La Revue du praticien
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The favorable pneumonia outcome with antibiotics according to the recommendations is defined by improving clinical symptoms in 48-72 hours followed by their normalization within less than 10 days. This is different to stop progression of radiological abnormalities that can be delayed for 48-72 hours and moreover to radiological normalization which may require 4 to 8 weeks. ⋯ The non favorable outcome 5-6 days after two successive lines of antibiotic therapy may also result from a non infectious cause: immunologic, toxic or tumoral pneumonitis. Practitioner dilemna is not to worry too early (slow-resolving pneumonia with clinical cure in normal time but slow radiological resolution) or too late (non-resolving pneumonia with no clinical cure and persistence or radiological extension).
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La Revue du praticien · Oct 2011
[Risk of reactivation or exacerbation of an infectious disease during iatrogenic immunosuppression or immune reconstitution].
Drug induced immunosuppression increases the risk of infections, both occurring as reactivation of latent-infections and occurrence of recent opportunistic ones. Thus, a careful mandatory infection screening is needed before immunosuppressive drugs onset. In addition, immune reconstitution after immunosuppression cessation can be associated with acute worsening of the underlying infection leading to the immune reconstitution inflammatory syndrome that must be differenciated from infection recurrences, relapses or resistance to antiinfective agents.
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Pneumonia is a major cause of morbidity and mortality in France. Microbial epidemiology, profile of bacterial resistance and prognosis depend on the type of pneumonia (community acquired pneumonia [CAP], health-care associated pneumonia, hospital acquired pneumonia or ventilator associated bacterial pneumonia). ⋯ Comorbidities, risk factors or impairment of the host defence mechanisms changes the microbial classic epidemiology of CAP. Patients with health care-associated pneumonia have an increased risk of multidrug-resistant bacteria, initial inappropriate antimicrobial treatment, severity and mortality, due to a different microbial epidemiology from those of CAP.
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Statins, combined with life-style advices, have a key position in the prevention of cardiovascular diseases. By inhibiting HMG-CoA reductase enzyme, these medications reduce total and LDL cholesterol levels in a dose-dependent manner. They also exert various pleiotropic effects that may contribute to the cardiovascular protection. ⋯ Statins have proven their efficacy in numerous controlled randomized trials (recently pooled in meta-analyses), both in primary and secondary prevention, including various specific populations, among them patients with diabetes. Tolerance and safety profile is rather good even if muscular and hepatic adverse events may occur. The prescription of statins should target high-risk individuals and both therapeutic inertia and drug non-compliance should be avoided.