The definition of quality of life in solid organ transplantation: A psychological qualitative model

Quality of life has been extensively discussed in acute and chronic illnesses. However a dynamic model grounded in the experience of patients in the course of transplantation has not been to our knowledge developed. In a qualitative longitudinal study, patients awaiting solid organ transplantation participated in semi-structured interviews: Exploring topics pre-selected on previous research literature review. Creative interview was privileged, open to themes patients would like to discuss at the different steps of the transplantation process. A qualitative thematic and reflexive analysis was performed, and a model of the dimensions constitutive of quality of life from the perspective of the patients was elaborated. Quality of life is not a stable construct in a long lasting illness-course, but evolves with illness constraints, treatments and outcomes. Dimensions constitutive of quality of life are defined, each of them containing different sub-categories depending on the organ related illness co-morbidities and the stage of illness-course.

Hemodialysis for cefepime intoxication: A case report

Introduction: We report a case of cefepime intoxication with acute severe neurologic symptoms, which was treated by temporary hemodialysis. Patients (or Materials) and Methods: Cefepime 2 g BID for endovascular prosthesis infection was prescribed to a frail, chronically ill 88-year-old woman with a serum creatinine of 199 μmol/L and an estimated creatinine clearance of 13 mL/min (Cockroft formula). Two days later, she was transferred to a neurocritical care unit because of acute aphasia, myoclonic jerks, and delirium with a Glasgow coma scale score of 12/15. The following day, in the absence of other causes, cefepime intoxication was hypothesized, and cefepime was withdrawn after a total of 7 doses = 14 g. Over the next 24 hours, two 3-hour hemodialysis (HD) sessions were performed under cefepime concentration monitoring. Results: Cefepime plasma levels were measured by liquid chromatography/ mass spectrometry. There is no validated reference range, but a study (Chapuis T et al, Critical Care, 2010) found a 50% risk of neurotoxicity with residual levels > 15 mg/L. In our patient, levels were 83.3 mg/L 10 hours after last dose, 24.1 mg/L immediately after the first HD session, 13.4 mg/L immediately before the second HD session, and 2.5 mg/L immediately after the second HD session. The patient made a full clinical recovery over the next 48 hours. The 70% to 80% fall in plasmatic levels observed during each HD session is in accordance with literature data (Schmaldienst S et al, Eur J Clin Pharmacol, 2000, and Manyor LM et al, Pharmacotherapy, 2008). According to kinetic simulation, cefepime dropped at a concentration < 15 mg/L 15 hours earlier with HD than it would have without. Conclusion: Neuropsychiatric adverse effects of beta-lactam antibiotics can be easily overlooked by clinicians. One should be especially cautious with their use in very old and frail patients in whom plasma creatinine poorly estimates renal function and cognitive impairment is highly prevalent. Temporary hemodialysis effectively clears cefepime, but its role in hastening clinical recovery may be limited.

Hepatitis C virus RNA replication requires a conserved structural motif within the transmembrane domain of the NS5B RNA-dependent RNA polymerase.

Hepatitis C virus (HCV) nonstructural protein 5B (NS5B), the viral RNA-dependent RNA polymerase (RdRp), is a tail-anchored protein with a highly conserved C-terminal transmembrane domain (TMD) that is required for the assembly of a functional replication complex. Here, we report that the TMD of the HCV RdRp can be functionally replaced by a newly identified analogous membrane anchor of the GB virus B (GBV-B) NS5B RdRp. Replicons with a chimeric RdRp consisting of the HCV catalytic domain and the GBV-B membrane anchor replicated with reduced efficiency. Compensatory amino acid changes at defined positions within the TMD improved the replication efficiency of these chimeras. These observations highlight a conserved structural motif within the TMD of the HCV NS5B RdRp that is required for RNA replication.

Foch et Douglas Haig à la gare Victoria [19 juillet 1919] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 55090

Maréchal Foch et Douglas Haig à la gare Victoria [19 juillet 1919] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 55091

[Soldats] français au défilé de la Victoire à Londres [19 juillet 1919] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 55092

[Soldats] américains au défilé de la Victoire à Londres [19 juillet 1919] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 55093

[Défilé de la Victoire à Londres le 19 juillet 1919] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 55094

Le maréchal Foch au défilé de la Victoire à Londres [19 juillet 1919] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 55095

Défilé de la Victoire à Londres [19 juillet 1919] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 55096

Poilus français au défilé de la Victoire à Londres [19 juillet 1919] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 55097

Les nurses au défilé de la Victoire à Londres [19 juillet 1919] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 55098

Capitaine Tyl (détachement polonais) au défilé de la Victoire à Londres [19 juillet 1919] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 55099

[Défilé de la Victoire à Londres le 19 juillet 1919] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 55100