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Research paper thumbnail of Le diagnostic de la maladie d'Alzheimer en m�decineg�n�rale

Research paper thumbnail of La détection de la maladie d'Alzheimer par le médecin généraliste : résultats d'une enquête préliminaire auprès des médecins du réseau Sentinelles

La Revue de Médecine Interne, 2004

Propos.-Le médecin généraliste joue un rôle fondamental dans l'initiation du processus diagnostiq... more Propos.-Le médecin généraliste joue un rôle fondamental dans l'initiation du processus diagnostique de la maladie d'Alzheimer. L'objectif de cette étude est de connaître les pratiques diagnostiques de la maladie en médecine générale. Méthode.-Enquête par voie postale auprès de 1176 médecins Sentinelles. Les questionnaire comprenait des questions (1) sur le nombre de nouveaux cas et de cas suivis ; (2) à propos du dernier patient et (3) sur l'opinion du généraliste concernant le diagnostic précoce. Résultats.-Le taux de réponse était de 43 %. Le médecin généraliste Sentinelle a rapporté avoir vu 1,5 nouveaux cas de maladie d'Alzheimer et en avoir suivi quatre en 2002. Les motifs de consultation les plus fréquents étaient : des troubles de mémoire seuls (84 %) ou accompagnés d'une perturbation de la vie quotidienne et de désorientation (43 %). Soixante-seize pour cent des Sentinelles utilisaient le Mini Mental State ; 91 % ont envoyé le patient en consultation spécialisée. Cinquante-quatre pour cent des médecins ont annoncé le diagnostic au patient ; 94 % à la famille. Vingt-six pour cent des médecins utilisaient systématiquement le manuel diagnostique DSM IV. Soixante dix-sept pour cent trouvaient le diagnostic précoce utile. Conclusion.-Les résultats, comparés aux données provenant d'enquêtes réalisées dans d'autres pays européens, montrent que le médecin généraliste français est favorable à un diagnostic précoce, malgré le fait que la maladie d'Alzheimer soit légèrement sous-détectée en médecine générale et, qu'il se trouve en bonne position par rapport à ses collègues européens concernant l'envoi en consultation spécialisée, le suivi des critères diagnostiques et l'annonce du diagnostic à la famille.

Research paper thumbnail of Le diagnostic de la maladie d'Alzheimer en médecinegénérale

La Revue de Médecine Interne, 2003

Research paper thumbnail of Author reply: sample size calculation using exact methods in diagnostic test studies

Journal of Clinical Epidemiology, 2007

Research paper thumbnail of Antibiotic-associated diarrhea and Clostridlum difficlle in the community

Research paper thumbnail of Antibiotic-associated diarrhoea and Clostridium difficile> in the community

Alimentary Pharmacology and Therapeutics, 2003

Background: Clostridium difficile is the main cause of nosocomial infectious diarrhoea and the ca... more Background: Clostridium difficile is the main cause of nosocomial infectious diarrhoea and the causative agent of antibiotic-associated colitis. The involvement of C. difficile infection in antibiotic-associated diarrhoea in the community is poorly documented. Methods: We studied prospectively 266 adult outpatients in the Paris (France) area who were prescribed a 5-10-day course of antimicrobial chemotherapy. Stools were screened for C. difficile before and 14 days after the start of treatment by standard culture, toxigenic culture and testing for the cytopathic effect of toxin B. Patients were requested to note daily stool frequency and consistency. Diarrhoea was defined as the passage of at least three loose stools per day. Results: Forty-six (17.5%) of the 262 assessable patients had diarrhoea during the study period. Diarrhoea was mild and self-limited in all patients, and lasted for only 1 day in 65.6% of cases. C. difficile was isolated before and after treatment from one patient, who did not develop diarrhoea. C. difficile was detected only on day 14 in 10 patients (3.8%). The isolate was toxin producing in seven patients. Four of these seven patients had mild self-limited diarrhoea. Toxin-producing C. difficile was isolated significantly more frequently from patients who had diarrhoea than from those who were diarrhoea free (8.7% vs. 1.4%, P ¼ 0.02). Conclusion: The acquisition of toxin-producing C. difficile appears to be frequent during antimicrobial chemotherapy in the community [estimated rate of 2700 (1150-5400) cases per 100 000 exposures to antibiotics]. However, C. difficile is not the main agent of mild antibiotic-associated diarrhoea in outpatients .

Research paper thumbnail of Association Analysis of Drug Metabolizing Enzyme Gene Polymorphisms in AIDS Patients with Cutaneous Reactions to Sulfonamides

Journal of Investigative Dermatology, 2005

Research paper thumbnail of Hepatitis C virus-Epstein-barr virus interaction in patients with AIDS

Journal of Medical Virology, 2002

Immortalization of B cells by Epstein-Barr virus (EBV) and their subsequent proliferation leads t... more Immortalization of B cells by Epstein-Barr virus (EBV) and their subsequent proliferation leads to B-cell non-Hodgkin's lymphoma in immunocompromised patients. The role of hepatitis C virus (HCV) in B-cell non-Hodgkin's lymphoma has recently been raised, and an interaction between HCV and EBV is supported by recent in vitro experiments. The aim of this study was to investigate in vivo interactions between HCV and EBV in patients with AIDS, i.e., patients exposed to the risk of EBV-related B-cell non-Hodgkin's lymphoma. A total of 135 patients were prospectively studied. Serological and molecular markers of HCV, EBV, and human immunodeficiency virus (HIV) infection were sought. All the patients harbored latent EBV infection, and 20% had detectable HCV RNA in serum. No significant relationship was found between HIV, HCV, and EBV viral load in peripheral blood mononuclear cells or plasma. There was no difference between anti-HCV-positive and-negative patients or between HCV RNA-positive and-negative patients with regard to the prevalence of EBV markers, especially EBV replication markers. The presence of EBV replication markers was not related to HCV RNA seropositivity or to HCV viral load. Five patients subsequently developed B-cell non-Hodgkin's lymphoma, none of whom had markers of EBV or HCV replication. These results argue against an in vivo interaction between HCV and EBV in patients with AIDS, and against a role of HCV infection in the occurrence of B-cell non-Hodgkin's lymphoma in these patients.

Research paper thumbnail of Sample size calculation should be performed for design accuracy in diagnostic test studies

Journal of Clinical Epidemiology, 2005

Guidelines for conducting studies and reading medical literature on diagnostic tests have been pu... more Guidelines for conducting studies and reading medical literature on diagnostic tests have been published: Requirements for the selection of cases and controls, and for ensuring a correct reference standard are now clarified. Our objective was to provide tables for sample size determination in this context. In the usual situation, where the prevalence Prev of the disease of interest is <0.50, one first determines the minimal number Ncases of cases required to ensure a given precision of the sensitivity estimate. Computations are based on the binomial distribution, for user-specified type I and type II error levels. The minimal number N(controls) of controls is then derived so as to allow for representativeness of the study population, according to Ncontrols=Ncases [(1-Prev)/Prev]. Tables give the values of Ncases corresponding to expected sensitivities from 0.60 to 0.99, acceptable lower 95% confidence limits from 0.50 to 0.98, and 5% probability of the estimated lower confidence limit being lower than the acceptable level. When designing diagnostic test studies, sample size calculations should be performed in order to guarantee the design accuracy.

Research paper thumbnail of Le diagnostic de la maladie d'Alzheimer en m�decineg�n�rale

Research paper thumbnail of La détection de la maladie d'Alzheimer par le médecin généraliste : résultats d'une enquête préliminaire auprès des médecins du réseau Sentinelles

La Revue de Médecine Interne, 2004

Propos.-Le médecin généraliste joue un rôle fondamental dans l'initiation du processus diagnostiq... more Propos.-Le médecin généraliste joue un rôle fondamental dans l'initiation du processus diagnostique de la maladie d'Alzheimer. L'objectif de cette étude est de connaître les pratiques diagnostiques de la maladie en médecine générale. Méthode.-Enquête par voie postale auprès de 1176 médecins Sentinelles. Les questionnaire comprenait des questions (1) sur le nombre de nouveaux cas et de cas suivis ; (2) à propos du dernier patient et (3) sur l'opinion du généraliste concernant le diagnostic précoce. Résultats.-Le taux de réponse était de 43 %. Le médecin généraliste Sentinelle a rapporté avoir vu 1,5 nouveaux cas de maladie d'Alzheimer et en avoir suivi quatre en 2002. Les motifs de consultation les plus fréquents étaient : des troubles de mémoire seuls (84 %) ou accompagnés d'une perturbation de la vie quotidienne et de désorientation (43 %). Soixante-seize pour cent des Sentinelles utilisaient le Mini Mental State ; 91 % ont envoyé le patient en consultation spécialisée. Cinquante-quatre pour cent des médecins ont annoncé le diagnostic au patient ; 94 % à la famille. Vingt-six pour cent des médecins utilisaient systématiquement le manuel diagnostique DSM IV. Soixante dix-sept pour cent trouvaient le diagnostic précoce utile. Conclusion.-Les résultats, comparés aux données provenant d'enquêtes réalisées dans d'autres pays européens, montrent que le médecin généraliste français est favorable à un diagnostic précoce, malgré le fait que la maladie d'Alzheimer soit légèrement sous-détectée en médecine générale et, qu'il se trouve en bonne position par rapport à ses collègues européens concernant l'envoi en consultation spécialisée, le suivi des critères diagnostiques et l'annonce du diagnostic à la famille.

Research paper thumbnail of Le diagnostic de la maladie d'Alzheimer en médecinegénérale

La Revue de Médecine Interne, 2003

Research paper thumbnail of Author reply: sample size calculation using exact methods in diagnostic test studies

Journal of Clinical Epidemiology, 2007

Research paper thumbnail of Antibiotic-associated diarrhea and Clostridlum difficlle in the community

Research paper thumbnail of Antibiotic-associated diarrhoea and Clostridium difficile> in the community

Alimentary Pharmacology and Therapeutics, 2003

Background: Clostridium difficile is the main cause of nosocomial infectious diarrhoea and the ca... more Background: Clostridium difficile is the main cause of nosocomial infectious diarrhoea and the causative agent of antibiotic-associated colitis. The involvement of C. difficile infection in antibiotic-associated diarrhoea in the community is poorly documented. Methods: We studied prospectively 266 adult outpatients in the Paris (France) area who were prescribed a 5-10-day course of antimicrobial chemotherapy. Stools were screened for C. difficile before and 14 days after the start of treatment by standard culture, toxigenic culture and testing for the cytopathic effect of toxin B. Patients were requested to note daily stool frequency and consistency. Diarrhoea was defined as the passage of at least three loose stools per day. Results: Forty-six (17.5%) of the 262 assessable patients had diarrhoea during the study period. Diarrhoea was mild and self-limited in all patients, and lasted for only 1 day in 65.6% of cases. C. difficile was isolated before and after treatment from one patient, who did not develop diarrhoea. C. difficile was detected only on day 14 in 10 patients (3.8%). The isolate was toxin producing in seven patients. Four of these seven patients had mild self-limited diarrhoea. Toxin-producing C. difficile was isolated significantly more frequently from patients who had diarrhoea than from those who were diarrhoea free (8.7% vs. 1.4%, P ¼ 0.02). Conclusion: The acquisition of toxin-producing C. difficile appears to be frequent during antimicrobial chemotherapy in the community [estimated rate of 2700 (1150-5400) cases per 100 000 exposures to antibiotics]. However, C. difficile is not the main agent of mild antibiotic-associated diarrhoea in outpatients .

Research paper thumbnail of Association Analysis of Drug Metabolizing Enzyme Gene Polymorphisms in AIDS Patients with Cutaneous Reactions to Sulfonamides

Journal of Investigative Dermatology, 2005

Research paper thumbnail of Hepatitis C virus-Epstein-barr virus interaction in patients with AIDS

Journal of Medical Virology, 2002

Immortalization of B cells by Epstein-Barr virus (EBV) and their subsequent proliferation leads t... more Immortalization of B cells by Epstein-Barr virus (EBV) and their subsequent proliferation leads to B-cell non-Hodgkin's lymphoma in immunocompromised patients. The role of hepatitis C virus (HCV) in B-cell non-Hodgkin's lymphoma has recently been raised, and an interaction between HCV and EBV is supported by recent in vitro experiments. The aim of this study was to investigate in vivo interactions between HCV and EBV in patients with AIDS, i.e., patients exposed to the risk of EBV-related B-cell non-Hodgkin's lymphoma. A total of 135 patients were prospectively studied. Serological and molecular markers of HCV, EBV, and human immunodeficiency virus (HIV) infection were sought. All the patients harbored latent EBV infection, and 20% had detectable HCV RNA in serum. No significant relationship was found between HIV, HCV, and EBV viral load in peripheral blood mononuclear cells or plasma. There was no difference between anti-HCV-positive and-negative patients or between HCV RNA-positive and-negative patients with regard to the prevalence of EBV markers, especially EBV replication markers. The presence of EBV replication markers was not related to HCV RNA seropositivity or to HCV viral load. Five patients subsequently developed B-cell non-Hodgkin's lymphoma, none of whom had markers of EBV or HCV replication. These results argue against an in vivo interaction between HCV and EBV in patients with AIDS, and against a role of HCV infection in the occurrence of B-cell non-Hodgkin's lymphoma in these patients.

Research paper thumbnail of Sample size calculation should be performed for design accuracy in diagnostic test studies

Journal of Clinical Epidemiology, 2005

Guidelines for conducting studies and reading medical literature on diagnostic tests have been pu... more Guidelines for conducting studies and reading medical literature on diagnostic tests have been published: Requirements for the selection of cases and controls, and for ensuring a correct reference standard are now clarified. Our objective was to provide tables for sample size determination in this context. In the usual situation, where the prevalence Prev of the disease of interest is <0.50, one first determines the minimal number Ncases of cases required to ensure a given precision of the sensitivity estimate. Computations are based on the binomial distribution, for user-specified type I and type II error levels. The minimal number N(controls) of controls is then derived so as to allow for representativeness of the study population, according to Ncontrols=Ncases [(1-Prev)/Prev]. Tables give the values of Ncases corresponding to expected sensitivities from 0.60 to 0.99, acceptable lower 95% confidence limits from 0.50 to 0.98, and 5% probability of the estimated lower confidence limit being lower than the acceptable level. When designing diagnostic test studies, sample size calculations should be performed in order to guarantee the design accuracy.