C Mayaud

Pierre and Marie Curie University - Paris 6, Lutetia Parisorum, Île-de-France, France

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Publications (297)672.27 Total impact

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    ABSTRACT: Introduction The number of emergency consultations for respiratory issues increases. Despite no hospitalization’s criteria, some patients require a clinical assessment by a pulmonologist in a short delay. However, there is a lack of access for specialists. Thus, a post-emergency consultation has been set up in the respirology department at Tenon hospital. The objective of this study was to evaluate the usefulness of this new post-emergency consultation. Materials and methods We conducted a retrospective observational study, from January 2012 to September 2013 on the post-emergency consultation of Tenon hospital. Results 297 patients were scheduled and 231 (78%) came in post-emergency consultation during this period: 170 were finally included in the study because 21% of patients who came, were no previously been through the emergency department (ED). The consultation’s delay was relatively short (eight days on average). Asthma, COPD and respiratory infectious diseases represented the main diagnosis. The diagnosis retained at the post-emergency consultation compared to that of ED was concordant in 50% of cases, improved in 32% of cases and discordant in 18% of cases. In 44%, a therapeutic change was made at the end of the post-emergency consultation. In 89%, a new pulmonology consultation was scheduled to establish a specialized care. Conclusion: The post-emergency consultation is useful to improve the diagnosis and/or the treatment close to 50% of patients and to organize their respirology management in nearly 90% of cases.
    No preview · Article · Dec 2015 · Annales Francaises de Medecine d'Urgence
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    ABSTRACT: Clinical decision making relative to community acquired-pneumonia CAP diagnosis is difficult. Chest X-ray is key in establishing parenchymal lung involvement. However, radiological performance may lead to misdiagnosis, rendering questionable the utility of chest CT-scan in patients with clinically-suspected CAP. To assess whether early multidetector chest CT-scan affects diagnosis and management of patients visiting the emergency department with suspected CAP. 319 prospectively enrolled patients with clinically suspected CAP patients underwent multidetector chest CT-scan within 4 hours. CAP diagnosis probability (definite, probable, possible or excluded), and therapeutic plans (antibiotic initiation/discontinuation, hospitalisation/discharge) were established by emergency physicians before and after CT scan results. The adjudication committee established the final CAP classification on day 28. Chest X-ray revealed a parenchymal infiltrate in 188 patients. CAP was initially classified as definite in 143 patients (44.8%), probable or possible in 172 (53.8%), excluded in 4 (1.2%). CT-scan revealed a parenchymal infiltrate in 40 (33%) of the patients without infiltrate on chest X-ray and excluded CAP in 56 (29.8%) of the 188 with parenchymal infiltrate on X-ray. CT-scan modified classification in 187 (58.6% 95%CI 53.2-64.0); leading to 50.8% definite CAP and 28.8% excluded CAP; 80% of modifications were in accordance with adjudication committee classification. Due to CT-scan, antibiotics were initiated in 51 (16%) and discontinued in 29 (9%), and hospitalisation was decided in 22 and discharge in 23. In CAP-suspected patients visiting the emergency unit, early CT-scan findings complementary to chest X-ray markedly affect both diagnosis and clinical management. Clinical trial registration available at www.clinicaltrials.gov, ID NCT01574066.
    No preview · Article · Jul 2015 · American Journal of Respiratory and Critical Care Medicine
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    ABSTRACT: The spectrum of pulmonary diseases that can affect human immunodeficiency virus (HIV)-infected patients is wide and includes both HIV and non-HIV-related conditions. Opportunistic infections and neoplasms remain a major concern even in the current era of combination antiretroviral therapy. Although these diseases have characteristic clinical and radiological features, there can be considerable variation in these depending on the patient's CD4 lymphocyte count. The patient's history, physical examination, CD4 count and chest radiograph features must be considered in establishing an appropriate diagnostic algorithm. In this article, we propose different diagnostic approaches HIV infected to patients with respiratory symptoms depending on their clinico-radiological pattern. Copyright © 2014 SPLF. Published by Elsevier Masson SAS. All rights reserved.
    No preview · Article · Dec 2014
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    ABSTRACT: The spectrum of pulmonary diseases that can affect human immunodeficiency virus (HIV)-infected patients is wide and includes both HIV and non-HIV-related conditions. Opportunistic infections and neoplasms remain a major concern even in the current era of combination antiretroviral therapy. Although these diseases have characteristic clinical and radiological features, there can be considerable variation in these depending on the patient's CD4 lymphocyte count. The patient's history, physical examination, CD4 count and chest radiograph features must be considered in establishing an appropriate diagnostic algorithm. In this article, we propose different diagnostic approaches HIV infected to patients with respiratory symptoms depending on their clinico-radiological pattern.
    No preview · Article · Aug 2014 · Revue des Maladies Respiratoires
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    ABSTRACT: Introduction – objectifs La faible concordance inter-observateurs dans la lecture de la radiographie thoracique (RT) et la meilleure sensibilité du scanner thoracique (ST) soulève la question de l’utilité du ST dans la prise en charge des patients (pts) suspects de PAC. L’objectif était de déterminer l’impact diagnostique et thérapeutique du ST dans les suspicions cliniques de PAC. Matériels et méthodes Cette étude prospective multicentrique incluait des pts suspects de PAC (≥ 1 signe d’infection systémique et ≥ 1 signe respiratoire récent). Un ST avec interprétation standardisée était réalisé dans les 4 heures. La certitude diagnostique (échelle de Likert) de PAC et les projets thérapeutiques étaient établis par l’urgentiste avant puis après le ST. Le diagnostic final de PAC était établi à J 28 par un comité d’adjudication (CA). Résultats Entre novembre 2011 et décembre 2012, 319 pts ont été inclus (âge moyen 64,7 ans). Avant ST, le diagnostic de PAC était certain pour 143 pts (44,8 %), probable pour 118 (37 %), possible pour 54 (17 %) et exclu pour 4 pts (1,2 %). Après ST, le diagnostic était certain pour 162 pts (50,8 %), probable pour 35 (11 %), possible pour 30 (9,4 %), exclu pour 92 pts (28,8 % ; diagnostic alternatif retenu). Le diagnostic était modifié par le ST chez 187 pts (58,6 % IC95 % [53,2 ; 64]), et conforme au diagnostic final du CA dans 73 % des cas. Un traitement antibiotique était initié (51pts) ou interrompu (29 pts) à la suite du ST chez 70 pts (22 %). Conclusion En cas de suspicion clinique de PAC, le ST précoce modifie la probabilité diagnostique dans 60 % des cas, exclut ce diagnostic dans 30 % et modifie le choix thérapeutique chez 20 %. L’impact sur le pronostic devrait être évalué.
    No preview · Article · Jun 2014 · Médecine et Maladies Infectieuses
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    ABSTRACT: Background: Shortening the interval between antituberculosis treatment onset and initiation of antiretroviral therapy (ART) reduces mortality in severely immunocompromised human immunodeficiency virus (HIV)-infected patients with tuberculosis. A better understanding of causes and determinants of death may lead to new strategies to further enhance survival. Methods: We assessed mortality rates, causes of death, and factors of mortality in Cambodian HIV-infected adults with CD4 count ≤200 cells/µL and tuberculosis, randomized to initiate ART either 2 weeks (early ART) or 8 weeks (late ART) after tuberculosis treatment onset in the CAMELIA clinical trial. Results: Six hundred sixty-one patients enrolled contributed to 1366.1 person-years of follow-up; 149 (22.5%) died. There were 8.3 deaths per 100 person-years (95% confidence interval [CI], 6.4-10.7) in the early-ART group and 13.8 deaths per 100 person-years (95% CI, 11.2-16.9) in the late-ART group (P = .002). Tuberculosis was the primary cause of death (28%), followed by other HIV-associated conditions (19%). Factors independently associated with mortality in the first 26 weeks were the age, body mass index, hemoglobin, interrupted or ineffective tuberculosis treatment before identification of drug resistance, disseminated tuberculosis, and nontuberculous mycobacterial disease. After 50 weeks in the trial, the most frequent causes of death were non-HIV related or tuberculosis related, including drug toxicity; factors associated with mortality were late ART, loss to follow-up, and absence of cotrimoxazole prophylaxis. Conclusions: Despite ART introduction, mortality remained high, with tuberculosis as the leading cause of death. Reducing tuberculosis-related mortality remains a challenge in resource-limited settings and requires innovative strategies. Clinical Trials Registration. NCT00226434.
    Preview · Article · Apr 2014 · Clinical Infectious Diseases
  • C Mayaud · J Cadranel
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    ABSTRACT: During the last 30years pulmonary involvement has played a major role in the history of HIV infection. Initially, the unexplained occurrence of pneumocystis revealed the emergence of AIDS and the suspicion of its African origin. Before the era of triple therapy the natural history of AIDS was dominated by the occurrence of repeated lung infections and respiratory physicians were at the forefront of their diagnosis, treatment and prophylaxis. With the provision of antiretroviral therapy (ART), the natural history of AIDS has been transformed in those patients who benefit from it. In addition to paradoxical reactions observed following the introduction of ART, the pulmonologist is also facing a chronic stage of controlled HIV infection, and unexpected events, the incidence of which increases with time: pulmonary arterial hypertension and lung cancer certainly, COPD and fibrosis perhaps… but this story remains to be written.
    No preview · Article · Feb 2014 · Revue des Maladies Respiratoires
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    ABSTRACT: Little is known about post-infectious pulmonary sequelae in countries like Cambodia where tuberculosis is hyper-endemic and childhood pulmonary infections are highly frequent. We describe the characteristics of hospitalized Cambodian patients presenting with community-acquired acute lower respiratory infections (ALRI) on post-infectious pulmonary sequelae (ALRIPS). Between 2007 and 2010, inpatients ≥15 years with ALRI were prospectively recruited. Clinical, biological, radiological and microbiological data were collected. Chest radiographs were re-interpreted by experts to compare patients with ALRIPS, on previously healthy lungs (ALRIHL) and active pulmonary tuberculosis (TB). Patients without chest radiograph abnormality or with abnormality suggestive as other chronic respiratory diseases were excluded from this analysis. Among the 2351 inpatients with community-acquired ALRI, 1800 were eligible: 426 (18%) ALRIPS, 878 (37%) ALRIHL and 496 (21%) TB. ALRIPS patients had less frequent fever than other ALRI (p < 0.001) and more productive cough than ALRIHL (p < 0.001). Streptococcus pneumoniae, Haemophilus influenzae, and Pseudomonas aeruginosa accounted for 83% of ALRIPS group positive cultures. H. influenzae and P. aeruginosa were significantly associated with ALRIPS compared with ALRIHL. Treatment was appropriate in 58% of ALRIPS patients. Finally, 79% of ALRIPS were not recognized by local clinicians. In-hospital mortality was low (1%) but probably underestimated in the ALRIPS group. ALRIPS remains often misdiagnosed as TB with inappropriate treatment in low-income countries. Better-targeted training programs would help reduce the morbidity burden and financial costs.
    Full-text · Article · Aug 2013 · Respiratory medicine
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    ABSTRACT: Background Few data exist on viral and bacterial etiology of acute lower respiratory infections (ALRI) in ≥5 year –old persons in the tropics. Methods We conducted active surveillance of community-acquired ALRI in two hospitals in Cambodia, a low-income tropical country. Patients were tested for acid-fast bacilli (AFB) by direct sputum examination, other bacteria by blood and/or sputum cultures, and respiratory viruses using molecular techniques on nasopharyngeal/throat swabs. Pulmonologists reviewed clinical/laboratory data and interpreted chest X-rays (CXR) to confirm ALRI. Results Between April 2007 - December 2009, 1,904 patients aged ≥5 years were admitted with acute pneumonia (50.4%), lung sequelae-associated ALRI (24.3%), isolated pleural effusions (8.9%) or normal CXR-related ALRI (17.1%); 61 (3.2%) died during hospitalization. The two former diagnoses were predominantly due to bacterial etiologies while viral detection was more frequent in the two latter diagnoses. AFB-positive accounted for 25.6% of acute pneumonia. Of the positive cultures (16.8%), abscess-prone Gram-negative bacteria (39.6%) and Haemophilus influenzae (38.0%) were most frequent, followed by Streptococcus pneumoniae (17.7%). Of the identified viruses, the three most common viruses included rhinoviruses (49.5%), respiratory syncytial virus (17.7%) and influenza viruses (12.1%) regardless of the diagnostic groups. Wheezing was associated with viral identification (31.9% vs. 13.8%, p < 0.001) independent of age and time-to-admission. Conclusions High frequency of H. influenzae and S. pneumoniae infections support the need for introduction of the respective vaccines in the national immunization program. Tuberculosis was frequent in patients with acute pneumonia, requiring further investigation. The relationship between respiratory viruses and wheezing merits further studies.
    Full-text · Article · Feb 2013 · BMC Infectious Diseases
  • C. Mayaud · A. Parrot · M. Fartoukh · J. Cadranel
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    ABSTRACT: L’éventualité d’une hémorragie intra-alvéolaire (HIA) entrainant la venue aux urgences d’un adulte non immunodéprimé est rare. Elle doit néanmoins être connue dans la mesure où l’HIA engage alors le pronostic vital et justifie dès le passage aux urgences une prise en charge adaptée à sa gravité et à son mécanisme présumé: immun ou non immun.
    No preview · Chapter · Jan 2013
  • C. Mayaud · J. Cadranel
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    ABSTRACT: During the last 30 years pulmonary involvement has played a major role in the history of HIV infection. Initially, the unexplained occurrence of pneumocystis revealed the emergence of AIDS and the suspicion of its African origin. Before the era of triple therapy the natural history of AIDS was dominated by the occurrence of repeated lung infections and respiratory physicians were at the forefront of their diagnosis, treatment and prophylaxis. With the provision of antiretroviral therapy (ART), the natural history of AIDS has been transformed in those patients who benefit from it. In addition to paradoxical reactions observed following the introduction of ART, the pulmonologist is also facing a chronic stage of controlled HIV infection, and unexpected events, the incidence of which increases with time: pulmonary arterial hypertension and lung cancer certainly, COPD and fibrosis perhaps… but this story remains to be written.
    No preview · Article · Jan 2013
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    Full-text · Article · Jan 2013
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    ABSTRACT: Background: Viruses are detected in most hospitalized children admitted for acute respiratory infections. Etiologic understanding is needed to improve clinical management and prevention, particularly in resource-limited tropical countries. Methods: A 3-year prospective descriptive study was conducted among Cambodian children admitted to 2 provincial hospitals for acute lower respiratory tract infection. Molecular detection for 18 viral pathogens using multiplex polymerase chain reaction/reverse transcription polymerase chain reactions was performed. Results: We enrolled 1006 children less than 5 years of age of whom 423 (42%), 428 (42%) and 155 (16%) had pneumonia, bronchiolitis and unclassified lower respiratory tract infections, respectively. Of the 551 (55%) with documented viral infection, a single virus was detected in 491 (89%), including rhinovirus (n = 169; 34%), respiratory syncytial virus (n = 167; 34%), parainfluenza virus (n = 40; 8%), human metapneumovirus (n = 39; 8%), influenza virus (n = 31; 6%), bocavirus (n = 16; 3%), adenovirus (n = 15; 3%), coronavirus (n = 9; 2%) and enterovirus (n = 5; 1%). Coinfections with multiple viruses were detected in 6% (2 viruses detected in 59 cases; 3 viruses detected in 1 case). Conclusion: Similar to other tropical countries, rhinovirus and respiratory syncytial virus were the principal viral pathogens detected among children hospitalized for lower tract respiratory infection in Cambodia.
    Full-text · Article · Aug 2012 · The Pediatric Infectious Disease Journal

  • No preview · Article · Jan 2012 · Revue des Maladies Respiratoires
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    ABSTRACT: In many Asian countries, Klebsiella pneumoniae (KP) is the second pathogen responsible for community-acquired pneumonia. Yet, very little is known about KP etiology in ALRI in Cambodia, a country that has one of the weakest medical infrastructures in the region. We present here the first clinico-radiological description of KP community-acquired ALRI in hospitalized Cambodian patients. Through ALRI surveillance in two provincial hospitals, KP was isolated from sputum and blood cultures, and identified by API20E gallery from patients ≥ 5 years-old with fever and respiratory symptoms onset ≤14 days. Antibiotics susceptibility testing was provided systematically to clinicians when bacteria were isolated. We collected patients' clinical, radiological and microbiological data and their outcome 3 months after discharge. We also compared KP-related with other bacteria-related ALRI to determine risk factors for KP infection. From April 2007 to December 2009, 2315 ALRI patients ≥ 5 years-old were enrolled including 587 whose bacterial etiology could be assigned. Of these, 47 (8.0%) had KP infection; their median age was 55 years and 68.1% were females. Reported prior medication was high (42.5%). Patients' chest radiographs showed pneumonia (61.3% including 39% that were necrotizing), preexisting parenchyma lesions (29.5%) and pleural effusions alone (4.5%) and normal parenchyma (4.5%). Five patients had severe conditions on admission and one patient died during hospitalization. Of the 39 patients that were hospital discharged, 14 died including 12 within 1 month after discharge. Only 13 patients (28%) received an appropriate antibiotherapy. Extended-spectrum beta-lactamases (ESBL) - producing strains were found in 8 (17.0%) patients. Female gender (Odds ratio (OR) 2.1; p = 0.04) and diabetes mellitus (OR 3.1; p = 0.03) were independent risk factors for KP-related ALRI. KP ALRI in Cambodia has high fatality rate, are more frequently found in women, and should be considered in diabetic patients. The extremely high frequency of ESBL-producing strains in the study is alarming in the context of uncontrolled antibiotic consumption and in absence of microbiology capacity in most public-sector hospitals.
    Full-text · Article · Jan 2012 · BMC Infectious Diseases
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    Full-text · Article · Jan 2012 · The Pediatric Infectious Disease Journal
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    ABSTRACT: To identify factors associated with negative direct sputum examination among African and Cambodian patients co-infected by Mycobacterium tuberculosis and HIV. Prospective multicenter study (ANRS1260) conducted in Cambodia, Senegal and Central African Republic. Univariate and multivariate analyses (logistic regression) were used to identify clinical and radiological features associated with negative direct sputum examination in HIV-infected patients with positive M. tuberculosis culture on Lowenstein-Jensen medium. Between September 2002 and December 2005, 175 co-infected patients were hospitalized with at least one respiratory symptom and pulmonary radiographic anomaly. Acid-fast bacillus (AFB) examination was positive in sputum samples from 110 subjects (63%) and negative in 65 patients (37%). Most patients were at an advanced stage of HIV disease (92% at stage III or IV of the WHO classification) with a median CD4 cell count of 36/mm³. In this context, we found that sputum AFB negativity was more frequent in co-infected subjects with associated respiratory tract infections (OR = 2.8 [95%CI:1.1-7.0]), dyspnea (OR = 2.5 [95%CI:1.1-5.6]), and localized interstitial opacities (OR = 3.1 [95%CI:1.3-7.6]), but was less frequent with CD4 ≤ 50/mm³ (OR = 0.4 [95%CI:0.2-0.90), adenopathies (OR = 0.4 [95%CI:0.2-0.93]) and cavitation (OR = 0.1 [95%CI:0.03-0.6]). One novel finding of this study is the association between concomitant respiratory tract infection and negative sputum AFB, particularly in Cambodia. This finding suggests that repeating AFB testing in AFB-negative patients should be conducted when broad spectrum antibiotic treatment does not lead to complete recovery from respiratory symptoms. In HIV-infected patients with a CD4 cell count below 50/mm3 without an identified cause of pneumonia, systematic AFB direct sputum examination is justified because of atypical clinical features (without cavitation) and high pulmonary mycobacterial burden.
    Full-text · Article · Jun 2011 · PLoS ONE
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    ABSTRACT: Melioidosis is a disease caused by Burkholderia pseudomallei and considered endemic in South-East Asia but remains poorly documented in Cambodia. We report the first series of hospitalized pulmonary melioidosis cases identified in Cambodia describing clinical characteristics and outcomes. We characterized cases of acute lower respiratory infections (ALRI) that were identified through surveillance in two provincial hospitals. Severity was defined by systolic blood pressure, cardiac frequency, respiratory rate, oxygen saturation and body temperature. B. pseudomallei was detected in sputum or blood cultures and confirmed by API20NE gallery. We followed up these cases between 6 months and 2 years after hospital discharge to assess the cost-of-illness and long-term outcome. During April 2007 - January 2010, 39 ALRI cases had melioidosis, of which three aged ≤2 years; the median age was 46 years and 56.4% were males. A close contact with soil and water was identified in 30 patients (76.9%). Pneumonia was the main radiological feature (82.3%). Eleven patients were severe cases. Twenty-four (61.5%) patients died including 13 who died within 61 days after discharge. Of the deceased, 23 did not receive any antibiotics effective against B. pseudomallei. Effective drugs that were available did not include ceftazidime. Mean total illness-related costs was of US$65 (range $25-$5000). Almost two-thirds (61.5%) incurred debt and 28.2% sold land or other belongings to pay illness-related costs. The observed high fatality rate is likely explained by the lack or limited access to efficient antibiotics and under-recognition of the disease among clinicians, which led to inappropriate therapy.
    Full-text · Article · May 2011 · BMC Infectious Diseases
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    ABSTRACT: Most clinical guidelines recommend that AIDS-free, HIV-infected persons with CD4 cell counts below 0.350 × 10(9) cells/L initiate combined antiretroviral therapy (cART), but the optimal CD4 cell count at which cART should be initiated remains a matter of debate. To identify the optimal CD4 cell count at which cART should be initiated. Prospective observational data from the HIV-CAUSAL Collaboration and dynamic marginal structural models were used to compare cART initiation strategies for CD4 thresholds between 0.200 and 0.500 × 10(9) cells/L. HIV clinics in Europe and the Veterans Health Administration system in the United States. 20, 971 HIV-infected, therapy-naive persons with baseline CD4 cell counts at or above 0.500 × 10(9) cells/L and no previous AIDS-defining illnesses, of whom 8392 had a CD4 cell count that decreased into the range of 0.200 to 0.499 × 10(9) cells/L and were included in the analysis. Hazard ratios and survival proportions for all-cause mortality and a combined end point of AIDS-defining illness or death. Compared with initiating cART at the CD4 cell count threshold of 0.500 × 10(9) cells/L, the mortality hazard ratio was 1.01 (95% CI, 0.84 to 1.22) for the 0.350 threshold and 1.20 (CI, 0.97 to 1.48) for the 0.200 threshold. The corresponding hazard ratios were 1.38 (CI, 1.23 to 1.56) and 1.90 (CI, 1.67 to 2.15), respectively, for the combined end point of AIDS-defining illness or death. Limitations: CD4 cell count at cART initiation was not randomized. Residual confounding may exist. Initiation of cART at a threshold CD4 count of 0.500 × 10(9) cells/L increases AIDS-free survival. However, mortality did not vary substantially with the use of CD4 thresholds between 0.300 and 0.500 × 10(9) cells/L.
    Full-text · Article · Apr 2011 · Annals of internal medicine
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    Full-text · Article · Jan 2011 · BMC proceedings

Publication Stats

3k Citations
672.27 Total Impact Points

Institutions

  • 2005-2014
    • Pierre and Marie Curie University - Paris 6
      • Faculté de médecine Pierre et Marie Curie
      Lutetia Parisorum, Île-de-France, France
  • 2007-2013
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
    • Centre Hospitalier Victor Dupouy
      Argenteuil, Île-de-France, France
    • Université Paris-Sorbonne - Paris IV
      Lutetia Parisorum, Île-de-France, France
  • 2006-2007
    • Hôpital Tenon (Hôpitaux Universitaires Est Parisien)
      Lutetia Parisorum, Île-de-France, France
    • Hôpital Foch
      Lutetia Parisorum, Île-de-France, France
  • 1992
    • Hôpital Bichat - Claude-Bernard (Hôpitaux Universitaires Paris Nord Val de Seine)
      Lutetia Parisorum, Île-de-France, France
  • 1987-1990
    • Institut Pasteur
      Lutetia Parisorum, Île-de-France, France
    • Hôpital Charles Foix – Groupe Hospitaliere "La Pitié Salpêtrière - Charles Foix"
      Ivry, Île-de-France, France