Syndrome d'immunodéficience acquise (AIDS) révélé par un herpes génital sévère. A propos de deux cas.

The authors present 2 cases of AIDS revealed by severe recurrent genital herpes simplex. The patients are 2 young, previously healthy, African women without histories of homosexuality or drug abuse. The first patient died after 5 months of follow-up (post mortem findings: viral bronchopneumonia with positive cultures for herpes and cytomegalovirus (CMV), viral colitis due to CMV). The second patient survived. She has been treated, during the last 11 months, for filariasis, buccal and vaginal candidiasis and cerebral toxoplasmosis.

LPS-binding protein and IL-6 Mark paradoxical tuberculosis immune reconstitution inflammatory syndrome in HIV patients

Background: Tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) remains a poorly understood complication in HIV-TB co-infected patients initiating antiretroviral therapy (ART). The role of the innate immune system in TB-IRIS is becoming increasingly apparent, however the potential involvement in TB-IRIS of a leaky gut and proteins that interfere with TLR stimulation by binding PAMPs has not been investigated before. Here we aimed to investigate the innate nature of the cytokine response in TB-IRIS and to identify novel potential biomarkers. Methods: From a large prospective cohort of HIV-TB co-infected patients receiving TB treatment, we compared 40 patients who developed TB-IRIS during the first month of ART with 40 patients matched for age, sex and baseline CD4 count who did not. We analyzed plasma levels of lipopolysaccharide (LPS)-binding protein (LBP), LPS, sCD14, endotoxin-core antibody, intestinal fatty acid-binding protein (I-FABP) and 18 pro-and anti-inflammatory cytokines before and during ART. Results: We observed lower baseline levels of IL-6 (p = 0.041), GCSF (p = 0.036) and LBP (p = 0.016) in TB-IRIS patients. At IRIS event, we detected higher levels of LBP, IL-1RA, IL-4, IL-6, IL-7, IL-8, G-CSF (p ≤ 0.032) and lower I-FABP levels (p = 0.013) compared to HIV-TB co-infected controls. Only IL-6 showed an independent effect in multivariate models containing significant cytokines from pre-ART (p = 0.039) and during TB-IRIS (p = 0.034). Conclusion: We report pre-ART IL-6 and LBP levels as well as IL-6, LBP and I-FABP levels during IRIS-event as potential biomarkers in TB-IRIS. Our results show no evidence of the possible contribution of a leaky gut to TB-IRIS and indicate that IL-6 holds a distinct role in the disturbed innate cytokine profile before and during TB-IRIS. Future clinical studies should investigate the importance and clinical relevance of these markers for the diagnosis and treatment of TB-IRIS. Copyright: © 2013 Goovaerts et al.

Antigen-specific interferon-gamma responses and innate cytokine balance in TB-IRIS.

Tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) remains a poorly understood complication in HIV-TB patients receiving antiretroviral therapy (ART). TB-IRIS could be associated with an exaggerated immune response to TB-antigens. We compared the recovery of IFNγ responses to recall and TB-antigens and explored in vitro innate cytokine production in TB-IRIS patients.

Clinical Spectrum, risk factors and outcome of immune reconstitution inflammatory syndrome in patients with tuberculosis-HIV coinfection.

info:eu-repo/semantics/published

Modulation of the complement system in monocytes contributes to tuberculosis-associated immune reconstitution inflammatory syndrome.

Tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is a common complication in HIV-TB co-infected patients receiving combined antiretroviral therapy (cART). This study investigated a putative contribution of monocytes to the development of TB-IRIS.

The role of monocytes in the development of Tuberculosis-associated Immune Reconstitution Inflammatory Syndrome

info:eu-repo/semantics/published

‘Close as a kiss’: Gyn/Affection in Margaret Atwood’s The Penelopiad

Margaret Atwood’s novella The Penelopiad (2005) seemingly celebrates Penelope’s agency in opposition to Homer’s myth in The Odyssey. However, the twelve murdered maids steal the book to suggest the possibility of what Janice Raymond calls gyn/affection, a female bonding based on the logic of emotion that, in Atwood’s revision, verges on Kristevan abjection, the sinister and the fantastic, and serves a cathartic effect not only in the maids but also in the reader. This essay aims to question the generally accepted empowerment of Atwood’s Penelope and celebrates the murdered maids as the locus of emotion, where marginal aspects of gender and class merge to weave a powerful metaphorical tapestry of popular and traditionally feminized literary genres that, in plunging into and embracing the semiotic realm, ultimately solidify into an eclectic but compact alternative tradition of women’s writing and myth-making.

Welles, Kozintsev, Kurosawa, Zeffirelli: Great Shakespeareans

A study of four major Shakespearean filmmakers

Learning fluid prescription skills: why is it so challenging?

IIt is well recognised that medical students and junior doctors find fluid prescription a challenging topic. This study was designed to gain a greater understanding of the experiences that medical students face related to learning about fluid prescribing. Methods: A qualitative approach, using focus groups, was employed in this research. Final-year medical students in academic year 2011-12 at Queen's University Belfast were invited to participate during their 'Assistantship' placement in March 2012. Discussions in focus groups, consisting of between six and eight students, were recorded and transcribed verbatim. The research team, consisting of three separate investigators, conducted thematic analysis independently. A final consensus regarding emerging themes was reached by discussion within the whole research team. Medical students and junior doctors find fluid prescription a challenging topic Results: Five prominent themes emerged: 'Teaching experience: a disruptive variation'; 'Curricular disconnections'; 'The driving test: Theory-practice transformation'; 'Role modelling: which standard to aspire to?'; and finally 'Reconciling the perceived risk'. Discussion: This re search provided insights into medical students' opinions of the teaching practices and learning experiences related to fluid prescribing. The learning of prescribing skills is complex andcontextual. In the development of such skills, medical students are often exposed to conflicting educational experiences that challenge the novicelearner in making judgements on best prescribing practice. This study adds to the body of evidence that fluid prescription is a difficult topic, and has generated a number of multifaceted and strategic recommendations to potentially improve fluid prescription teaching.

England's Citizenship Education Experiment - Active Citizenship or Service?

This chapter explores the history of active citizenship education in English schools in relation to the more established tradition of service learning in the US.

Role of Intersectoral Collaboration in Mental Health Policy Formulation And Service Delivery in Saint Lucia

RESUMO: Santa Lúcia pequena ilha de país em desenvolvimento com recursos limitados e é confrontada com uma série de desafios socioeconômicos que exigem soluções criativas e inovadoras. É comprovado que a combinação de recursos entre setores para estabelecer os determinantes social, econômico e ambiental da saúde são uma estratégia útil para melhorar a saúde da população, principalmente a sua saúde mental. Este estudo, o primeiro do seu tipo em Santa Lúcia, procurou examinar até que ponto a disponibilidade de uma política nacional de saúde mental levou a ação intersetorial para o fornecimento de serviços e promoção da saúde mental. Além disso, o estudo examinou o nível de colaboração intersetorial que existe entre as agências que prestam cuidados diretos e serviços de suporte para pessoas com doenças mentais e problemas sérios de saúde mental. O estudo também teve como objetivo identificar os fatores que promovem ou dificultam a colaboração intersectorial e gerar recomendações que possam ser aplicadas para países muito pequenos e com perfis socioeconômicos semelhantes. Os dados gerados a partir de três (3) fontes foram sintetizados para formar uma visão ampla das questões. Uma avaliação da política de saúde mental de 2007, uma avaliação que identifica até que ponto a ação intersetorial atualmente deixa a prestação de serviços de saúde mental e a administração de entrevistas semiestruturadas nas mãos de gestores do programa de diferentes agências em todos os setores. O estudo concluiu que, apesar da disponibilidade de uma política de saúde mental, que articula clara e explicitamente a colaboração intersetorial como área prioritária para ação, quase não existe no sistema de fornecimento atual do serviço. Os provedores de serviços em todos os setores reconhecem que há os benefícios da colaboração intersectorial e com entraves significativos em relação à colaboração intersetorial, que por sua vez, impede uma abordagem nacional para o planejamento e o fornecimento do serviço. A colaboração intersetorial não será possível se os próprios setores dependerem da abordagem direta do setor da saúde ou se a atmosfera geral for ofuscada pela estigmatização das doenças mentais.------------------------------------------------------------------------ABSTRACT: Saint Lucia a small island developing country with limited resources, is faced with a number of socio-economic challenges which require creative and innovative solutions to address. Combining resources across sectors to address the social, economic and environmental determinants of health has proven to be a useful strategy for improving population health in particular mental health. This study, the first of its kind for Saint Lucia sought to examine the extent to which the availability of a national mental health policy led to intersectoral action for mental health promotion and service delivery. In addition the study examined the level of intersectoral collaboration which actually exist between agencies which provide direct care and support services to people with mental illnesses and significant mental health problems. The study also aimed to identify the factors which promote or hinder intersectoral collaboration and generate recommendations which can be applied to extremely small countries with similar socio-economic profiles. Data generated from three (3) sources was synthesized to form a broad picture of the issues. An evaluation of the mental health policy of 2007, an assessment of the extent to which intersectoral action currently exist in mental health service delivery and the administration of semi-structured interviews with program managers from different agencies across sectors to identify implementation issues. The study concluded that despite the availability of a mental health policy which clearly and explicitly articulates intersectoral collaboration as a priority area for action, very little exists in the current service delivery system. Services providers across sectors acknowledge the benefits of intersectoral collaboration and that there are significant barriers to intersectoral collaboration, which in turn hinders a national approach to service planning and delivery. Intersectoral collaboration is not possible if sectors themselves are dependent on a top-down health sector driven and dominated approach, or if the general atmosphere is clouded by stigmatization of mental health illnesses.

[21 lettres autographes signées de Léon Halévy à Jacques Léopold Heugel, 1861?-1875]

1er juillet [1861] : Promet un article sur la distribution des récompenses des Salons et des Concours où il rappellera le nom et les oeuvres de Gustave Doré dont il a "le talent en grande estime" : "Le concours de sculpture a été très fort ; le nombre de médailles est trop restreint, et les Grands Prix de Rome toujours favorisés". Evoque aussi le nom de Charles Garnier : "Le "Sujet d'Opéra" de Garnier a obtenu la première médaille d'architecture. Décision tout exceptionnelle et très flatteuse car l'oeuvre ne faisait point partie, à proprement parler, de l'Exposition d'Architecture" (NLAS-212-1). - Février 1865 : Réclame un droit de réponse à un article de Blaze de Bury paru dans le "Ménestrel". La lettre contient également la réponse de Heugel datée du 3 février 1865 dans laquelle l'éditeur lui demande d'adoucir ses propos (NLAS-212-9). - 30 juillet 1866 : Echanges et négociations au sujet de la publication de "Tobie" de Fromental Halévy. Est vexé que l'éditeur ne voie pas dans cette parution une bonne affaire et rappelle qu'il a donné au "Ménestrel" "à titre purement gratuit" un travail important sur l'oeuvre de son frère, alors que tant d'autres collègues sont très bien payés pour fournir des notices sur des compositeurs auxquelles il reproche "un esprit de dénigrement à l'égard de [s]on cher frère". Tente de rendre justice à son frère : "Je ne puis cependant m'empêcher de remarquer, quand j'entre chez vous, qu'à côté des bustes ou portraits de Meyerbeer, de Rossini, d'Auber, qui décorent vos magasins, je ne vois pas une seule image du grand maître qui fut leur égal" (NLAS-212-11). - 2 août 1866 : Le remercie pour le témoignage personnel de ses sentiments à l'égard de son "cher et regretté frère" : "cette justice que vous lui avez toujours rendue me dédommage amplement des torts que peuvent avoir envers sa mémoire plusieurs écrivains qui ont coopéré avec moi au monument que vous élevez à la gloire de nos grands maîtres français et étrangers" (NLAS-212-12). - 25 avril 1867 : au sujet des droits d'auteur de "Tobie" (NLAS-212-16). - 7 mai 1873 : Se dit heureux que son article convienne au directeur du "Ménestrel". Évoque "Carmen" de Bizet : "Ludovic [Halévy] et Meilhac sont à l'oeuvre et achèvent un poème où l'ami Bizet aura toute occasion de déployer son talent" (NLAS-212-17). - 16 juin 1875 : Le remercie pour son article consacré à "[leur] cher et infortuné Bizet" : "Impossible de rendre un hommage plus complet et en meilleurs termes à une existence si courte et si bien remplie" (NLAS-212-19). - 22 juin 1875 : Au sujet d'un opéra inachevé de Bizet, "Le Cid" : "La seule personne qui pourrait vous donner des renseignements que vous désirez sur l'opéra laissé inachevé par Bizet [...] serait sa jeune et malheureuse veuve, ma pauvre nièce Geneviève, mais elle est dans un tel état de prostration, d'accablement et d'inconsolable affliction qu'il est encore impossible de l'interroger sur un sujet si douloureux pour elle et qui raviverait de si poignants souvenirs" (NLAS-212-20). - Contient aussi 2 LAS de sa belle-soeur Léonie Halévy au sujet de sa fondation "Le Pain à bon marché" (NLAS-212-22/23)

RECUEIL DES ŒUVRES POÉTIQUES de Jehan Molinet. Ms. in-fol. sur papier de 201 f., demi-rel. v. f, tr. r. (Rel. du XVIIIe siècle.)

Complainte (La) de Grece