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Van Severen C, Koch S, Faure J, Poncin M, Loly JP. Peroral endoscopic myotomy: a two-center retrospective study of practice and adverse events. Acta Gastroenterol Belg 2024; 87:7-13. [PMID: 38431785 DOI: 10.51821/87.1.12358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Background and study aims Peroral endoscopic myotomy (POEM) is the preferred technique for the treatment of esophageal motility disorders and is less invasive than surgery. This study was performed to compare two university centers in the practice of POEM, in terms of efficacy and adverse events, for the treatment of esophageal motility disorder. Patients and methods Retrospective comparative study of patients undergoing a POEM between September 2020 and December 2022 from the University Hospital of Liège (Belgium) and Besançon (France). The clinical success was defined by an Eckardt score ≤ 3 after the procedure. Results Fifty-five patients were included. In both centers, 87,3% of the patients had achalasia (mostly type II), and 12,7% had another esophageal motility disorder. The use of antibiotic prophylaxis was systematic in Liège center but not in Besançon center (100% and 9.1% respectively). The mean value of the post-operative Eckardt score was 1.55± 2.48 in both center with 93.2% of patients with a score ≤ 3 (92% in Besançon and 94.74% in Liège). The rate of adverse event was generally low. There were two minor adverse events more frequent in Liège, clinical capnomediastinum and pain at day one, but they were managed with conservative treatment. Only 7.3% of the total patients had an infectious phenomenon that did not correlate with the use of antibiotic prophylaxis. Conclusion The post-operative Eckardt score and the adverse event rate were comparable between the university centers. This study confirmed that POEM is a safe and effective technique. It also showed that using an antibiotic prophylaxis does not influence the development of infectious adverse events.
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Affiliation(s)
- C Van Severen
- Centre Hospitalier universitaire de Liège, Gastroenterology and Hepatology, Liège, Belgium
| | - S Koch
- Centre Hospitalier régional universitaire de Besançon, Gastroenterology, Besançon, France
| | - J Faure
- Centre Hospitalier régional universitaire de Besançon, Gastroenterology, Besançon, France
| | - M Poncin
- Centre Hospitalier universitaire de Liège, Gastroenterology and Hepatology, Liège, Belgium
| | - J-P Loly
- Centre Hospitalier universitaire de Liège, Gastroenterology and Hepatology, Liège, Belgium
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Poncin M, Marembo J, Chitando P, Sreenivasan N, Makwara I, Machekanyanga Z, Nyabyenda W, Mukeredzi I, Munyanyi M, Hidle A, Chingwena F, Chigwena C, Atuhebwe P, Matzger H, Chigerwe R, Shaum A, Date K, Garone D, Chonzi P, Barak J, Phiri I, Rupfutse M, Masunda K, Gasasira A, Manangazira P. Implementation of an outbreak response vaccination campaign with typhoid conjugate vaccine – Harare, Zimbabwe, 2019. Vaccine X 2022; 12:100201. [PMID: 35983519 PMCID: PMC9379662 DOI: 10.1016/j.jvacx.2022.100201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/07/2022] [Accepted: 07/29/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Typhoid fever is a public-health problem in Harare, the capital city of Zimbabwe, with seasonal outbreaks occurring annually since 2010. In 2019, the Ministry of Health and Child Care (MOHCC) organized the first typhoid conjugate vaccination campaign in Africa in response to a recurring typhoid outbreak in a large urban setting. Method As part of a larger public health response to a typhoid fever outbreak in Harare, Gavi approved in September 2018 a MOHCC request for 340,000 doses of recently prequalified Typbar-TCV to implement a mass vaccination campaign. To select areas for the campaign, typhoid fever surveillance data from January 2016 until June 2018 was reviewed. We collected and analyzed information from the MOHCC and its partners to describe the vaccination campaign planning, implementation, feasibility, administrative coverage and financial costs. Results The campaign was conducted in nine high-density suburbs of Harare over eight days in February–March 2019 and targeted all children aged 6 months–15 years; however, the target age range was extended up to 45 years in one suburb due to the past high attack rate among adults. A total of 318,698 people were vaccinated, resulting in overall administrative coverage of 85.4 percent. More than 750 community volunteers and personnel from the MOHCC and the Ministry of Education were trained and involved in social mobilization and vaccination activities. The MOHCC used a combination of vaccination strategies (i.e., fixed and mobile immunization sites, a creche and school-based strategy, and door-to-door activities). Financial costs were estimated at US$ 2.39 per dose, including the vaccine and vaccination supplies (US$ 0.79 operational costs per dose excluding vaccine and vaccination supplies). Conclusion A mass targeted campaign in densely populated urban areas in Harare, using the recently prequalified typhoid conjugate vaccine, was feasible and achieved a high overall coverage in a short period of time.
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Affiliation(s)
- M. Poncin
- World Health Organization, Geneva, Switzerland
- Corresponding author at: Square Clair-Matin 44, 1213 Petit Lancy, Switzerland.
| | - J. Marembo
- Ministry of Health and Child Care, Harare, Zimbabwe
| | - P. Chitando
- Harare City Health Department, Harare, Zimbabwe
| | - N. Sreenivasan
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, USA
| | - I. Makwara
- Ministry of Health and Child Care, Harare, Zimbabwe
| | | | | | | | - M. Munyanyi
- Ministry of Health and Child Care, Harare, Zimbabwe
| | | | | | - C. Chigwena
- Ministry of Health and Child Care, Harare, Zimbabwe
| | - P. Atuhebwe
- World Health Organization, Brazzaville, Republic of the Congo
| | - H. Matzger
- World Health Organization, Geneva, Switzerland
| | - R. Chigerwe
- Harare City Health Department, Harare, Zimbabwe
| | | | - K. Date
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, USA
| | - D. Garone
- Médecins Sans Frontières, Brussels, Belgium
| | - P. Chonzi
- Harare City Health Department, Harare, Zimbabwe
| | - J. Barak
- United Nations Children's Fund, Harare, Zimbabwe
| | - I. Phiri
- Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - K. Masunda
- Harare City Health Department, Harare, Zimbabwe
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Winstead A, Strysko J, Relan P, Conners EE, Martinsen AL, Lopez V, Arons M, Masunda KP, Mukeredzi I, Manyara J, Duri C, Mashe T, Phiri I, Poncin M, Sreenivasan N, Aubert RD, Fuller L, Balachandra S, Mintz E, Manangazira P. Notes from the Field: Cholera Outbreak — Zimbabwe, September 2018–March 2019. MMWR Morb Mortal Wkly Rep 2020; 69:527-528. [PMID: 32352952 PMCID: PMC7206988 DOI: 10.15585/mmwr.mm6917a3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Mankor J, Disselhorst M, Poncin M, Vroman H, Baas P, Aerts J. P1.04-32 Ki67+PD-1+ Central Memory CD8 T-Cell Frequencies Predict Response Upon Nivolumab+Ipilimumab in Malignant Pleural Mesothelioma. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ferreras E, Matapo B, Chizema-Kawesha E, Chewe O, Mzyece H, Blake A, Moonde L, Zulu G, Poncin M, Sinyange N, Kasese-Chanda N, Phiri C, Malama K, Mukonka V, Cohuet S, Uzzeni F, Ciglenecki I, Danovaro-Holliday MC, Luquero FJ, Pezzoli L. Delayed second dose of oral cholera vaccine administered before high-risk period for cholera transmission: Cholera control strategy in Lusaka, 2016. PLoS One 2019; 14:e0219040. [PMID: 31469853 PMCID: PMC6716633 DOI: 10.1371/journal.pone.0219040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 06/16/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In April 2016, an emergency vaccination campaign using one dose of Oral Cholera Vaccine (OCV) was organized in response to a cholera outbreak that started in Lusaka in February 2016. In December 2016, a second round of vaccination was conducted, with the objective of increasing the duration of protection, before the high-risk period for cholera transmission. We assessed vaccination coverage for the first and second rounds of the OCV campaign. METHODS Vaccination coverage was estimated after each round from a sample selected from targeted-areas for vaccination using a cross-sectional survey in to establish the vaccination status of the individuals recruited. The study population included all individuals older than 12 months residing in the areas targeted for vaccination. We interviewed 505 randomly selected individuals after the first round and 442 after the second round. Vaccination status was ascertained either by vaccination card or verbal reporting. Households were selected using spatial random sampling. RESULTS The vaccination coverage with two doses was 58.1% (25/43; 95%CI: 42.1-72.9) in children 1-5 years old, 59.5% (69/116; 95%CI: 49.9-68.5) in children 5-15 years old and 19.9% (56/281; 95%CI: 15.4-25.1) in adults above 15 years old. The overall dropout rate was 10.9% (95%CI: 8.1-14.1). Overall, 69.9% (n = 309/442; 95%CI: 65.4-74.1) reported to have received at least one OCV dose. CONCLUSIONS The areas at highest risk of suffering cholera outbreaks were targeted for vaccination obtaining relatively high vaccine coverage after each round. However, the long delay between doses in areas subject to considerable population movement resulted in many individuals receiving only one OCV dose. Additional vaccination campaigns may be required to sustain protection over time in case of persistence of risk. Further evidence is needed to establish a maximum optimal interval time of a delayed second dose and variations in different settings.
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Affiliation(s)
- Eva Ferreras
- World Health Organization, Lusaka, Zambia
- Epicentre, Paris, France
| | | | | | - Orbrie Chewe
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
| | - Hannah Mzyece
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
| | | | | | | | - Marc Poncin
- Médecins Sans Frontières, Geneva, Switzerland
| | - Nyambe Sinyange
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
| | | | | | | | | | | | | | | | | | - Francisco J. Luquero
- Epicentre, Paris, France
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Dumoulin D, de Goeje P, Poncin M, Bezemer K, Groen H, Smit E, Dingemans AM, Kunert A, Hendriks R, Aerts J. Paclitaxel/ carboplatin/ bevacizumab in non-small cell lung cancer patients induces peripheral effector CD8 T cell proliferation that could be prone for treatment with checkpoint inhibitors. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz073.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Camacho A, Bouhenia M, Azman AS, Poncin M, Zagaria N, Luquero FJ. Cholera epidemic in Yemen – Author's reply. The Lancet Global Health 2018; 6:e1284-e1285. [DOI: 10.1016/s2214-109x(18)30395-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 08/09/2018] [Indexed: 10/28/2022] Open
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Mwaba J, Ferreras E, Chizema-Kawesa E, Mwimbe D, Tafirenyika F, Rauzier J, Blake A, Rakesh A, Poncin M, Stoitsova S, Kwenda G, Azman AS, Chewe O, Serafini M, Lukwesa-Musyani C, Cohuet S, Quilici ML, Luquero FJ, Page AL. Evaluation of the SD bioline cholera rapid diagnostic test during the 2016 cholera outbreak in Lusaka, Zambia. Trop Med Int Health 2018; 23:834-840. [PMID: 29851181 DOI: 10.1111/tmi.13084] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess the performance of the SD Bioline Cholera Ag O1/O139 rapid diagnostic test (RDT) compared to a reference standard combining culture and PCR for the diagnosis of cholera cases during an outbreak. METHODS RDT and bacterial culture were performed on site using fresh stools collected from cholera suspected cases, and from stools enriched in alkaline peptone water. Dried stool samples on filter paper were tested for V. cholerae by PCR in Lusaka (as part of a laboratory technology transfer project) and at a reference laboratory in Paris, France. A sample was considered positive for cholera by the reference standard if any of the culture or PCR tests was positive for V. cholerae O1 or O139. RESULTS Among the 170 samples tested with SD Bioline and compared to the reference standard, the RDT showed a sensitivity of 90.9% (95% CI: 81.3-96.6) and specificity of 95.2% (95% CI: 89.1-98.4). After enrichment, the sensitivity was 95.5% (95% CI: 87.3-99.1) and specificity 100% (95% CI: 96.5-100). CONCLUSION The observed sensitivity and specificity were within recommendations set by the Global Task Force for Cholera Control on the use of cholera RDT (sensitivity = 90%; specificity = 85%). Although the sample size was small, our findings suggest that the SD Bioline RDT could be used in the field to rapidly alert public health officials to the likely presence of cholera cases when an outbreak is suspected.
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Affiliation(s)
- John Mwaba
- Department of Pathology and Microbiology, University Teaching Hospital, Lusaka, Zambia
| | | | | | - Daniel Mwimbe
- Department of Pathology and Microbiology, University Teaching Hospital, Lusaka, Zambia
| | | | | | | | | | - Marc Poncin
- Médecins Sans Frontières, Geneva, Switzerland
| | - Savina Stoitsova
- European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden.,National Institute of Public Health, National Institute of Hygiene, Warsaw, Poland
| | - Geoffrey Kwenda
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Andrew S Azman
- Médecins Sans Frontières, Geneva, Switzerland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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9
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Camacho A, Bouhenia M, Alyusfi R, Alkohlani A, Naji MAM, de Radiguès X, Abubakar AM, Almoalmi A, Seguin C, Sagrado MJ, Poncin M, McRae M, Musoke M, Rakesh A, Porten K, Haskew C, Atkins KE, Eggo RM, Azman AS, Broekhuijsen M, Saatcioglu MA, Pezzoli L, Quilici ML, Al-Mesbahy AR, Zagaria N, Luquero FJ. Cholera epidemic in Yemen, 2016-18: an analysis of surveillance data. Lancet Glob Health 2018; 6:e680-e690. [PMID: 29731398 PMCID: PMC5952990 DOI: 10.1016/s2214-109x(18)30230-4] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 04/18/2018] [Indexed: 12/02/2022]
Abstract
Background In war-torn Yemen, reports of confirmed cholera started in late September, 2016. The disease continues to plague Yemen today in what has become the largest documented cholera epidemic of modern times. We aimed to describe the key epidemiological features of this epidemic, including the drivers of cholera transmission during the outbreak. Methods The Yemen Health Authorities set up a national cholera surveillance system to collect information on suspected cholera cases presenting at health facilities. Individual variables included symptom onset date, age, severity of dehydration, and rapid diagnostic test result. Suspected cholera cases were confirmed by culture, and a subset of samples had additional phenotypic and genotypic analysis. We first conducted descriptive analyses at national and governorate levels. We divided the epidemic into three time periods: the first wave (Sept 28, 2016, to April 23, 2017), the increasing phase of the second wave (April 24, 2017, to July 2, 2017), and the decreasing phase of the second wave (July 3, 2017, to March 12, 2018). We reconstructed the changes in cholera transmission over time by estimating the instantaneous reproduction number, Rt. Finally, we estimated the association between rainfall and the daily cholera incidence during the increasing phase of the second epidemic wave by fitting a spatiotemporal regression model. Findings From Sept 28, 2016, to March 12, 2018, 1 103 683 suspected cholera cases (attack rate 3·69%) and 2385 deaths (case fatality risk 0·22%) were reported countrywide. The epidemic consisted of two distinct waves with a surge in transmission in May, 2017, corresponding to a median Rt of more than 2 in 13 of 23 governorates. Microbiological analyses suggested that the same Vibrio cholerae O1 Ogawa strain circulated in both waves. We found a positive, non-linear, association between weekly rainfall and suspected cholera incidence in the following 10 days; the relative risk of cholera after a weekly rainfall of 25 mm was 1·42 (95% CI 1·31–1·55) compared with a week without rain. Interpretation Our analysis suggests that the small first cholera epidemic wave seeded cholera across Yemen during the dry season. When the rains returned in April, 2017, they triggered widespread cholera transmission that led to the large second wave. These results suggest that cholera could resurge during the ongoing 2018 rainy season if transmission remains active. Therefore, health authorities and partners should immediately enhance current control efforts to mitigate the risk of a new cholera epidemic wave in Yemen. Funding Health Authorities of Yemen, WHO, and Médecins Sans Frontières.
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Affiliation(s)
- Anton Camacho
- Epicentre, Paris, France; London School of Hygiene & Tropical Medicine, London, UK.
| | | | | | | | | | | | | | | | | | | | - Marc Poncin
- Médecins Sans Frontières, Geneva, Switzerland
| | | | | | | | | | | | | | | | - Andrew S Azman
- Johns Hopkins School of Public Health, Baltimore, MD, USA
| | | | | | | | - Marie-Laure Quilici
- National Reference Center for Vibrios and Cholera, Institut Pasteur, Paris, France
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Kabore C, Poncin M, Hurtgen B, Moerman F, Moonen M. [Osteoarticular tuberculosis nosology and diagnostic pitfalls]. Rev Med Liege 2018; 73:191-196. [PMID: 29676872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Osteoarticular or skeletal tuberculosis is a clinical manifestation of extrapulmonary tuberculosis, occurring during the lympho-hematogenous spread of Mycobacterium tuberculosis from a pulmonary primary infection or reactivation of latent infection, years or even decades after the initial infection. Bone and joint tuberculosis is a rare disease with non-specific symptoms and radiological characteristics, often delaying diagnosis for more than a year after clinical onset. First-line hospital departments should develop a clinical suspicion when confronted with a subacute inflammatory bone or joint pathology in patients with underlying comorbidities, especially when coming from tuberculosis-endemic countries. We report a clinical case characterized by lumbar and pelvic abscesses, before addressing in detail the different types of skeletal involvement related to tuberculosis, through a review of the literature.
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Affiliation(s)
- C Kabore
- Chirurgie de l'Appareil locomoteur, CHU Sart Tilman, Liège, Belgique
| | - M Poncin
- Médecine interne, CHU Sart Tilman, Liège, Belgique
| | | | - F Moerman
- Service de Médecine interne générale, CHR Citadelle, Liège, Belgique
| | - M Moonen
- Service de Médecine interne générale, CHR Citadelle, Liège, Belgique
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Ferreras E, Chizema-Kawesha E, Blake A, Chewe O, Mwaba J, Zulu G, Poncin M, Rakesh A, Page AL, Stoitsova S, Voute C, Uzzeni F, Robert H, Serafini M, Matapo B, Eiros JM, Quilici ML, Pezzoli L, Azman AS, Cohuet S, Ciglenecki I, Malama K, Luquero FJ. Single-Dose Cholera Vaccine in Response to an Outbreak in Zambia. N Engl J Med 2018; 378:577-579. [PMID: 29414267 DOI: 10.1056/nejmc1711583] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | | | | | | | - John Mwaba
- University Teaching Hospital, Lusaka, Zambia
| | | | - Marc Poncin
- Médecins sans Frontières, Geneva, Switzerland
| | | | | | - Savina Stoitsova
- European Program for Intervention Epidemiology Training, Stockholm, Sweden
| | | | | | | | | | | | | | | | | | - Andrew S Azman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Poncin M, Zulu G, Voute C, Ferreras E, Muleya CM, Malama K, Pezzoli L, Mufunda J, Robert H, Uzzeni F, Luquero FJ, Chizema E, Ciglenecki I. Implementation research: reactive mass vaccination with single-dose oral cholera vaccine, Zambia. Bull World Health Organ 2017; 96:86-93. [PMID: 29403111 PMCID: PMC5791774 DOI: 10.2471/blt.16.189241] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 09/30/2017] [Accepted: 10/02/2017] [Indexed: 12/19/2022] Open
Abstract
Objective To describe the implementation and feasibility of an innovative mass vaccination strategy – based on single-dose oral cholera vaccine – to curb a cholera epidemic in a large urban setting. Method In April 2016, in the early stages of a cholera outbreak in Lusaka, Zambia, the health ministry collaborated with Médecins Sans Frontières and the World Health Organization in organizing a mass vaccination campaign, based on single-dose oral cholera vaccine. Over a period of 17 days, partners mobilized 1700 health ministry staff and community volunteers for community sensitization, social mobilization and vaccination activities in 10 townships. On each day, doses of vaccine were delivered to vaccination sites and administrative coverage was estimated. Findings Overall, vaccination teams administered 424 100 doses of vaccine to an estimated target population of 578 043, resulting in an estimated administrative coverage of 73.4%. After the campaign, few cholera cases were reported and there was no evidence of the disease spreading within the vaccinated areas. The total cost of the campaign – 2.31 United States dollars (US$) per dose – included the relatively low cost of local delivery – US$ 0.41 per dose. Conclusion We found that an early and large-scale targeted reactive campaign using a single-dose oral vaccine, organized in response to a cholera epidemic within a large city, to be feasible and appeared effective. While cholera vaccines remain in short supply, the maximization of the number of vaccines in response to a cholera epidemic, by the use of just one dose per member of an at-risk community, should be considered.
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Affiliation(s)
- Marc Poncin
- Médecins sans Frontières, 78, rue de Lausanne, Case Postale 1016, 1211 Geneva, Switzerland
| | - Gideon Zulu
- Republic of Zambia Ministry of Health, Lusaka, Zambia
| | - Caroline Voute
- Médecins sans Frontières, 78, rue de Lausanne, Case Postale 1016, 1211 Geneva, Switzerland
| | | | | | | | | | | | - Hugues Robert
- Médecins sans Frontières, 78, rue de Lausanne, Case Postale 1016, 1211 Geneva, Switzerland
| | - Florent Uzzeni
- Médecins sans Frontières, 78, rue de Lausanne, Case Postale 1016, 1211 Geneva, Switzerland
| | | | | | - Iza Ciglenecki
- Médecins sans Frontières, 78, rue de Lausanne, Case Postale 1016, 1211 Geneva, Switzerland
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Sissoko D, Laouenan C, Folkesson E, M'Lebing AB, Beavogui AH, Baize S, Camara AM, Maes P, Shepherd S, Danel C, Carazo S, Conde MN, Gala JL, Colin G, Savini H, Bore JA, Le Marcis F, Koundouno FR, Petitjean F, Lamah MC, Diederich S, Tounkara A, Poelart G, Berbain E, Dindart JM, Duraffour S, Lefevre A, Leno T, Peyrouset O, Irenge L, Bangoura N, Palich R, Hinzmann J, Kraus A, Barry TS, Berette S, Bongono A, Camara MS, Munoz VC, Doumbouya L, Harouna S, Kighoma PM, Koundouno FR, Lolamou R, Loua CM, Massala V, Moumouni K, Provost C, Samake N, Sekou C, Soumah A, Arnould I, Komano MS, Gustin L, Berutto C, Camara D, Camara FS, Colpaert J, Delamou L, Jansson L, Kourouma E, Loua M, Malme K, Manfrin E, Maomou A, Milinouno A, Ombelet S, Sidiboun AY, Verreckt I, Yombouno P, Bocquin A, Carbonnelle C, Carmoi T, Frange P, Mely S, Nguyen VK, Pannetier D, Taburet AM, Treluyer JM, Kolie J, Moh R, Gonzalez MC, Kuisma E, Liedigk B, Ngabo D, Rudolf M, Thom R, Kerber R, Gabriel M, Di Caro A, Wölfel R, Badir J, Bentahir M, Deccache Y, Dumont C, Durant JF, El Bakkouri K, Uwamahoro MG, Smits B, Toufik N, Van Cauwenberghe S, Ezzedine K, D'Ortenzio E, Pizarro L, Etienne A, Guedj J, Fizet A, de Sainte Fare EB, Murgue B, Tran-Minh T, Rapp C, Piguet P, Poncin M, Draguez B, Duverger TA, Barbe S, Baret G, Defourny I, Carroll M, Raoul H, Augier A, Eholie SP, Yazdanpanah Y, Levy-Marchal C, Antierrens A, Van Herp M, Günther S, de Lamballerie X, Keïta S, Mentre F, Anglaret X, Malvy D. Correction: Experimental Treatment with Favipiravir for Ebola Virus Disease (the JIKI Trial): A Historically Controlled, Single-Arm Proof-of-Concept Trial in Guinea. PLoS Med 2016; 13:e1002009. [PMID: 27046271 PMCID: PMC4821578 DOI: 10.1371/journal.pmed.1002009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pmed.1001967.].
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Calain P, Poncin M. Reaching out to Ebola victims: Coercion, persuasion or an appeal for self-sacrifice? Soc Sci Med 2015; 147:126-33. [PMID: 26561947 DOI: 10.1016/j.socscimed.2015.10.063] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/26/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
Abstract
The 2014-2015 Ebola crisis in West Africa has highlighted the practical limits of upholding human rights and common ethical principles when applying emergency public-health measures. The role of medical teams in the implementation of quarantine and isolation has been equivocal, particularly when such measures are opposed by communities who are coerced by the temporary suspension of civil liberties. In their encounters with Ebola victims, outreach teams face moral dilemmas, where the boundaries are unclear between coercion, persuasion and appeals for self-sacrifice. For those teams, we propose a set of practical recommendations aimed at respecting the autonomy of epidemic victims and easing tensions within communities. We recognize that some of these recommendations are progressively achievable, depending on the specific stage or setting of an outbreak. Yet with the increasing availability of experimental treatments and research interventions, weighing patients' autonomy against the common good will become an even more pressing ethical obligation.
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Affiliation(s)
- Philippe Calain
- Research Unit on Humanitarian Stakes and Practices (UREPH), Médecins Sans Frontières, Rue de Lausanne 78, 1211 Genève 21, Switzerland.
| | - Marc Poncin
- Research Unit on Humanitarian Stakes and Practices (UREPH), Médecins Sans Frontières, Rue de Lausanne 78, 1211 Genève 21, Switzerland
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Poncin M, Neumann A, Luminet O, Vande Weghe N, Philippot P, de Timary P. P-38DISEASE RECOGNITION IS RELATED TO SPECIFIC AUTOBIOGRAPHICAL MEMORY DEFICITS IN ALCOHOL-DEPENDENCE. Alcohol Alcohol 2015. [DOI: 10.1093/alcalc/agv080.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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16
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Lannoy S, Billieux J, Poncin M, Maurage P. P-41INTERACTIONS BETWEEN DRINKING MOTIVES AND IMPULSIVITY IN BINGE DRINKING: A CLUSTER ANALYSIS. Alcohol Alcohol 2015. [DOI: 10.1093/alcalc/agv080.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Lannoy S, Billieux J, Poncin M, Maurage P. FOC6-2INTERACTIONS BETWEEN DRINKING MOTIVES AND IMPULSIVITY IN BINGE DRINKING: A CLUSTER ANALYSIS. Alcohol Alcohol 2015. [DOI: 10.1093/alcalc/agv079.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Barry M, Touré A, Traoré FA, Sako FB, Sylla D, Kpamy DO, Bah EI, Bangoura M, Poncin M, Keita S, Tounkara TM, Cisse M, Vanhems P. Clinical predictors of mortality in patients with Ebola virus disease. Clin Infect Dis 2015; 60:1821-4. [PMID: 25770172 DOI: 10.1093/cid/civ202] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 02/01/2015] [Indexed: 11/13/2022] Open
Abstract
In an observational cohort study including 89 Ebola patients, predictive factors of death were analyzed. The crude mortality rate was 43.8%. Myalgia (adjusted odds ratio [OR], 4.04; P = .02), hemorrrhage (adjusted OR, 3.5; P = .02), and difficulty breathing (adjusted OR, 5.75; P = .01) were independently associated with death.
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Affiliation(s)
- Moumié Barry
- Service des Maladies Infectieuses et Tropicales, Hôpital National Donka
| | | | - Fodé Amara Traoré
- Service des Maladies Infectieuses et Tropicales, Hôpital National Donka Chaire de Dermatologie et Maladies Infectieuses, and
| | - Fodé-Bangaly Sako
- Service des Maladies Infectieuses et Tropicales, Hôpital National Donka
| | - Djibril Sylla
- Chaire de Médecine Interne, Université de Conakry, CHU Conakry
| | - Dimai Ouo Kpamy
- Service des Maladies Infectieuses et Tropicales, Hôpital National Donka
| | | | - M'Mah Bangoura
- Service des Maladies Infectieuses et Tropicales, Hôpital National Donka
| | | | - Sakoba Keita
- Division Prévention et lutte contre la Maladie, Ministère de la Santé Publique, Guinée
| | | | | | - Philippe Vanhems
- Service d'Hygiène Hospitalière, Epidémiologie et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon, et Université Claude Bernard, Université Lyon 1, France
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Barry M, Traoré FA, Sako FB, Kpamy DO, Bah EI, Poncin M, Keita S, Cisse M, Touré A. Ebola outbreak in Conakry, Guinea: epidemiological, clinical, and outcome features. Med Mal Infect 2014; 44:491-4. [PMID: 25391486 DOI: 10.1016/j.medmal.2014.09.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 09/26/2014] [Accepted: 09/29/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The authors studied the epidemiological, clinical, and outcome features of the Ebola virus disease in patients hospitalized at the Ebola treatment center (ETC) in Conakry to identify clinical factors associated with death. MATERIALS AND METHODS A prospective study was conducted from March 25 to August 20, 2014. The diagnosis of Ebola virus infection was made on real-time PCR. RESULTS Ninety patients, with a positive test result, were hospitalized. Their mean age was 34.12±14.29 years and 63% were male patients. Most worked in the informal sector (38%) and in the medical and paramedical staff (physicians 12%, nurses 6%, and laboratory technicians 1%). Most patients lived in the Conakry suburbs (74%) and in Boffa (11%). The main clinical signs were physical asthenia (80%) and fever (72%). Hemorrhagic signs were observed in 26% of patients. The comparison of clinical manifestations showed that hiccups (P=0.04), respiratory distress (P=0.04), and hemorrhagic symptoms (P=0.01) were more frequent among patients who died. Malaria (72%) and diabetes (2%) were the most frequent co-morbidities. The crude case fatality rate was 44% [95% confidence interval (33-54%)]. The average hospital stay was 7.96±5.81 days. CONCLUSION The first Ebola outbreak in Conakry was characterized by the young age of patients, discrete hemorrhagic signs related to lethality. Its control relies on a strict use of preventive measures.
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Affiliation(s)
- M Barry
- Service des maladies infectieuses et tropicales, hôpital national Donka, CHU de Conakry, Quartier Cameroun, Conakry, Guinea
| | - F A Traoré
- Service des maladies infectieuses et tropicales, hôpital national Donka, CHU de Conakry, Quartier Cameroun, Conakry, Guinea; Chaire de dermatologie et maladies infectieuses, département de médecine, université de Conakry, Conakry, Guinea.
| | - F B Sako
- Service des maladies infectieuses et tropicales, hôpital national Donka, CHU de Conakry, Quartier Cameroun, Conakry, Guinea; Chaire de dermatologie et maladies infectieuses, département de médecine, université de Conakry, Conakry, Guinea
| | - D O Kpamy
- Service des maladies infectieuses et tropicales, hôpital national Donka, CHU de Conakry, Quartier Cameroun, Conakry, Guinea
| | - E I Bah
- Service des maladies infectieuses et tropicales, hôpital national Donka, CHU de Conakry, Quartier Cameroun, Conakry, Guinea
| | - M Poncin
- Coordonateur projet MSF urgence Ebola, hôpital Donka, Conakry, Guinea
| | - S Keita
- Division de la prévention et de la lutte contre la maladie, ministère de la Santé, Guinea
| | - M Cisse
- Chaire de dermatologie et maladies infectieuses, département de médecine, université de Conakry, Conakry, Guinea
| | - A Touré
- Chaire de santé publique, département de pharmacie, université de Conakry, Conakry, Guinea
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Poncin M, Reenaers C, Van Kemseke C, Belaiche J, Seidel L, Meunier P, Louis E. Depth of remission in Crohn's disease patients seen in a referral centre : associated factors and impact on disease outcome. Acta Gastroenterol Belg 2014; 77:41-46. [PMID: 24761690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Our goals were to assess the prevalence of biological and tissue remission in routine practice in Crohn's disease, and to evaluate the correlation between biological or tissue remission and clinical or demographic characteristics as well as their impact on disease outcome. METHODS We performed a retrospective monocenter study. Biological remission was defined by a CRP < 5 mg/I. Tissue remission was defined by the absence of ulcer at endoscopy and/or absence of signs of acute inflammation at MRI. Association with demographic, clinical and laboratory markers was studied by logistic regression models and rates of relapses, hospitalizations and surgeries were compared using the logrank test. RESULTS Among the 263 patients included, 147 were in clinical remission; 102/147 (69%) were in biological remission. Fifty-six patients also had morphological evaluation: 37 (66%) were in tissue remission. Biological remission was associated with older age, higher hemoglobin and lower BMI. Tissue remission was associated with older age, lower platelets count, absence of previous surgery, and the use of immunosuppressant. Time-to-relapse was significantly longer in patients with biological remission and in patients with tissue remission as compared to patients without biological or tissue remission. CONCLUSIONS Among the patients in clinical remission seen as outpatients, two thirds were either in biological and/or tissue remission. Biological and/or tissue remission was associated with a better outcome than clinical remission alone.
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Calain P, Fiore N, Poncin M, Hurst SA. Research Ethics and International Epidemic Response: The Case of Ebola and Marburg Hemorrhagic Fevers. Public Health Ethics 2009. [DOI: 10.1093/phe/phn037] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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22
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Affiliation(s)
- C Stokes
- Médecins Sans Frontières, London, UK
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23
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Abstract
Tinea capitis is rare in adults, although a few cases have been described in HIV-infected patients. We present two cases in black African adults who were HIV positive. In one, the condition led to the diagnosis of HIV infection. It is possible that the rarity of tinea capitis in HIV-positive adults could be related to increased colonization of their scalp by Pityrosporum (Malassezia) spp. In patients well controlled with an antiviral therapy, the treatment of tinea capitis seems no more difficult than in non-immunosuppressed patients. There is possibly a relation between clinical presentation and degree of immunodeficiency.
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Affiliation(s)
- N Lateur
- Department of Dermatology, CHU Saint Pierre,Free University of Brussels, 129 Boulevard de Waterloo, 1000 Bruxelles, Belgium
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24
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Snoeck R, Van Ranst M, Andrei G, De Clercq E, De Wit S, Poncin M, Clumeck N. Treatment of anogenital papillomavirus infections with an acyclic nucleoside phosphonate analogue. N Engl J Med 1995; 333:943-4. [PMID: 7666893 DOI: 10.1056/nejm199510053331418] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Blackledge MJ, Medvedeva S, Poncin M, Guerlesquin F, Bruschi M, Marion D. Structure and dynamics of ferrocytochrome c553 from Desulfovibrio vulgaris studied by NMR spectroscopy and restrained molecular dynamics. J Mol Biol 1995; 245:661-81. [PMID: 7844834 DOI: 10.1006/jmbi.1994.0054] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The solution structure of Desulfovibrio vulgaris Hildenborough (DvH) ferrocytochrome c553 has been determined by nuclear magnetic resonance spectroscopy and combined simulated annealing/high temperature restrained molecular dynamics calculations. This three-stage protocol consists of an initial determination of overall fold from randomised co-ordinates, followed by a 20 picosecond exploratory stage, during which the non-bonded terms are simplified to facilitate as broad a sampling of conformational space as possible, and a 26 picosecond refinement stage, using the full AMBER force field. This latter stage systematically improved the energetic and convergence characteristics of the ensemble, while still satisfying the experimental restraints. Forty structures have been obtained from a total of 875 distance constraints for this protein of 79 amino acid residues. The root-mean-square deviation over all residues with respect to the mean is 0.70(+/- 0.12)A for the backbone (N, C alpha and C') atoms. Two conformations of the turn motif at the solvent/heme cleft interface have been identified, both fulfilling the experimental data and having equally viable energetic characteristics. The stability of the ensemble and the dynamic characteristics have been further investigated by subjecting ten of the structures to constraint-free molecular dynamics calculations (130 picoseconds) in vacuo. The structures were found to be stable to within 1.5 A of the initial backbone conformation. Comparison with the dynamic behaviour of the restrained molecular dynamics calculations has been used to identify regions of inherent flexibility in the molecule.
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Affiliation(s)
- M J Blackledge
- Institut de Biologie Structurale Jean-Pierre Ebel (CEA-CNRS), Grenoble, France
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26
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Abstract
We report here the NMR structure of dendrotoxin I, a powerful potassium channel blocker from the venom of the African Elapidae snake Dendroaspis polylepis polylepis (black mamba), calculated from an experimentally-derived set of 719 geometric restraints. The backbone of the toxin superimposes on bovine pancreatic trypsin inhibitor (BPTI) with a root-mean-square deviation of < 1.7 A. The surface electrostatic potential calculated for dendrotoxin I and BPTI, reveal an important difference which might account for the differences in function of the two proteins. These proteins may provide examples of adaptation for specific and diverse biological functions while at the same time maintaining the overall three-dimensional structure of a common ancestor.
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Affiliation(s)
- J M Lancelin
- Institute de Biologie Structurale CEA-CNRS, Grenoble, France
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27
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Abstract
Theoretical studies of the sequence-dependent conformation of B-DNA have been carried out using Jumna, a helicoidal co-ordinate minimization algorithm. The results obtained for a series of six oligomers with repetitive sequences show that, with the exception of the homopolymers (dA)n.(dT)n and (dG)n.(dC)n, all sequences can adopt a variety of conformations characterized by considerable changes in helicoidal parameters and also in sugar puckers which adopt C(2')-endo (falling into 2 classes) or, in the case of pyrimidine nucleotides, O(1')-endo forms. These studies lead to an improved understanding of the role of base sequence on DNA conformation and point to a number of interesting correlations between the various structural parameters describing the double helix.
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Affiliation(s)
- M Poncin
- Laboratoire de Biochimie Théorique, Institut de Biologie Physico-Chimique, Paris, France
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28
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Abstract
Systematic theoretical modeling of symmetric DNA oligomers, carried out earlier for the B conformation, is now extended to A-DNA. In contrast to the previous results, it is found that A-DNA shows no multiplicity of low-energy substate conformations. The possibilities of the Jumna algorithm are subsequently applied to studying deformations of the oligomers. Controlled winding and stretching deformations are used to study how the two allomorphs and different base sequences absorb such external stress. The results help explain the internal mechanics of the DNA double helix and the extent to which fine structure influences this behavior. The results point to some differences between the A and B double helices, but also to many similarities. Sequence effects on flexibility are relatively limited compared to their impact on optimal energy conformations. It is also shown that the conformational substates detected for B-DNA oligomers are preserved under deformation, but have little influence on its energetics.
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Affiliation(s)
- M Poncin
- Laboratoire de Biochimie Théorique, Institut de Biologie Physico-Chimique, Paris, France
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29
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Abstract
Calicheamicin gamma 1I is a recently discovered diyne-ene-containing antitumor antibiotic that cleaves DNA in a double-stranded fashion, a rarity among drugs, at specific sequences. It is proposed that the cutting specificity is due to a combination of the complementarity of the diyne-ene portion of the aglycone with DNA secondary structures and stabilization by association of the thiobenzoate-carbohydrate tail with the minor groove.
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Affiliation(s)
- N Zein
- Cyanamid Company, Medical Research Division, Lederle Laboratories, Pearl River, NY 10965
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