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Most of the published works so far have aimed at finding genes associated with multiple sclerosis (MS) susceptibility. Very few studies have attempted to correlate disease features with DNA variants. In a well-characterized sample (651 patients) representative of multiple sclerosis natural history, we engaged a comprehensive study of the role of human leukocyte antigen (HLA) in the course of the disease. We investigated the role of HLA-DRB1*15 allele in samples stratified according to severity evaluated by the Multiple Sclerosis Severity Score (MSSS), time to reach EDSS 6.0 and disease type. We found that HLA-DRB1*15 genotype does not influence MS severity even among patients presenting with a given type of the disease. However, we show for the first time that HLA-DRB1*15 allele modulates the course of MS for relapsing–remitting (RR) onset patients likely by precipitating the secondary progressive (SP) phase.Genes and Immunity (2008) 9, 570–574; doi:10.1038/gene.2008.52; published online 10 July 2008 [ABSTRACT FROM AUTHOR]

We prospectively evaluated serum procalcitonin concentrations in patients who presented to an emergency department (ED) with suspected infectious or inflammatory disease. Of 195 study patients, 68 had final diagnosis of systemic infection, and 24 of those 68 had elevated serum procalcitonin levels (0.5 ng/mL). The procalcitonin level had a sensitivity of 0.35 and specificity of 0.99 for the diagnosis of systemic infection. In multivariate analysis, the procalcitonin level was the only independent variable associated with this diagnosis; in contrast, the C-reactive protein level was not. All patients with systemic infections who ultimately died had procalcitonin levels of 1 0.5 ng/mL at admission. Procalcitonin levels were significantly higher in patients who ultimately died of systemic infection than in patients who survived. The optimal procalcitonin threshold for the ED population may be lower than that proposed for critically ill patients. Determination of the procalcitonin level may be useful for screening and prognosis of more-severely ill ED patients. [ABSTRACT FROM AUTHOR]

Background: Malaria antibody detection is a valuable tool in the prevention of transfusion-transmitted malaria in countries with a high proportion of donors with travel exposure to malaria. The immunofluorescent antibody test (IFAT) is still the reference method, but it is not suitable for screening of blood donors. ELISA would be an interesting alternative to the IFAT, but it lacks sensitivity.Study Design and Methods: To evaluate the potential value of a combined screening strategy based on malaria antigen and antibody detection, plasma samples from 203 patients infected with Plasmodium falciparum were tested with an ELISA for the detection of malaria antibodies (Malaria IgG CELISA, Cellabs) and a P. falciparum histidine-rich protein-2 kit (Malaria P.f., ICT Diagnostics) for the detection of malaria antigens.Results: Among patients with positive IFAT results, CELISA had a sensitivity of 71 percent, whereas the combined screening tests (CELISA and Malaria P.f.) had a sensitivity of 88 percent (p < 0.001). Sequential samples from 50 patients were tested. The combined screening tests shortened the detection of seroconversion from 11.4 +/- 1.6 to 5.3 +/- 1.1 days (p < 0.001).Conclusion: Combined malaria antigen and antibody detection, with methods compatible with mass screening, may constitute an attractive alternative to the IFAT for blood donor screening. [ABSTRACT FROM AUTHOR]

Twenty five patients with peripheral neuropathy at different stages of human immunodeficiency virus (HIV) infection are reported. Cerebrospinal fluid (CSF) findings were available in 17 cases, electrophysiology in all and a neuromuscular biopsy in 11. Of six otherwise asymptomatic HIV+ patients, five had chronic inflammatory demyelinating polyneuropathy (CIDP) and one acute inflammatory demyelinating polyneuropathy (AIDP). CSF showed pleocytosis in all cases. Infiltration of the endoneurium and/or the epineurium by mononuclear cells was seen in biopsies from three cases. These six patients recovered either spontaneously, or with corticosteroids or plasmaphereses. Of five patients with AIDS related complex (ARC), three had distal predominantly sensory peripheral neuropathy (DSPN), one CIDP and one mixed neuropathy. Of 14 patients with AIDS, one had mononeuropathy multiplex and 13 painful DSPN. Electrophysiological studies were consistent with an axonopathy. Nerve biopsies in six cases showed axonal changes but surprisingly associated with marked segmental demyelination in two cases. Cell infiltration was present in nerve samples in two cases. Five patients died within six months after the onset of the neuropathy. [ABSTRACT FROM AUTHOR]

To measure the prevalence and intensity of pain in hospitalized patients and to assess the quality of pain management, an exhaustive cross-sectional study was conducted in every department in a university hospital. Patients hospitalized for 24 hours or more completed an anonymous self-report questionnaire. Among the 1,475 inpatients, 998 completed the questionnaire. During the 24-hour period prior to our survey, 55% experienced pain. On 100 mm pain intensity measures, the median maximum pain experienced in the 24 preceding hours was 60 mm and the median pain intensity at the time of the survey was 30 mm. Although pain measured at the time of survey disappeared in only 16% of patients, 79% were satisfied with pain management. Despite a high satisfaction level, the prevalence and intensity of pain were very high. This study provided baseline data on pain in a French hospital and led to the implementation of a program for improving pain management. [ABSTRACT FROM AUTHOR]

Introduction La polémique née au début des années 90 de l’observation d’atteintes neurologiques démyélinisantes telles que la sclérose en plaques chez des sujets vaccinés quelques semaines auparavant contre l’hépatite B a laissé des traces dans l’esprit du public comme dans celui du corps médical, bien qu’aucune des études épidémiologiques menées ensuite sur ce sujet n’ait mis en évidence l’existence d’un lien de causalité entre ces événements et le vaccin de l’hépatite B. De ce fait, beaucoup de médecins encore maintenant sont réticents à vacciner un patient atteint de sclérose en plaques quel que soit le vaccin à administrer, mais surtout lorsqu’il s’agit d’un vaccin vivant tel que celui de la fièvre jaune, redoutant de provoquer une poussée évolutive ou une aggravation de la maladie en stimulant le système immunitaire. Pour d’autres praticiens au contraire, le rapport bénéfice/risque est en faveur de la vaccination chez ces patients. Matériels et méthodes Afin de mieux connaître les facteurs pouvant influer sur les attitudes et les pratiques dans cette situation, une enquête par questionnaire électronique a été réalisée au centre médical de l’institut Pasteur selon la méthode Delphi auprès de médecins de centres de conseils aux voyageurs (CCV), de neurologues et d’infectiologues. Résultats Des deux tours de questionnaire effectués, il ressort que les experts dans leur majorité pensent qu’il est possible de vacciner un patient atteint de SEP avec un vaccin inerte quel qu’il soit ; la majorité pense également qu’un vaccin vivant atténué peut être administré à un patient atteint de SEP ne recevant pas de traitement immunosuppresseur ou n’en recevant plus depuis au moins 3 mois. Si le déplacement est prévu dans une zone d’endémie amarile, la plupart des experts sont d’accord pour vacciner ce voyageur contre la fièvre jaune s’il n’est pas sous traitement immunosuppresseur ; seule une minorité lui conseille de renoncer à son voyage et aucun d’entre eux ne préfère lui proposer un certificat de contre-indication au vaccin amaril. Conclusion Les experts ayant répondu aux questions posées dans cette enquête, s’accordent sur le fait que la sclérose en plaques ne constitue pas en soi une contre-indication aux vaccinations en général ; une personne atteinte de SEP doit pouvoir bénéficier des vaccins dont elle a besoin, sous réserve d’une bonne évaluation du rapport bénéfice/risque. [ABSTRACT FROM AUTHOR]