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The decision on the appropriate surgical technique for treating cholesteatoma in children raises a number of controversial questions, most because of personal convictions rather than because of established data. We attempted to determine which patients are at risk of residual cholesteatoma in order to propose the most rational therapeutic strategy. A retrospective study of 250 children with cholesteatoma or severe retraction underwent surgery between 1986 and 1992. During this period 69 cases of residual cholesteatoma were recorded during a second intervention. After a mean follow-up of 33 months after the final operation, the Kaplan-Meier plot shows a rate of 31% and 34% at 3 and 5 years respectively. The univariate and multivariate (Cox regression) analysis was performed to search for a correlation between residual cholesteatoma development and past history including type of process involved, peroperative findings and surgical technique. Three factors were closely and independently related (p0.003) to residual cholesteatoma: invasion of the posterior middle ear, presence of ossicular erosion after excision and presumption of incomplete ablation. Inversely, age, surgical history, extension and nature of the process involved as well as surgical technique had no effect on development of residual cholesteatoma. Only one comparable study has been published where only ossicular erosion was found to be significant on multivariate analysis. The presence of one or more of the three of the factors mentioned above should lead to a second intervention, perhaps after a short delay, whatever the initial technique (open or closed).

In France, the sentinel general practitioners of the French Communicable Diseases Network (FCDN) monitor the epidemiological surveillance of eight communicable diseases, including measles. For the last 10 years, this surveillance has shown a seasonality of the annual incidence of measles (with peaks in late spring) and a decrease in incidence since the last outbreaks in 1986 and 1987. This decrease, the increasing mean age of the cases and an increase in the percentage of appropriately vaccinated cases are due to the increasing vaccination coverage of children due to the national immunization programme was reinforced in 1989. However, with 75,000 cases in 1993, measles is far from being a rare disease in France; epidemiological surveillance and improved vaccination coverage are still necessary.

Objective To evaluate the long-term results and predictive factors of a good outcome with the use of a total ossicular replacement prosthesis in children. Design Retrospective case review. Setting Tertiary referral center. Patients The study included 114 children (116 ears). Interventions A total of 116 ears underwent total ossicular chain reconstruction with a titanium prosthesis. Cartilage was always used for tympanic membrane reconstruction. Main Outcome Measures Audiological results were evaluated according to the guidelines of the American Academy of Otolaryngology–Head and Neck Surgery. Predictive factors of audiological results were determined. Logistic regression and χ2 tests were used for statistical analysis. Results The mean age at surgery was 9.8 years. Ossiculoplasty was performed during second-look surgery in 91 ears (78.4%) and during another stage in 25 ears (21.6%). The first-stage procedure was always performed for cholesteatoma. Audiometric results were available for 116 ears at 1 year, for 89 ears (76.7%) at 2 years, and for 42 ears (36.2%) at 5 years. Closure of the average air-bone gap (ABG) to within 20 dB was achieved in 65 ears (56%) at 1 year. The mean (SD) preoperative and postoperative (at 1 year) ABGs were 41.0 (9.5) dB and 22.4 (12.6) dB, respectively. There were no cases of extrusion, but 17 luxations of the prosthesis were confirmed by computed tomography. Luxation occurred on average at 31.4 months. Only three 4000-Hz degradations of bone conduction were reported, with no dead ears. We examined 3 predictive factors of auditory results: preoperative ABG, footplate status, and postoperative otoscopic findings. Conclusions Total ossiculoplasty is a reliable technique in children. Long-term hearing outcomes are stable and satisfactory, but luxation can occur at any time. Preoperative ABG and footplate status are negative predictive factors of auditory results.

Background Food insecurity exists whenever the availability of nutritionally adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways is limited or uncertain. It is a multidimensional, dynamic phenomenon that exists even in industrialised countries. The aim of this work was to estimate its prevalence and some of its social determinants in the Paris metropolitan area (PMA). Methods We used data from the SIRS cohort, a longitudinal health and socio epidemiological, population based, and representative survey of the general population of the PMA. This cross sectional analysis was based on the 2010 data. Food insecurity was estimated using the US-HFSS and computed in a three categories variable: food secure, low food secure and very low food secure and in a dichotomous variable for logistic regressions (food insecurity: yes/no). Results In 2010 about 94% of the households living in Paris metropolitan area were food secure. The remaining households—6.3%, 95% CI=[3.9 to 2.7], that is, approximatively 500 000 individuals - had experienced food insecurity during the past year. Almost 2.5% of the household living in Paris metropolitan area were in very low food security. If income was a major determinant of food insecurity (FI), some household's characteristics were associated with FI: single parent's families (OR=2.79, p

Introduction The ageing of the European population raises questions concerning the growing incidence of chronic diseases. Improving population health status, by acting on one of its most important determinants, that is, nutrition, was the target of the PNNS (Nutrition Health National Program) launched in 2001 in France. This study aimed to examine the individual and territorial characteristics associated with the PNNS guideline to eat: « at least five fruits and vegetables every day » (R5FV). Methods The third wave of the SIRS cohort interviewed a representative sample of the general population of Paris metropolitan area (3084 adults) in 2009–2010 about its knowledge of the R5VF. Adherence to this guideline, and reasons for non-adherence, were questioned too. Regression models analysed factors associated with non-knowledge of the guideline. Results The vast majority of the population (98%) was familiar with the R5VF but only 50% adhered to it. Men (aOR=2.58), foreigners (aOR=5.53), people who had never worked (aOR=6.66), those who had only primary level education (aOR=3.47), those residing in underprivileged neighbourhoods (aOR=2.05) were more likely to ignore it. Among those who knew it, reasons declared for not adhering were: too complicated to manage (28%), too expensive (26%) and not desiring (17%). Conclusion This study outlined individual and territorial inequalities in the reception of PNNS nutritional messages related to consumption of 5 F&V a day. Consideration of individuals9 demographic, socioeconomic and residence characteristics can identify population groups that necessitate to be targeted in order that current nutritional know-how reaches all people, especially the disadvantaged.

Background The relationship of food insecurity with overweight and obesity is still discussed in the literature. This work aimed to explore if this apparently paradoxical association was observed in Paris metropolitan area. Methods We used data from the “Health, Inequality and Social Breakout” (SIRS) cohort, a longitudinal health and socio epidemiological, population based and representative survey of the general population of the Paris metropolitan area. This cross sectional analysis was based on the 2010 data. Participants9 BMI was estimated using self-reported height and weight and computed in a dichotomous variable (BMI Results Overweight (BMI ≥25) prevalence was 39.8%. In men, nationality was significantly associated with being overweight: a European citizen has a higher risk of being overweight than a French one- (OR=2.89; p=0.002). In women, socio professional group was a significant determinant of overweight, with a higher risk for workers9 (OR=5.37 p Conclusion Food insecurity seems to be a stronger determinant of overweight among women. It remains important to explore and understand the pathway through which this situation is associated with overweight, particularly in terms of nutritional problems and food assistance programs.

We report here the identification and characterization of a new leaf-specific light-stimulated gene induced during cold acclimation of wheat. Sequence analysis revealed that the gene encodes a protein of 19 kDa with a pI of 8.8. This is a novel protein with a particular charge distribution. The C-terminal half has a high propensity to form an alpha-helix and contains all the acidic amino acids with a net negative charge of -7. On the other hand, the N-terminal half is rich in proline, lysine and arginine with a net positive charge of +10. These properties are commonly found in several transcription factors. The protein is also rich in alanine (21%), is hydrophilic but not boiling soluble in contrast to other alanine-rich proteins. During low temperature exposure, the corresponding mRNA accumulates rapidly in the leaf and remains at a constant level in two tolerant cultivars used. However, in a less tolerant cultivar, the mRNA level declines despite maintaining the plants at 4 degrees C. Southern blot analysis indicates that the differential expression in the less tolerant genotype is not due to a different genomic organization or gene copy number. The mRNA was specifically localized in leaf tissues and increased several-fold during the greening at 4 degrees C. Furthermore, this gene is not induced in callus cultures acclimated in the absence or presence of light. This suggests that the full expression of this gene is dependent on organized leaf tissue. The expression of this gene was not affected by ABA, drought, heat shock, salinity, wounding or anaerobiosis, demonstrating that it is specifically induced by low temperature. The Wcs19 mRNA is preferentially expressed in tolerant Gramineae species.

To analyze otologic features in patients with primary ciliary dyskinesia (PCD) aged 0 to 18 years and to evaluate the correlation between ultrastructural defects and severity of otologic features.Retrospective study.Pediatric referral center.Fifty-eight patients with PCD were evaluated in the following 4 age intervals: group 1, preschool (≤ 5 years [n = 47]); group 2, school (6-11 years [n = 50]); group 3, teenagers (12-17 years [n = 34]); and group 4, young adults (≥ 18 years; 27 years for the oldest [n = 10]). Follow-up was 2 to 6 years in each age group; 26 patients had total follow-up of more than 12 years. Ultrastructural defects occurred in the outer dynein arm (n = 33), the inner dynein arm (n = 13), and the central complex (n = 11). One patient had typical Kartagener syndrome with typical PCD features but normal ciliary ultrastructure.Frequency of acute otitis media, otitis media with effusion, otorrhea, chronic otitis media, hearing loss, and middle ear surgery and type of antibiotic regimen according to age and type of defect.Recurrent acute otitis media decreased from group 1 (32 of 47 [68%]) to group 4 (0 of 10 [0%]) (P.001). Otitis media with effusion was more severe in groups 1 through 3 than in group 4 (P = .02). Otorrhea decreased in group 4: 30% vs 80% (3 of 10 vs 36 of 41) in the other groups (P.001). Half of the patients with tympanostomy tubes eventually had tympanic perforation. Hearing loss was moderate in groups 1 through 3 and mild in group 4. Continuous antibiotic therapy could be slightly reduced only in group 4. Central complex defect was a significant marker of severity for all these criteria.Despite continuous antibiotic therapy, the middle ear condition in PCD remained severe throughout childhood, with improvement only after age 18 years. Armstrong grommet placement did not improve the middle ear condition. Central complex defect is a marker of severity.

IntroductionSuicidal behavior in adolescence is now well documented with regard to biological and psychological traits, family-environmental factors, and clinical management. In despite of this knowledge, few interventions are based on family therapy.ObjectivesTo examine the association between suicide attempt in the adolescent population in Quebec and family constellation with regard to family structure and family functioning adjusted for socio-economic factors.MethodsData: Social and Health Survey of Children and Adolescents in Quebec State performed in 1999 (Institut de la Statistique du Québec, Canada). Subjects: 1186 adolescents aged 13 years and 1160 adolescents aged 16, and their parents. Outcome: suicide attempt during lifetime. Independant variables: family structure, witnessing interparental violence and parental emotional support. Covariates: family socioeconomic background and demographic variables.Statistics: logistic regression analysis.Results81 adolescents reported one suicide attempt or more during lifetime, with a significant risk for girls but this risk was independant of age and ethnicity. The adolescents had a 2.5-fold higher risk of suicide attempt when they live in monoparental household (OR=2.46; 95% CI=[1.37-4.42]), a 3.8-fold higher risk when they witnessed interparental violence (OR=3.76; 95% CI=[2.10-6.74], and a 2 to 6-fold higher risk when parental support is low, particularly paternal support. These associations are not modified by familial socioeconomic status.ConclusionsThese results are concordant with family stress perspective in the un derstanding of suicidal beahvior in adolescents, and this independently of familial socio-economic deprivation. They give arguments for family centered therapy in the panel of interventions in health promotion in adolescence.

The French sentinel network created in 1984 consists of general practitioners from the whole mainland, recruited on a voluntary basis. The members of the network follow up the weekly epidemiological surveillance of 10 health indicators (influenza-like

A number of fluoroquinolones have been shown to interact adversely with theophylline. We studied the influence of coadministration of temafloxacin, a new fluoroquinolone antimicrobial agent, on steady-state theophylline pharmacokinetics. Twelve healthy subjects (8 males, 4 females; average age and weight 34 years and 62 kg, respectively) were given oral controlled-release theophylline in an individualized dosage to achieve a target plasma level of 10 mg/L. Once steady state was achieved, temafloxacin 600 mg given orally twice daily was concomitantly administered for 4-5 days. Serial blood samples were collected before and during simultaneous temafloxacin administration and plasma assayed for theophylline using a high-performance liquid chromatography technique. Theophylline pharmacokinetic parameters were determined noncompartmentally, and results of single and combined administration were compared. Theophylline plasma concentrations did not differ significantly with temafloxacin coadministration, and similar area-under-the-curve (AUC) values were observed. Theophylline oral clearance increased from 2.67 +/- 1.01 L/hour to 2.69 +/- 0.93 L/hour, when given alone and with temafloxacin, respectively (p = 0.92). Only 2 of 12 subjects showed an appreciable decrease in clearance when theophylline and temafloxacin were administered together, while 2 subjects demonstrated increases greater than 15% and 8 showed no change. We conclude that temafloxacin does not interact significantly with theophylline and that these agents can be safely administered together.

uatre jours de vie. En cas de TIR depassant une valeur seuil, une recherche des rincipales mutations est effectuee. Sont alors convoques les enfants homozyotes, heterozygotes et ceux dont la TIR reste superieure au seuil de controle bien u’aucune mutation n’ait ete identifiee. Un test de la sueur (TS) permet alors de onfirmer ou non le diagnostic. Sont inclus dans l’etude les enfants avec un TS ormal, se revelant donc faux positifs. Les parents ont ete interroges trois mois pres l’annonce du resultat final, afin d’apprecier les eventuelles inquietudes eclenchees par la suspicion d’une maladie grave meme si le diagnostic a ete limine rapidement. L’interrogatoire a ete mene a domicile par un psychologue elon un questionnaire cree pour l’etude. esultats.– Au total, 86 enfants ont ete inclus : 62 heterozygotes et 24 hypertrypinemies persistantes (resultats presentes par groupe sans comparaison). Dans haque groupe, pres de 95 % des parents etaient inquiets ou tres inquiets lors de a realisation du TS et de l’attente des resultats. Trois mois plus tard, dans les eux groupes, respectivement 83,3 et 100,0 % declaraient etre totalement rassues (des le TS pour 74,5 et 73,3 %, plus tard pour les autres). En cas de maladie ntercurrente, respectivement 1,7 et 4,2 % des parents pensaient toujours a la ucoviscidose, 15,3 et 8,3 % parfois ou souvent, et 83,0 et 87,5 % jamais. onclusion.– L’impact psychologique d’un resultat faux positif de mucovisciose semble modere a trois mois. Ce resultat etant a verifier a plus long terme, ’evaluation sera reconduite a un et deux ans.

Cet ouvrage est le fruit de seminaires mensuels organises depuis 2002 par le reseau multidisciplinaire de recherche en sante publique " SIRS IdF " (Sante, inegalites et ruptures sociales en Ile de France). Ce reseau est coordonne par l'equipe de recherche sur les determinants sociaux de la sante et du recours aux soins de l'INSERM (U707). Ces seminaires ont permis de creer des dynamiques d'echange entre les differents acteurs concernes par une meme problematique, d'ouvrir des filieres d'information elargies et transversales, de presenter les resultats des recherches aux professionnels concernes ainsi qu'aux decideurs, et de faire remonter la demande sociale des acteurs de terrain (medecins, associatifs...) vers les chercheurs. Est exposee ici une selection des meilleures contributions a la premiere annee de ces seminaires, sous la forme de courts chapitres, specifiquement rediges pour cette publication. Des themes precis tels que la sante des personnes sans domicile, le recours aux soins des personnes infectees a VIH ou encore les violences conjugales et la souffrance particuliere des adolescents sont abordes sous divers points de vue. Sociologues, epidemiologistes, demographes et psychologues ont pu confronter leur points de vue avec celui de medecins, de representants associatifs ou de responsables de dispositifs de soins. Ces seminaires ont conduit, notamment, a un double constat. Il est apparu que les facteurs pejoratifs pour la sante ou le recours aux soins des personnes defavorisees renvoyaient souvent a la question de leur(s) insertion(s) sociale(s) actuelle (s) et de l'accumulation de ruptures sociales au cours de leur vie. Des lors, de tels determinants - s'ils sont particulierement etudies pour certaines personnes ou categories de populations vulnerables et s'ils sont, aussi, reperes par les professionnels de sante et les dispositifs assistanciels - doivent sans doute etre recherches plus largement et plus systematiquement dans l'ensemble de la population. De ce point de vue, il apparait fructueux d'integrer resolument deux approches de recherche souvent distinguees, si ce n'est concurrentielles, en sante publique : celle des " interrelations sante - precarite " et celle des " inegalites sociales de sante ". Cette distinction apparait peu legitime pour les chercheurs, sans pertinence pour les praticiens et, finalement, prejudiciable a l'etude approfondie des determinants sociaux de la sante dans leur sens le plus large. Au-dela des situations particulieres de certains groupes sociaux, l'ambition de cet ouvrage est ainsi d'interroger chercheurs et professionnels sur les implications et la portee des constats qui y sont relates pour l'ensemble de la population. Cet ouvrage s'adresse ainsi a tous les chercheurs, universitaires, professionnels de la sante et de l'action sociale, etudiants et decideurs qui s'interessent, specifiquement, aux situations sanitaires et aux soins des populations vulnerables mais aussi a ceux s'interessent plus largement a la thematique des determinants sociaux de la sante. Ils y trouveront de nombreuses contributions susceptibles d'enrichir leur connaissances sur ces questions.

Objectives To analyze the clinical features of hearing impairment and to search for correlations with the genotype in patients with DFNB1. Design Case series. Setting Collaborative study in referral centers, institutional practice. Patients A total of 256 hearing-impaired patients selected on the basis of the presence of biallelic mutations in GJB2 or the association of 1 GJB2 mutation with the GJB6 deletion ( GJB6 -D13S1830)del. Main Outcome Measures The prevalence of GJB2 mutations and the GJB6 deletion and audiometric phenotypes related to the most frequent genotypes. Results Twenty-nine different GJB2 mutations were identified. Allelic frequency of 35delG was 69%, and the other common mutations, 313del14, E47X, Q57X, and L90P, accounted for 2.6% to 2.9% of the variants. Concerning GJB6 , ( GJB6 -D13S1830)del accounted for 5% of all mutated alleles and was observed in 25 of 93 compound heterozygous patients. Three novel GJB2 mutations, 355del9, V95M, and 573delCA, were identified. Hearing impairment was frequently less severe in compound heterozygotes 35delG/L90P and 35delG/N206S than in 35delG homozygotes. Moderate or mild hearing impairment was more frequent in patients with 1 or 2 noninactivating mutations than in patients with 2 inactivating mutations. Of 93 patients, hearing loss was stable in 73, progressive in 21, and fluctuant in 2. Progressive hearing loss was more frequent in patients with 1 or 2 noninactivating mutations than in those with 2 inactivating mutations. In 49 families, hearing loss was compared between siblings with similar genotypes, and variability in terms of severity was found in 18 families (37%). Conclusion Genotype may affect deafness severity, but environmental and other genetic factors may also modulate the severity and evolution of GJB2-GJB6 deafness.

Background: Disseminated infection with Mycobacterium avium is common with late-stage acquired immunodeficiency syndrome (AIDS), and no antimicrobial agent has been found to be clearly effective. Methods: A multicenter open trial was conducted to assess the antimicrobial activity and clinical efficacy of clarithromycin—a new macrolide antibiotic—against disseminated M avium in 77 patients with late-stage AIDS. Blood cultures were taken at baseline and during treatment; side effects were also evaluated. Results: Mycobacterium avium was eradicated from blood cultures in 11 (63%) of 16 evaluable patients receiving daily doses or 500 or 1000 mg, (n=21) and in 45 of 46 (98%) of those receiving 1500 or 2000 mg (n=56). Eradication after 2 months was influenced by continuity of drug treatment; 36 of 42 patients with no relapse had received continuous treatment vs six of 14 patients whose drug treatment had been stopped for 7 days or longer. After 2 to 7 months of treatment, acquired resistance associated with relapse was observed. Drug side effects were elevated liver enzyme levels (26%) and impaired hearing (4%). Concomitant AIDS drugs had no favorable effect on outcome and may have worsened liver toxicity. Conclusions: Clarithromycin has bacteriologic efficacy against M avium infection in late-stage AIDS, although drug resistance eventually develops. Further studies are needed to investigate safe, effective concomitant drugs. (Arch Intern Med. 1993;153:368-372)

Neste artigo, apresentam-se diversas acepções do termo “Anticolonialismo” que levam em conta aspectos culturais situados espacialmente e vinculados a diferentes contextos históricos. A palavra diz muito sobre as diferentes mentalidades e aos modos como o conceito foi empregado ao longo dos tempos.

With the widespread dissemination of the Internet throughout the world of health, it would be relevant to report on current knowledge about health information search on the Internet from the consumers' standpoint.We conducted a bibliographical research over the past five years and distinguished between international and French studies.For a long time, the (mostly US) studies have been merely descriptive. The studies highlight that the factors associated with health searches on the Internet are similar to the factors underlying the digital divide. Consumer searches are deemed efficient although search skills are comparatively below standard. Attempts are underway to set up tools, circulate them widely, and ensure better quality information on the Internet. However, comprehension and literacy are still issues in some social groups. Regarding the impact on consumer health per se, a (positive) effect of the Internet seems to emerge but research should be continued.Many of the behaviors, uses or limits addressed in this paper pertain to any information search on the Internet but other problems or differences also occur in the specific area of health. Longitudinal investigations are needed, specifically to gain deeper insight into the impacts we have addressed, while rolling out a comprehensive approach to the temporal evolution of user practices and experiences. Specifically, the central issue is still to determine how (and for whom) the Internet alters information search behaviors and, in fine, to what extent this affects health behaviors and the recourse to healthcare.

From a series of 30 cases of immediate allergy to the latex of Hevea Brasiliensis, the authors recall the principal clinical aspects of these allergies, specially contact urticaria (during the use of surgical or cleaning gloves) and systemic anaphylactic accidents, essentially the anaphylactic shock during surgical procedures. They mention the diagnostic procedures; skin tests and measurement of specific IgE (RAST). They show the interest of biological research, yielding to the identification of the allergens of the latex in order to obtain non allergenic latex. Such a result would be of interest to limit the number of the accidents in a period where the use of rubber protective material is much larger/gloves and condoms).

Musica do parnaso was published in 1705 and it was reissued only in the twentieth century. This long period out of circulation seems to be related to a nationalist literature conception in the late eighteenth century, that was intensified during the Brazilian Romanticism and made the access to this book difficult to readers. In this article we propose to analyze a few Manuel Botelho de Oliveira’s poems, considering aspects related to the seventeenth-century’s poetic.

In France, the entire population theoretically has access to health coverage, but in fact a section of the poorest population does not. Institutions have therefore been set up to provide medical care for the destitute. The objectives of this study were to describe the social characteristics of the HIV-positive destitute population attending an out-patient clinic providing free health care for the destitute in a Paris University Hospital, to compare their clinical-epidemiological characteristics with those of non-destitute HIV-positive patients, and to evaluate the quality of their care. We performed a historical prospective study wherein a cohort of 115 HIV-positive destitute patients (defined as having no health coverage at their first consultation) was compared with a control cohort of 183 HIV-positive non-destitute patients attending the same clinic. Ninety-five per cent of the destitute patients had no stable employment, 32% had no source of income, 75% had no permanent residence and 27% were i.v. drug abusers. Fifty-nine per cent were foreigners, most of whom had legal residence papers and had been in France for more than 3 years. When comparing the control and the destitute groups, the latter had a three times greater risk of developing tuberculosis (RH = 3.2, CI 95% = [1.1-9.4]). Medical compliance, access to antiretroviral treatment and hospitalization were identical in both groups. No difference was observed in terms of occurrence of a new AIDS-related disease during follow-up when full-blown AIDS before entry, CD4 count at entry and transmission group were taken into account in multivariate analysis. From the moment that destitute patients attended this adapted medico-social facility, their access to care was the same as, if not better than, that of the other patients. The development of out-patient medico-social facilities for HIV-positive destitute patients must be a public health priority even for those countries theoretically providing generalized health coverage.

Measles vaccine has been available and widely used in the United States for 30 years. During the first 20 years, the incidence of measles dramatically decreased and the Department of Health hoped that the disease would be eradicated from the United States by 1982. Yet, as early as 1970, some American epidemiologists started to doubt whether it would be possible to attain this goal with a single dose schedule. From 1989, many outbreaks have occurred in some inner-cities. This resurgence shows that the existence of small non-immune population groups is sufficient for a persistent and epidemic transmission of the disease. New control measures were proposed, and evaluated, to increase the vaccination coverage of these populations and to prolong the immunity of adolescents vaccinated in their early childhood. With 30 years experience, the description of the modifications of the epidemiological characteristics of measles following mass vaccination is useful for countries which became involved in such programmes more recently.

Neste artigo propõe-se analisar a acepção de “Pictórico”, nos moldes como o termo foi entendido por manuais brasileiros de literatura publicados no século XX. O dado imagético não se restringe ao período chamado “Barroco”, tampouco define o movimento a que determinados autores foram atrelados. Na análise, recorre-se a manuais da Antiguidade greco-latina e da Era Moderna que defendiam a pintura e a literatura como artes análogas.

Background Tuberculosis remains one of the leading causes of morbidity and mortality in low-resource countries. One contagious patient can infect 10 to 20 contacts in these settings. Delays in diagnosing TB therefore contribute to the spread of the disease and sustain the epidemic. Objectives The aim of this study was to assess delays in diagnosing tuberculosis and the factors associated with these delays in the public hospitals in Moundou and Ndjamena, Chad. Methods A structured questionnaire was administered to 286 new tuberculosis patients to evaluate patient delay (time from the onset of symptoms to the first formal or informal care), health-care system delay (time from the first health care to tuberculosis treatment) and total delay (sum of the patient and system delays). Logistic regression was used to identify risk factors associated with long diagnostic delays (defined as greater than the median). Results and discussion The median [interquartile range] patient delay, system delay and total delay were 15 [7–30], 36 [19–65] and 57.5 [33–95] days, respectively. Low economic status (aOR [adjusted odds ratio] =2.38 [1.08-5.25]), not being referred to a health service (aOR = 1.75 [1.02- 3.02]) and a secondary level education (aOR = 0.33 [0.12-0.92]) were associated with a long patient delay. Risk factors for a long system delay were a low level of education (aOR = 4.71 [1.34-16.51]) and the belief that traditional medicine and informal care can cure TB (aOR = 5.46 [2.37-12.60]). Conclusion Targeted strengthening of the health-care system, including improving patient access, addressing deficiencies in health-related human resources, and improving laboratory networks and linkages as well as community mobilization will make for better outcomes in tuberculosis diagnosis.

Background Guidelines for the use of antiretroviral agents for HIV-1 infection recommend combining at least three agents. The toxicity, cost, and complexity of such regimens warrant the search for other options. Methods MONARK is a prospective, open-label, randomized, 96-week trial comparing the safety and efficacy of lopinavir/ritonavir monotherapy with a standard lopinavir/ritonavir plus zidovudine and lamivudine regimen as an initial treatment regimen in HIV-infected patients with HIV-RNA levels less than 100,000 copies/ml. The primary endpoint was the proportion of patients with HIV-1-RNA levels below 400 copies/ml at week 24 and below 50 copies/ml at week 48. Results Eight-three and 53 patients were randomly assigned and exposed in the monotherapy and triple-drug groups, respectively. At week 48, by an intent-to-treat analysis, 53 of 83 patients (64%) in the monotherapy group and 40 of 53 patients (75%) in the triple-drug group achieved the primary endpoint (P = 0.19). The on-treatment analysis indicates that 80 and 95% of patients reached the primary endpoint in the monotherapy and triple-drug groups, respectively (P = 0.02). In the monotherapy arm, protease inhibitor-associated resistance mutations were seen in three of the 21 patients qualifying for genotypic resistance testing, with a modest impact on lopinavir susceptibility. None of the serious reported adverse events were considered to be related to study treatment. Conclusion Our results suggest that lopinavir/ritonavir monotherapy demonstrates lower rates of virological suppression when compared with lopinavir/ritonavir triple therapy and therefore should not be considered as a preferred treatment option for widespread use in antiretroviral-naive patients.

The seeds and roots of Heliotropium lasocarpium, contain a pyrrolizidine alkaloid which causes toxic liver injury and veno-occlusive disease (VOD), characterised by an occlusive lesion of the centrolobular veins of the liver, when consumed by humans. The Farkhar region of Southern Tadjikistan, was blockaded from May to November 1992. This led to a famine and a delay of two months in the wheat harvest. Heliotropium lasocarpium had time to grow in the fields and their seeds were therefore collected with the wheat. The contaminated wheat was distributed to the population, who milled it and made bread. The first case of liver toxicity was six weeks after the first consumption of the contaminated bread. By March 1993, 3,906 cases had been recorded (attack rate = 4%). The attack rate were 0.4%, 5.4%, 4.0%, 2.8% and 1.5% for the less than 1 year, 1-14 years, 15-30 years, 31-50 years and over 50 years age groups respectively. The overall case fatality ratio (CFR) was 1.3% and increased with age from 0 to 5.9% in the same age groups. Two of the ten collective farms represented 83.3% of the cases attack rate of 16.9% and 23.6%. Four stages of illness were defined. Stage I corresponds to abdominal pain, nausea or vomiting, and asthenia. All stage I patients (55.5%) recovered rapidly. Stage II is an association of Stage I and hepatomegalia (29.9%). Stage III includes ascites in addition to these symptoms (13.7%) and stage IV alteration of consciousness (0.9%). The last case was reported on March 4th 1993.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute bronchitis and chronic obstructive pulmonary disease exacerbations are frequent reasons for consultation with a general practitioner (GP). Since no consensus exists about the use of antibiotics in such indications and little is known about the use of pulmonary function tests in general practice, our objective was to describe GP's attitudes and prescription habits when faced with patients suffering from acute bronchitis (AB) or chronic bronchitis (CB) exacerbation.The GPs participating in public health surveillance through the "réseau Sentinelles" (French Communicable Diseases Network) in March 1993 answered a postal questionnaire. This questionnaire collected their clinical attitude and prescriptions for 7 clinical cases of varying severity.430 (94.7%) of the GPs answered the questionnaire. Of these more than 95% prescribed antibiotics in all the clinical cases, including for common acute bronchitis. Wide spectrum penicillins and macrolides were prescribed significantly less often as the past history increased in severity, whereas tetracyclins and oral cephalosporins were prescribed significantly more often in severe cases. Fluoroquinolones were nearly exclusively reserved for the treatment of advanced CB. Smoking cessation was systematically advised by the GPs. Faced with AB and a smoking history, 44.2% of the GPs prescribed a chest x-ray. In the case of repeat episodes of winter bronchitis, more than 70% of them evoked the diagnosis of CB. 98.% of the GPs had easy access to pulmonary function tests (PFTs) which 69.2% of the GPs prescribed as soon as CB was suspected.In the absence of a therapeutical consensus regarding bronchitis, antibiotics were prescribed virtually systematically. PFTs were not yet a routine gesture in general practice even though they were widely available and prescribed.