État de la résistance du pneumocoque en 1999 dans la région Rhône-Alpes

Objective – The authors wanted to determine the state of pneumococcus resistance in the Rhône-Alpes region, in 1999.Patients and method – One thousand eight hundred and thirteen strains of S. pneumoniae (Sp) (64.5% adults, 35.5% children) were collected by 31 clinical microbiological laboratories. Susceptibility to oxacillin of the strains (isolated in pathogenic conditions) was measured according to CA-SFM standards. The MICs of penicillin (P), amoxicillin (AMX), and cefotaxime (CTX) were determined (E-test or ATB-Pneumo gallery) for all strains resistant to penicillin G (PRP). The regional coordinating center checked the MIC and serotype of each PRP strain.Results – The prevalence of PRP (MIC > 0.06 mg/L) was 40.5%. Resistance (I + R) to ERY, TET, SXT, and C was respectively 42%, 27.4%, 37.9%, and 19.2%. Among the 9.4% of strains resistant to P (MIC > 1 mg/L), 63.3% were intermediate to AMX (0.5 < MIC ⩽ 2 mg/L) and 0.8% resistant to CTX (MIC > 2 mg/L). The multiresistance was frequent in PRP: 70.7% to ERY, 72% to TET, 45% to SXT, 32.8% to C, and only 0.4% to RIF. PRP of serotype 14 (23.8%) were the most frequent, followed by serotypes 6 (16%), 23 (15.7%), 9 (12%), 19 (11%), and 15 (2.8%).Discussion – PRP have been increasing since 1997 (29.5% vs. 40.5%), AMX-R strains are still infrequent (2%), and CTX-R strains even though rare (0.3%) are now isolated.     

Bécégite généralisée : étude de quatre observations

Inoculation by the BCG in the birth is compulsory in our country since 1959. Adverse reactions induced by vaccination with the BCG are rare varying from zero to 23.8%. Spread infections are even rarer and their estimated incidence is 0.1 to 4.3 per one million vaccinated children. The fatal disseminated BCG infection is exceptional and affects especially the children presenting an immune defect. The role of a familial gene defect needs to be taken into consideration. The BCG osteitis is found in second position in clinical forms after the suppurative lymphadenitis; it arises generally five months to five years after the vaccination. We report four observations of disseminated BCG infection occuring in children from three months to four years with a mortal evolution in two cases. Our objective is to discuss pathologic aspects of BCG disease.     

Adecuación de la utilización de benzodiazepinas en ancianos desde la oficina de farmacia. Un estudio de colaboración médico-farmacéutico

AimsTo improve the use of benzodiazepines (BZD) in the elderly by a pharmacist-physician collaboration, and to insure that BZD are effective, safe, and used as long as necessary.DesignA single blind controlled study was conducted on 11 pharmacies in the Community of Valencia.SettingEleven pharmacies in the Community of Valencia.ParticipantsPatients older than 65 years treated with BZD attending the participating pharmacies.InterventionsInterviews and pharmaceutical care for a year.Main measurementdetection of duplications, adverse drug reactions, drug interactions and measuring the effectiveness of the treatment.ResultsWe studied 314 patients, randomised to control or intervention and who used 346 BZD. The majority (67 %) of patients used BZD for more than 1 year. Only 5 % patients with anxiety knew the duration of treatment should be one month. Long-acting BZD were used by 20 % of the patients, 76 % used medium-acting (39 % lorazepam and 37 % other BZD) and 4 % short-acting BZD. A total of 132 drug interactions were detected and 278 adverse drug reactions: 32 % memory loss, 21 % drowsiness, 12 % lack of coordination, 8.3 % dizziness and confusion, 8,3 % disorientation and 10 % others. A total of 426 pharmacist interventions were performed, 30 accepted by the doctor and 78 were resolved at the end of the year of study. Eleven per cent of cases were considered satisfactory in the control group and 30 % in the intervention group.ConclusionThe use of benzodiazepines in the Community of Valencia exceeds the recommendations of the Spanish Medicines Agency.     

Évaluation de la fonction rénale chez l’enfant en nutrition parentérale cyclique prolongée

Objective. – A few data are available about the influence of long-term parenteral nutrition (PN) on renal function in children. However, the outcome of children with intractable digestive disease in long-term PN is either lifelong PN or small bowel transplantation requiring prolonged administration of nephrotoxic drugs. Therefore, it is important to assess the risk of PN induced nephrotoxicity. The aim of this study was to provide data about glomerular and tubular renal function in children on long-term PN.Patients and Methods. – Twenty-eight patients were studied, aged 10 months to 23 years (mean: 7.5 years), without uropathy, who had received PN for a mean 5.9 years (10 months–16 years). Underlying diseases were: short bowel syndrome (21), functional gut disease (6) and other (1). Blood and urinary samples were used to measure: creatinine, creatinine clearance (CrCl), inuline clearance (InCl) and PAH clearance (PAHCl), microalbuminuria and β2microglobulinuria. Renal ultrasonography was performed.Results. – Creatinine was normal in all the patients. InCl was normal in 75% of the patients. PAHCl was normal in all the studied patients (16). Microalbuminuria and β2microglobulinuria were normal in 17/19 patients. Renal ultrasonography was normal in all the patients. No correlation appeared between InCl and CrCl, neither between the duration of PN and glomerular function.Conclusions. – Renal function being normal in 75% of the population studied, neither the role of PN itself, nor the role of underlying disease, on renal function impairment could be assessed. The InCl appears as the best marker of glomerular function.     

Profil épidémiologique des femmes victimes de violences psychologiques en période pré- et post-partum dans la région de Sédhiou,Sénégal

BackgroundIn Senegal, psychological violence remains a taboo subject insofar as it often arises in the closed circle of family life. It has a highly negative impact on the health of pregnant women. The objective of this work was to study the epidemiological profile of female victims of psychological violence before and after birth in the Sédhiou region.MethodAn observational, cross-sectional and analytical study was carried out from December 4, 2018 to April 4, 2019. The study population consisted of all the women received for postnatal consultation in one of the referral health structures in the Sédhiou region. Data were collected using a survey form and a questionnaire administered to the women having met the inclusion criteria. The data were entered using CS Pro software and subsequently analyzed using R 3.4.4 software.ResultsThe mean age of the women was 25.4 ± 7.8 (14–43 years). A total of 222 women (55.5 %) had suffered psychological violence during the prepartum period. Isolated psychological violence represented 44.3 % of the surveyed population, while psychological violence associated with sexual or physical violence represented 8.0 % and 5.4 % of the respondent population, respectively. The factors associated with psychological violence during the prepartum period were pursuit of a professional activity [ORaj = 4.7 (1.3–17.0)], high educational status [ORaj = 7.0 (4.2–11.5)] and performance of fewer than 3 antenatal consultations (ANC) [ORaj = 2.2 (1.2–4.0)]. Maternal, fetal and neonatal complications were more frequent among victims of psychological violence (P < 0.05). During the postpartum period, 26.5 % of the women who had been victims of violence during the prepartum period mentioned the fact that the aggression had ceased. The other women continued to endure violence, which was even more intense among 2.5 %.ConclusionPsychological violence among pregnant women has a negative impact on the health of the mother and the newborn. This state of affairs should induce health care providers to increase popular awareness of its detrimental effects. Communication efforts aimed at behavioral change will need to be combined during prenatal consultations with strengthened screening for violence, the objective being to achieve improved care.     

Étude de la fragilité de la personne âgée et de l’activité physique en médecine générale : à propos d’une étude prospective

IntroductionFrailty is a transient and reversible condition that can lead to significant morbidity and mortality and to the loss of autonomy. It is one of the key issues in public health and the prevention of addiction. Physical activity is often described as a protective factor against addiction and as a factor in limiting frailty. Our goal is to analyze the relationship between physical activity and frailty among the elderlyMethodsA cross-sectional observational study was carried out in three general practice clinics located in the French department of Eure. Patients aged 65 and over were included during a consultation with their GP. Dependent patients under the ADL scale were excluded. Level of physical activity was assessed by the Ricci and Gagnon questionnaire, which defines an active profile as a score ≥ 18 points. Frailty was sought out by the Fried scale and the SEGA A grid. Multivariate analysis was performed to adjust frailty scores to age, gender, and level of physical activity.ResultsOut of the 70 patients included, 36 were active (51%) and 34 inactive (49%). They were predominantly female with 47 women (67%). Average age was 75.3 years. Twelve patients were diagnosed as frail (17%) with the Fried scale and 24 (34%) with the SEGA A grid. Bivariate analysis revealed a greater frailty according to the Fried criteria in the inactive than in the active patients (mean for active patients 0.56 IC95 [0.31; 0.80], compared to 1.76 [1.21; 2.32] in the inactive patients, p < 0.0001). The difference in mean was likewise significant regarding the SEGA A score (6.42 IC95 [5.34, 7.49] in the active population, as opposed to 8.65 IC95 [7.15, 10.15] among the inactive, p = 0.017). In multivariate analysis, the Fried scale was primarily influenced by age and ADL, while the SEGA score was impacted by female gender and level of physical activity.ConclusionPhysical activity seems to have a positive effect on frailty. It would be interesting to propose systematic screening for frailty in general medicine and to institute preventive measures, including physical activity. Initiatives encouraging and promoting seniors’ physical activity should be strengthened.