Presse Med
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Synercid', an antibiotic designed around the concept of molecular synergism, is composed of 70% dafopristin or spectrogramin A and 30% quinupristin or spectrogramin B. First, dafopristin binds to the ribosomal 50S unit changing the conformation of the ribosome. This increases the affinity of quinupristin that in turn binds to the bacterial ribosome. This double binding interrupts protein synthesis and blocks bacterial growth. ⋯ In vitro, Synercid is particularly active against Gram positive cocci, irrespective of the strain's resistance phenotype. It is notably active against meti-sensitive and meti-resistant S. aureus, S. pneumoniae, S. pyogenes and Enterococcus faecium. MECHANISMS OF RESISTANCE TO MACROLIDES/LINCOSAMIDES/STREPTOGRAMINS: The most frequently encountered mechanism is a modification of the ribosomal target. Two other mechanisms can also be operating: enzyme inactivation or efflux phenomenon. Another mechanism of resistance, LSA phenotype, remains poorly understood. Only a very small proportion of the patients are concerned by resistance (9 patients in a study enrolling 880 patients).
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CONTRACEPTION: As in women who do not have a heart transplant, contraception is never perfect, irrespective of the method, intrauterine device (risk of infection), estrogens, progestogens. PREGNANCY: Besides the general effects also observed in all pregnant women, pregnancy in the heart transplant recipient also carries the risk of cytomegalovirus infection and preeclampsia.
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Multicenter Study
[Diagnostic and therapeutic management of urinary infections. Survey in the medical services of the hospitals south of the Marseille Hospital Center].
The aim of this prospective study was to observe diagnostic and antibiotic prescribing practices in urinary tract infection disease (UTID) in comparison with available guidelines. ⋯ This survey points out the divergence between guidelines and real management of UTID in hospitals. Clinical practices should be revisited to be in agreement with guidelines. Drafting antibiotic prescription guides explaining UTID management would be helpful for training future physicians.
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A revolutionary technology has totally renovated the treatment of aneurysms of the abdominal aorta. Classical "dissection-graft" procedures require a wide abdominal incision with clamping and declamping times, and often major blood loss. Perioperative mortality varies from 3% to 7% depending on the team's experience and the presence of comorbidities. Complications occur in 30% of the patients; often benign they can be quite serious. As direct consequence of the development of peripheral stents, endoprostheses can now be introduced via the femoral route through a short inguinal incision. Operative trauma is considerably reduced, greatly shortening the recovery time. Mortality is low, of around 1%, and postoperative complications are much less frequent and much less severe. There is also a 3-fold reduction in the duration of the hospital stay. ⋯ Improved prosthetic design and durability is an important point. Randomized studies organized in France, as well as in England and Holland and the United States, are currently assessing the contribution of this new technique and its relative role compared with conventional surgery.