B Acad Nat Med Paris
-
SUMMARYThe explosion of vaccines during the 20th century allowed the control of numerous infectious plagues but multiple challenges oppose conservation and extension of these successes. The hesitation of modern societies in front of vaccinations requires researches in life, human and social sciences in order to reach a better understanding of vaccines mechanism of action and to improve the tolerance and acceptability of vaccines and additives. ⋯ The recent difficulties faced by the development of vaccines against malaria, tuberculosis or AIDS illustrate the necessity of moving beyond classical recipes and of elaborating new vectors and new adjuvants, of better understanding the heterogeneity of vaccine immunity and of developing alternative routes of immunization. Multidisciplinary researches using the most recent advances in molecular, structural and cellular biology, in microbiology, immunology and of genetic engineering to answer these worldwide challenges.
-
B Acad Nat Med Paris · Nov 2016
[Diagnosis and treatment of emerging viral diseases : how can we do better ?]
Virus emergence episodes follow one another at a steady pace. The medical and scientific community responds to needs as and when they arise but finds difficult to propose a global strategy in the medium and long term. ⋯ This effort should also include sero-epidemiological studies aiming at obtaining a more accurate mapping of the circulation of potentially re-emerging pathogens. Regarding therapeutics (with the exception of vaccines which are addressed in another presentation), the expected improvements are the advance implementation of ready-to-use protocol frames for clinical trials and that of an ambitious strategy aiming at gradually covering the taxonomic spectrum of evolutionary virus groups infecting vertebrates.
-
B Acad Nat Med Paris · Mar 2016
Review[SPA therapy for pain of patients with chronic low back pain, knee osteo-arthritis and fibromyalgia].
The data of 33 randomized controlled trials suggest that chronic pain of patients with chronic low back pain, knee osteo-arthritis, fibromyalgia is significantly improved by balneotherapy and significantly better improved than by control treatments. For chronic low back pain (10 RCT, 1192 patients) pain was better improved in balneotherapy group and the weighted mean of the differential improvement was 19.66 (95 % CI: 16.6 ; 22.8) and the effect size was 1.1 (95 %CI: 0.82 ; 1.38) favouring balneotherapy. For knee osteo-arthritis pain (17 RCT, 1428 patients) pain was better improved in balneotherapy group and the weighted mean of the differential improvement was 13.24 (95 % CI: 5.52 ; 20.96) and the effect size was 0.72 (95 %CI: 0.51 ; 0.93) favouring balneotherapy. ⋯ Balneotherapy is a safe treatment as only 1 % of the patients receiving balneotherapy had to interrupt the treatment. However several methodological biases were observed in many trials, mainly a lack of statistical power due to a limited enrolment of patients, an insufficient duration of follow-up, an inhomogeneity of treatments. The clinical benefit has to be confirmed by stronger data of evidence but these data are sufficient to perform a more complete scientific analysis (meta-analysis) ; but further clinical investigations with a better methodological quality remain necessary.
-
B Acad Nat Med Paris · Mar 2016
Review[Plasmodium falciparum resistance to artemisinin-based combination therapies (ACTs): Fears of widespread drug resistance].
Malaria treatment with ACTs (Artemisinin-based Combination Therapies), combining a chemical derivative of artemisinin, and a partner drug has, for more than 15 years, produced a notable decrease in the mortality in tropical and subtropical areas. However, since 2008, a serious threat has emerged in western Cambodia, where the clinical efficacy of artemisinins has significantly declined, with a delayed parasite clearance rate and high recrudescence rates in the following weeks. ⋯ ACTs remain effective as long as the partner drug retains its activity but more and more clinical failures related to parasite resistance to both resistant parasites in sub-Saharan Africa, the continent most affected by malaria, as was the case in the past with other antimalarial treatments. It is therefore essential to better understand, from phenotypic and genotypic points of view, the mechanisms of resistance developed by the parasite Plasmodium falciparum face artemisinin and its derivatives in order to offer new therapeutic tools.
-
B Acad Nat Med Paris · Mar 2016
[Malaria is still a leading cause of fever and death among children and pregnant women in Africa in 2015].
The prevalence and morbidity of P. vivax, P. ovale (curisi et wallikeri) and P. malariae remain underestimated. However important progress has been made. According to the WHO World Malaria report between 2000 and 2015 the malaria incidence has decreased by 42% while the incidence of malaria deaths has decreased by 66%. ⋯ Innovative a robust approach is needed with strong government commitment and partners support to lead battle. A new hope is emerging with the development of candidate vaccine from whole sporozoïte, the other candidates vaccines blocking the transmission in phase 1b and the new SMC Plus strategy (AQ-SP+Azithromycine). Conclusion: lessons learnt from the malaria eradication era in the 50s must be factored in while developing the malaria elimination strategy for Africa by 2030.