ete tires au sort pour leur appartenance au groupe telemedecine (appareil de visiophonie au domicile) ou au groupe temoin (prise en charge habituelle en HAD). Le groupe telemedecine comportait 16 patients apparies a 16 autres qui constituaient le groupe temoin. Les criteres d’appariement etaient l’âge, l’indice de Karnofsky et l’objectif d’admission en HAD. Resultats La duree de communication visiophonique a ete en moyenne de 6 minutes. Le nombre moyen d’appels a ete de 23 par patient, soit 0,7 appels par jour ouvrable. La visiophonie a permis une coordination en temps reel et un meilleur suivi des plaies avec prise de photos. C’etait un apport pour le suivi de patients douloureux, les soins techniques infirmiers, l’education du patient ou de son entourage. Le score d’anxiete a l’echelle HAD ( Hospital Anxiety Depression scale ) a diminue significativement au cours de la prise en charge des patients du groupe telemedecine contrairement a ceux du groupe temoin (p = 0,048). Dans le groupe telemedecine, tous les patients et leur entourage ont ete tres satisfaits ou satisfaits de la prise en charge et de la communication (15 cas sur 15), alors que 88 % des soignants le sont (14 cas sur 16), sans difference significative avec le groupe temoin. Conclusion Le programme ViSaDom a confirme la faisabilite et l’acceptabilite de la communication visiophonique. C’est un outil prometteur pour la qualite et l’efficacite des soins en HAD.

Dengue fever in patients under biologics

Dengue fever (DF) is an epidemic viral mosquito-borne infection limited to tropical and subtropical countries. Biological therapies have been frequently used for the last 15 years in the treatment of inflammatory rheumatic conditions like rheumatoid arthritis. However, no data is available regarding the characteristics of this infection in patients on biological therapy. Yet, numerous patients on biotherapy have holidays in countries where DF exists. Moreover, the mosquitoes Aedes albopictus, vector of this viral disease, is now found in some developed countries such as southern Europe and the USA, allowing the possibility of a DF outbreak. We conducted a survey of individuals on biotherapy and described a case series of the patients experiencing DF. Our 8 patients on biotherapy (anti-TNF, n=6; rituximab, n=2) for a rheumatic condition did not experience severe DF.