Toxicité sérotoninergique résultant d’une interaction médicamenteuse entre le bleu de méthylène et les inhibiteurs de la recapture de la sérotonine

Background:

Methylene blue is used in medical practice for various reasons. Recent findings point to a potential interaction with serotonin reuptake inhibitors (SRIs) that could lead to serotonergic toxicity.

Objective:

To describe the risk of serotonergic toxicity associated with the interaction between methylene blue and SRIs.

Data sources:

Relevant publications were searched systematically via MEDLINE (1946 to March 21, 2013) and Embase (1974 to 2013, week 11) with the following search terms: “methylene blue”, “methylthioninium”, “monoamine oxidase inhibitors”, “serotonin reup-take inhibitors”, and “serotonin syndrome”. No restrictions were applied in relation to the indication for methylene blue or the language of publication. The reference lists of identified articles were also searched.

Study selection and data extraction:

Eighteen case reports and 2 case series were identified for inclusion. To date, no randomized controlled trials have been published.

Data synthesis:

The first case report indicating suspicion of an interaction between methylene blue and SRIs was published in 2003. Seventeen other case reports describing the same type of interaction have been published since then. The 2 case series provided data from about 325 parathyroidectomies in which methylene blue was used for staining. The 17 patients who experienced central nervous system toxicity were all taking SRIs in the preoperative period.

Conclusion:

When administered in combination with SRIs, methylene blue may lead to serotonergic toxicity at doses as low as 0.7 mg/kg. Methylene blue would seem to have monoamine oxidase A inhibitory properties. Precautions should be taken to avoid this interaction.[Publisher’s translation]     

Le diagnostic rapide des mécanismes de résistance aux antibiotiques

Rapid tests using immunologic, biochemical or molecular biology techniques have been introduced for routine diagnosis in the laboratories of microbiology. The development of rapid tests for the detection of antimicrobial resistance mechanisms is justified in patients with high mortality risk when the antimicrobial therapy is unadapted. Rapid tests for detection of beta-lactamase and methicillin-resistance in staphylococci are available for routine use. The development of new molecular techniques for identification coupled with the detection of resistance genes should allow to widely expand the number of resistance mechanisms screened for.     

Plantes médicinales populaires des marchés de Dakar (Sénégal)

Abstract

In Senegal about six hundred species are used in traditional medicine. Some of these plants are sold by herbalists in Dakar markets and in the suburbs. This study shows that only forty species are commonly used for various indications in popular traditional medicine in this area.     

The "médecin de papier", myth or reality?

"Le médecin de papier" can be defined as a little handbook regularly brought up to date, which gave and still gives the captains of merchant ships, fishing-boats or yachts, elementary rules in order to care for their crew in case there were or are no--sea going-- surgeons or doctors on board. Generally speaking, it could be divided into two parts. The first one was a sort of summary of the symptoms and of the treatments of the most frequent maritime diseases. The second one included a list of the medicinal products on board and their main characteristics as well as the way to use and administrate them. "Le médecin de papier" was created by the royal order of August the fourth 1819, as there were not enough surgeons applying for embarking due to the new academical organisation of the studies. So, this "médecin de papier" was given to the captains of the ships who according to the law, wen allowed not to embark--sea going--surgeons. Those vessels had a crew which could be between eight to nineteen men. The editions were on the increase in every French harbour and all through the years, according to the progress of the pharmaceutic science and of the therapeutics; it also depended on the good will and inspiration of the surgeons and chemists who were members of the committees checking on the medecine chests.     

Mécanismes moléculaires de l’émergence de souches de Neisseria meningitidis responsables d’infections invasives

Neisseria meningitidis is a commensal bacterium of the human nasopharynx that occasionally provokes invasive disease (meningitis and septicemia). Virulence factors facilitate the ability of the bacteria to multiply in its host and to invade sterile sites such as the blood, the cerebrospinal fluid or other sites such as the synovial or pericardial fluids. However, meningococcal disease is not a part of the transmission cycle. Moreover, N. meningitidis is highly variable due to frequent DNA exchanges between strains. New variants that are modified in their virulence and/or transmissibility are continually generated. New genotypes of N. meningitidis may exhibit enhanced virulence that enables them to escape the host immune defense (short term evolution). Variants with a selective advantage in transmissibility may spread rapidly among susceptible hosts (long term evolution).