Chickenpox: A highly infectious disease

All parents know. When a child has had chickenpox in the nursery or school, there are all "opportunities" for all his comrades "benefit". Extremely common in children, chickenpox is indeed very ... highly contagious.

Originally chickenpox, a disease most mundane of life, a virus of the family herpes viruses, herpes zoster virus. The same virus herpes zoster can remain dormant for years in the body and determine the occurrence of shingles in adults, generally older, who developed chickenpox in their younger years.

An incubation period of two weeks

   Chickenpox occurs most often in children 2 to 10 years, but it can also be seen in some adults who had previously escaped ^1. It is then readily worst home. The virus is transmitted by skin lesions that cause illness, or through saliva droplets ¹ and an estimated 600 000 to 700 000 people are infected each year in France by one ^4.

The incubation period of chickenpox is between 10 to 21 days, as a rule from 14 to 16 days, and infected children are highly contagious 48 hours before until 5 days after the onset of lesions ^2. But the problem is that many young patients have only very discrete lesions that go unnoticed, as they pass though indeed chickenpox!

Telemedicine service sleep apnea

In France, 500,000 people with sleep apnea are treated with a continuous positive airway pressure device (CPAP) to wear at night. Despite its effectiveness, the treatment of choice, very restrictive, is often not observed or abandoned during the first 6 months. Respir @ dom, a telemedicine project, aims to improve monitoring. Explanations.
This remote monitoring treatment of sleep apnea creates a link between the greatest doctor, home health provider and the patient, it makes player treatment.

Sleep apnea: poor adherence

  The sleep apnea affects 5-7% of the population. More than 500,000 people are treated with a continuous positive airway pressure device (CPAP), which sends pressurized air into the airway through a mask applied to the face. This treatment helps to lower cardiovascular risk and metabolic , increased risk in people with sleep apnea syndrome. "The mask must be worn at least 3 to 4 hours per night to ensure long-term effect on cardiovascular prevention in particular," said Dr. Sylvie Royant-Parola, President of the Network and project coordinator Morpheus Respir @ dom. However, "20 to 33% of patients discontinue treatment during the first 4 months and 20 to 50% have insufficient compliance," she informs. "It is not so easy to get used to wearing the mask mandatory every night," says the doctor. Social Security takes into account the duration of use for reimbursement.
In addition, in the current health care system, the health care provider at home that brings equipment home and maintains, was not aware of the technical problems (leaks, insufficient correction of apnea), or health and feelings of the patient between visits. These factors impede adherence. Hence the idea of ​​a telemedicine service which aims to increase the number of people who follow their treatment correctly. "Patients treated well from the start will not over-causing risk of cardiac complications or cerebrovascular accident (CVA) later, "said Dr Royant-Parola.

Sleep apnea: a proposed treatment monitoring through telemedicine

"Respir @ dom is a telemedicine service which involves the remote monitoring of patient treatment apneic" announcement Dr. Royant-Parola. Innovation? "All CPAP machines transmit data on a daily basis on a secure server in the Medical Record Medical Sleep (DMS) Network Morpheus via a GPRS system," said the specialist. These data are available by the doctor, home health provider and the patient. They are analyzed and automatically generate alerts in case of technical defects (malfunction, leakage, insufficient correction of apnea ...). "This allows for greater responsiveness and a more rapid physician and home health provider," said Dr. Royant-Parola. These alerts are sent first to the home health provider that will trigger an action to correct the problem. If it is necessary to modify the treatment, the doctor intervenes.
In parallel with this daily transmission, the patient can return data on its secure space in its DSM: clinical status, tolerance to treatment. "If the patient says he does not feel well, unmotivated, a warning is issued and the clinical health professional will be able to respond," said the physician coordinator of this project. He added: "It telemonitoring offers more personalized services to patients who also become involved in their treatment."

Respir @ dom, better inform the patient

With this project telemedicine, the patient is accompanied also better informed. "Respir @ dom, it is also a community platform supporting a forum moderated by a psychologist or a doctor," said Dr. Royant-Parola. The goal? "Create a dynamic support between patients to advance in the treatment of apnea and better manage their health." "We know the positive discourse of a patient is more convincing than the speech of a health professional," adds Dr. Royant-Parola. This site also informs people with apnea of ​​this disease, treatment, medical advances. There is also a serious game that can involve family and especially children. "With the various aspects of this project, we hope to less désappareillage, better adherence and, ultimately, less over-risk of stroke and heart attack , "says Dr. Royant-Parola.
Part telemonitoring program Respir @ dom is currently restricted to 200 patients included in the study of medico-economic evaluation which will end on 30 November 2013. This program will then be generalized. You can already find out about the site if you are concerned www.respiradom.fr (e).

Curative vaccine against AIDS tested on humans

On January 29, Public Assistance - Hospitals of Marseille (AP-HM) announced the start of clinical trials of a therapeutic vaccine against HIV. Embodying the work of Dr. Erwann Loret, these tests will be supervised by Dr. Isabelle Ravaux, Service of Infectious Diseases, Hospital of the Conception (AP-HM). It retails for around Doctissimo hopes this vaccine cure "Tat Oyi".

Doctissimo: What is the principle of the vaccine that you test?
Dr Isabelle Ravaux: It has been observed in people infected with HIV the presence of Tat protein produced by HIV. This protein is involved in the mechanisms of virus replication but also in extracellular "tricking" the immune system. It will firstly prevent killer cells to launch an attack HIV and secondly, it acts on B cells by reducing the production of antibodies against HIV.
Neutralizing Tat protein in an infected person, it hopes to restore his immunity and block the development of the disease. For this, we need to trigger the production of anti-Tat antibodies sufficient.

Doctissimo: How to successfully induce the immune response?
Dr Isabelle Ravaux: The choice of candidate is the brainchild of Erwann Loret, CNRS researcher. In a cohort of African patients who did not develop the disease (patients called HIV controllers ), in 1996 he discovered that the only abnormality was the virus called the Tat Oyi. In these patients, it was not functional and offered some protection to patients vis-à-vis HIV.
The idea of ​​using this protein "Tat Oty" as a vaccine candidate has naturally imposed. The same team has succeeded in synthesizing this protein. The vaccine "Tat Oty" demonstrated in experiments in vitro and in vivo animal (including macaques) good efficiency, the results of which have been published in leading scientific journals. The next step is testing in humans, for which we received the green light from the National Safety of Medicines (MSNA) January 24, 2013.

Doctissimo: How will unfold clinical trials for this vaccine?
Dr Isabelle Ravaux: Clinical trials will take place in clinical investigation center (CIC) plurithematic 9502 AP-HM. Our biomedical research protocol EVA TAT is divided into two phases.
In a first time, 48 patients treated with HAART with undetectable viral load will be divided into 4 groups. Three receive a dose Tat Oyi different for each group. The latter will receive a placebo. The vaccination consists of three intradermal injections one month apart (on the surface of the skin without penetrating the muscle tissue or vascular). Treatment should be stopped two months to assess the time during which the viral load remains undetectable in patients. Patient recruitment began in February 2013. These Phase I / IIa aim to validate the principle of such a vaccination (it lead to the production of anti-TAT?) Check the safety of these injections transdermal humans and validate the optimal dose, which induces better immune response. The results of this phase will be conducted in December 2013.
If successful (lengthening the time control statistically significant viral load without treatment), 80 patients will be recruited from January 2014 to phase IIb, which will demonstrate the effectiveness of the vaccine. Half of the patients receive the optimal dose of the vaccine and the other half a placebo. The results will be analyzed in March 2015 and should be published around June 2015.
All these tests are "double-blind", that is to say that neither the prescriber nor the patient knows whether the used syringe containing vaccine or placebo (this is the method to ensure results tests by removing the psychological effects of the injection).

Doctissimo: What are the benefits for this therapeutic vaccine?
Dr Isabelle Ravaux: The first potential benefit of this vaccine would be to replace the triple therapy is not without side effects ... or at least be able to do without for a while.
You know you will have difficulty disposing of new classes of antiretroviral drugs in 20 years - it improves the comfort of taking the treatment, reducing the number of tablets including, but laboratories are investing less in AIDS research. It is therefore important to find new strategies to defeat HIV can develop resistance to treatment.
Tomorrow, a combination vaccine could take over the triple and perhaps act on the virus reservoirs (those places where the virus is immune to existing treatments).

Doctissimo: After years of false hopes, vaccines (especially therapeutic vaccines) seem to know a new impetus. Why is this?
Dr Isabelle Ravaux: Therapeutic vaccines aim to stimulate or today "educate" the immune system to fight against HIV. Strategy is no longer targeting surface proteins of the virus, which we now know they are too changeable to induce an effective immune response. The recent encouraging results on therapeutic vaccines explore this route, as the only case of a patient known cure HIV . For this, we need to find the "trick" as held by the two types of HIV virus - HIV-1 and HIV-2 - the target that will not easily mutate. The objective is to obtain an effective immune response and durable. It is our hope with the Tat protein.

Doctissimo: How was funded research?
Dr Isabelle Ravaux: The phases of basic research has been funded by the National Research Agency against AIDS (ANRS). A research protocol was then filed with the agency, which was not accepted as a priority.
To fund this research, it was therefore necessary to conduct a fundraiser, it is for this purpose that the biotechnology company BIOSANTECH was created. It is therefore of private funds but this research would not have been possible without the support of public actors: the University of Aix-Marseille and the CNRS have allowed Dr. Loret continue its research and Assistance Public - Hospitals of Marseille and the South East SATT allowing the conduct of clinical trials.
 

Self-medication

More than 7 out of 10 French admit to resorting to self-medication. With the passage of hundreds of medications at the counter pharmacists, this practice will she still increase? What are the conditions for the free access of medicines in pharmacies? ... Discover the applications and limitations of this practice.

The boom of self-medication

On 1 July 2008, the Minister of Health, Roselyne Bachelot reveals the list of drugs that pass the counter in pharmacies. Revolution or "small leap forward"? Doctissimo give you some answers.

Orthokeratology: lenses only at night!

You can do more than glasses and are not completely satisfied with your lenses? Surgery remains ... Or its alternative, yet very widespread in France but much more in Asia and the United States: Orthokeratology or corneal reshaping.
Technology, and reversible for people slightly nearsighted and / or astigmatic , is to wear lenses overnight to change the curvature of the cornea and have corrected for the next day. Is it really effective? What are the risks and cons-indications? Why do not we hear more about? Dr. Phat Eam Lim, surgeon-ophthalmologist, is one of the few specialists in France to be able to adapt this type of lenses.

How Orthokeratology?

  Orthokeratology uses semi-rigid lenses whose inner face has a particular form: "It forces the cells of the epithelium, the outermost layer of the cornea, to position where we want during their natural migration from the periphery to the center, "said Dr Lim. The periphery thickens, thins the center ... In the end, over 5.5 mm in diameter, the surface of the cornea is less curved. Deeper cell layers are not modified.
"There is no question to crush the cornea as we sometimes hear, says the specialist. During the day, the epithelial cells are renewed and returned to their original location where the reversibility of the correction. ' Seven hours of night wear, sometimes less, help maintain a visual acuity of 10/10 the next day or the next day for the weak corrections.
Having to wear their lenses while sleeping may seem surprising. For Dr. Lim is a plus: "The night hygiene are maximal. Moreover, orthokeratology lenses cover a small area and are very permeable to oxygen. The most important is sometimes allow the cornea to breathe. This is even better the day when it is free and tears easily remove dust and pollutants. "

Who can benefit from orthokeratology lenses?

Orthokeratology lenses to correct myopia and astigmatism-4D up to -2.5 D, both at the same time if necessary. "They offer a real alternative to surgery for all those who wish to be released from their glasses or contact lenses during the day but do not want or can not be made, particularly in the case of cons-indication or if the view is not stabilized (myopia development, presbyopia beginner ...), says Dr Lim. Sometimes they can also be used when ordinary lenses have been deprecated. Sportsmen and professionals working in water or dust are particularly interested. " The specialist team of firefighters, rugby players, swimmers, surfers ... and pelota players, many in their area of ​​practice.
Children and adolescents may also benefit from the technique. "There is no minimum age to wear contact lenses, said the doctor. However, the ideal is to wait until the child know how to respect hygiene precautions to put and remove the lenses only in general from 8-10 years. seems as orthokeratology allows to stabilize the myopia in children, an international study is underway to confirm this. "
Against the absolute contraindications are rare, they are mainly people with conditions affecting the surface of the cornea as corneal dystrophies, keratoconus (degeneration of the cornea) ... In case of insufficient tear or cornea already very flat, it is possible to test but the result is more random.

What are the risks and side effects of orthokeratology?

Night, unless you have to get up frequently for activities requiring a correct view (taking care of an infant for example), the lenses are rarely troublesome. However, they can move, which disrupts the vision of day or night halos induce in people with large pupils.
Fear, after years of use, is that the cornea deforms permanently. "After two years, we have shown that it does not move and, in countries that use the technique for more than fifteen years, there has been no particular problem, notes Dr Lim. Epithelium As only corneal undergoes changes and remain transient, we have every reason to believe that orthokeratology not induce complications. Nevertheless, it is true that we still lack long-term studies to ensure its total safety. '
As with any lens, especially the risk of infection. In the early 2000s, Chinese teams reported cases of corneal ulcers, particularly among children and adolescents. Specialists insist on hygiene for lenses but their cases and solutions to be renewed regularly. Parents should be particularly attentive to how proceed younger and consult at the slightest suspicious signs (redness, pain ...). Maladaptation can also irritate the cornea and increase the risk of infection.
"After ten or twenty years, it is possible that we will see some changes in the cornea, similar to those observed with ordinary lenses, but this has not been demonstrated," says Dr. Lim.

A method that is slow to develop

Orthokeratology has existed since the 1960s. Long, the technique was only available by opticians or other non-medical professionals. Ophthalmologists were particularly reserved especially as they did not yet know how to alter the cornea.
And measuring devices became more sophisticated. They can now offer lenses suited ensuring that they are well tolerated. Biocompatibility and permeability of the materials used in their manufacture have also increased. Orthokeratology, a time abandoned in favor of surgery is first returned to Asia and North America. In France, ophthalmologists are interested for only two or three years.
Dr. Lim attributed the delay in part to a conservative French: "The surgeons are ophthalmologists Orthokeratology quite logical since it reproduces transiently they get through the operation (keratectomy). However, lentils are not their specialty. ophthalmologists It is the contactologues-which, until recent years, were insensitive to the technique. "
According to Dr. Jean-Bernard Rottier, President of SNOF (National Union of ophthalmologists in France), there are fewer than twenty ophthalmologists able to adapt orthokeratology lenses, which makes the technique very accessible in practice. As Dr Lim, he observes, however, that there is growing interest in his fellow contactologues. The number of trained practitioners should increase rapidly. Remain in the list.
For their part, the labs are already mobilized. In France, in 2004, only provided Technolens orthokeratology lenses to European standards, Ortho-K. Today Precilens offers DreamLite and Menicon Z-Night. Research is underway to develop models that can also correct the farsightedness and presbyopia .

Diane 35: suspended in 3 months, unless

The National Security Agency of the drug (MSNA) has decided to initiate a suspension of marketing authorizations on the market (AMM) of Diane 35 and its generic, announced January 30, its director general Prof. Dominique Maraninchi. This will take full effect in three months, he said, to allow women time to find satisfactory therapeutic alternatives. But the European Commission may decide otherwise ...

In the sights of the MSNA before "case" of pills called ^3rd generation , Diane 35 would simply costs the review process of all medications prior to 2005 initiated by MSNA, ensures its director General. Hmm ... can still imagine that "the atmosphere of tension, health crisis," mentioned by Dominique Maraninchi itself is not foreign, even if he is forbidden. "We expected a decision in January," he said to the press.

Diane 35, an anti-acne essentially as prescribed pill

Diane 35 is an anti-acne marketed in France since 1987, but according to a survey of MSNA, it was prescribed "preferentially" as an oral contraceptive by gynecologists and general practitioners. Composition, combining estrogen (ethinyl estradiol) an inhibitor of testosterone, hangs in effect ovulation. However, "this drug is not approved as contraceptive treatment. This is not a good pill," insisted Professor Maraninchi. Not only the Bayer laboratory has never submitted an application for marketing authorization in this sense, but "data [he provided the MSNA] does not correspond to what is expected of contraception," he said the director general of the agency Doctissimo.
Except ... "The precautions in the RCP [summaries of product characteristics, ed] and MA are the same as those of a pill," recognizes the MSNA that evokes a "likelihood of confusion" patients . "The texts were ambiguous, they must be clear now."

Diane 35: scales unfavorable benefit / risk

The National Security Agency of the drug has initiated a reassessment of the benefit / risk balance of Diane 35 as anti-acne treatment. She questioned why the laboratory, reviewing the literature, consulting with experts ... Regarding its effectiveness, "Cochrane review shows that Diane 35 is superior to placebo beyond any doubt." But "analysis of cohort studies have shown that Diane 35 is associated with an increased risk of venous thromboembolic disease (risk multiplied by 4) compared to women not taking Diane 35," reported Dr. Maraninchi.
Moreover, "the national pharmacovigilance database shows that in 25 years, the side effects are mainly thromboembolic effects ( phlebitis , pulmonary embolism ), which were associated with 4 deaths, "but" it also shows that these adverse events are frequently associated with other risk factors "that only take Diane 35, said Dominique Maraninchi.

Suspension of Diane 35 and its generic three months

With these data, "the MSNA considers that the benefit / risk balance is unfavorable in the treatment of acne." And its CEO announced that "the MSNA decided to initiate a suspension of marketing authorizations for Diane 35 and all its generic." This will take effect in three months, so that patients find their doctor alternative therapies to treat their acne and those taking the drug as a contraceptive make the choice of another method of contraception. "Patients should not discontinue treatment immediately, they should expect to see their doctor in consultation with him to consider another treatment," Dominique Maraninchi recommended.
Doctors, meanwhile, "should no longer prescribe [Diane 35], neither initiation nor renewal." And it is advised pharmacists to prescribe a minimum to avoid any interruption of treatment. "At the end of 3 months, all prescription and delivery will be banned" and prizes will be withdrawn from the market.

The European Commission may decide to maintain the commercialization of Diane 35

Except that this decision purely French, will have little weight to that will face the European Medicines Agency (EMA). However, "a Community arbitration procedure was initiated by the MSNA," said Carole Le Saulnier, Director of Legal and Regulatory Affairs of MSNA. It is up to European health authorities to take a decision at the European level. Because to date, each country sells Diane 35 has a national marketing authorization, which can be highly variable from one Member State to another. The European Commission has 60 days to analysis and should give its opinion within two months and a half. It may decide to suspension or withdrawal of marketing authorization, or a harmonization of the SPC. "If the Commission requested a product reletting, France should comply with this European decision. Nevertheless, we would have authority to determine the conditions for prescribing and dispensing most likely to protect patients," said Carole Le Saulnier. Dominique Maraninchi and adds: "We'd definitely commercialization [Diane 35] in ultra-precise indications, under strict conditions and only in the treatment of acne."
Is there a risk that patients do massive postponement of other anti-acne, like Accutane generic *? "We will follow if there is a carry-over effect on other hazardous treatments," assured the Director General of MSNA. Meanwhile, as for the pills 3 ^rd and 4 ^th generations, it encourages women not to panic, not to immediately discontinue treatment and consult their doctor promptly. A discourse that becomes familiar to the ears of patients ...
Amélie Pelletier, January 2013
Source
Press Conference of MSNA, Wednesday, Jan. 30, 2013.
* In 2008, Accutane, an anti-acne treatment based isotretinoin was withdrawn from the market by the laboratory, but its generic ( Curacné , Procuta , Contracné or Isotretinoin Teva ) are always available. Many complaints have been filed in France and the United States against this drug, believed to be responsible for cases of depression and suicide.