Où trouver des données pour la pharmacoépidémiologie en France ? Quelques idées

Prior to the conduct of a pharmacoepidemiologic study, it is necessary to obtain the following: 1) A literature review to identify previous studies conducted on the issue of interest; 2) Data on the profiles of use of the drugs of interest (i.e. frequency of exposure, demographic characteristics of users…). In France, there is currently no database, which routinely collects this type of information. In this paper, we provide a list of sources of information on drugs available in France that we have identified. These sources are scattered and highly heterogeneous in terms of available information and access requirements.     

Dépistage des bactériuries à l'admission chez les patients diabétiques : peut-on abandonner les examens cytobactériologiques urinaires systématiques ?

OBJECTIVES AND METHOD: The discordance between test by urine dipstick (nitrites and leucocyte-esterase) and analysis in laboratory, with urinary culture on the same sample was studied in diabetic patients, from October 2000 to May 2002, to eventually stop systematic laboratory test. The dipstick result (Clinitek 20 Bayer) was classified as "possibility of bacteriuria" if one of the two tests was positive. Bacteriuria was considered significant if the laboratory test result gave, at least 10(5) bacteria per mL, (one strain), and at least 10(4) leucocytes. The out point was the dipstick negative predictive value (NPV). RESULTS: The study included 683 patients. The dipstick result was "possibility of bacteriuria" in 153 cases (22.4%). Thirty-nine bacteriuria (5.7%) were reported, including 2 dipstick false negatives. The NPV was 99.6% [IC 95% : 99.1-100]. CONCLUSION: The systematic laboratory tests were stopped.     

L'éjaculation prématurée selon les médecins et les sexologues français de 1830 à 1960

Premature ejaculation is the most common male sexual dysfunction. In 1992 in France, it affected "persistently" (obtained the response "often") 11% of sexually active men aged between 18 and 69 years (and 65% "at least occasionally", in other words "often", "sometimes" or "fairly rarely"). However, for a long time this problem has attracted less specialist attention than erectile dysfunction. Until now, historians of sexuality and medicine have almost completely ignored it. In this article we therefore intend to do the preliminary work in a still poorly known area, by examining the hypotheses that were developed to explain this phenomenon, and the treatment recommendations that were made between 1830 and 1960 by French doctors and sexologists concerning premature ejaculation, mostly to married couples. We describe three steps in the development of these ideas. From 1830 to 1855, premature ejaculation was considered to be a mainly "physical" problem where the man was a victim (Morel de Rubempré, 1835, Roubaud, 1855). From 1856 to 1929, premature ejaculation was considered to be primarily a "psychological" problem where the man was entirely or partly "responsible" (Guyot, 1859; Doctor-Brennus, 1907). Finally, between 1930 and 1960 premature ejaculation appeared to be both a "physical" and "psychological" problem, with the man sometimes responsible for the phenomenon and sometimes its victim (see, in particular, Higier, 1932; Palazzoli, 1935; Chanson, 1953; Valensin, 1960).     

Quelles mesures de prévention primaire peut-on proposer pour éviter une borréliose de Lyme ?

Arthropod-borne diseases are a real public health problem. One of these, Lyme disease, is a bacterial infection due to Borrelia spp., transmitted by a hard tick, Ixodes spp.. The infection is particularly prevalent in the Northern Hemisphere and primary prevention relies on the use of repellents for cloth impregnation (pyrethroids) or for skin application (DEET). Pyrethroids and DEET are the two most studied repellents. The concentration of the active principle is essential to get a real repellent efficiency. The most efficient are: DEET at 30-50%, picaridin or KBR3023 at 20%, citriodiol at 30-50%, and IR35/35 at 20-35%. These molecules may induce adverse-effects. Considered for some time as cosmetics, a new European regulation now defines these molecules as biocides.     

Connaissance en sexologie des étudiants en médecine et leurs usages d'Internet

AimTo investigate possible relations between the basic knowledge of 4th year medical students in sexology and their use of the Internet.MethodsAll 4th year students (N = 102; median age = 21, SD = 1.7 years) in our department have answered 15 questions pertaining to basic knowledge in sexology (i.e. practical knowledge and knowledge about the line that separates normal sexuality from sexual disorder) as well as 4 groups of questions pertaining to their Internet use habits (connection types, amount of time spent on visiting sex oriented Internet websites, frequency of visit of sex oriented websites, levels of discomfort associated with de use of sexual websites measured with visual analogical scales [VAS]). We have correlated their performance on the "basic knowledge in sexology" questionnaire with the duration and frequency of their use of sexual websites, using Pearson's tests, or mean comparisons (Student).ResultsShow that the “sexual” use of the Internet is not important in this group. The most frequent use includes the “chat” activity, in which 42.7% of the subjects have reported having occasionally or frequently taken part; 11.2% have reported visiting websites that were explicitly sexual, and 3.2% have visited thematic websites on sexology. Students reported having been disturbed by sexual pictures at a 3.6/10 (VAS) intensity. There is no global relation between the number of hours the respondents reported having spent on the Internet and their knowledge in sexology. Moreover, the “sexual” use of Internet does not influence respondents' scores on the 'sexology questionnaire' apart from their aptitude to delineate the limits of normality in triolism. Students who mostly use the Internet during week-ends are also those who mostly use it for sexual purposes. On the other hand, students who visit the Internet mostly during the week have an infrequent sexual use of it, and consider homosexuality and masturbation to be pathological.ConclusionThe use of the Internet for sexual purposes is limited in our sample; it does not improve any additional aptitude, and – with occasional exceptions – does not generate erroneous notions about sexuality. A number of medical students still consider homosexuality and masturbation pathological should prompt lecturers to be vigilant while providing basic training in sexology.     

Protéines « lentes », protéines « rapides »

Protein intake is the main factor of regulation of anabolism. Intrinsic composition of dietary protein, digestibility and speed of digestion are major factors of regulation. Lactoserum proteins are named “fast” because quickly free in stomach, and hydrolyzed in duodenum. On the contrary, casein proteins are named “slow” because slowly free in small bowel and slowly absorbed. Ingested alone, slow proteins are more efficient to stimulate anabolism. “Slow or speed” characteristic of proteins persist also in complete feeding. “Proteic gain” of feeding could be assessed with this new data.     

Physiopathologie de la dyslipidémie du syndrome métabolique et du diabète de type 2

Lipid abnormalities in people with Metabolic Syndrome and Type 2 diabetes are likely to play an important role in the development of atherogenesis. These lipid disorders include not only quantitative but also qualitative abnormalities of lipoproteins which are potentially atherogenic. The main quantitative abnormalities are increased triglyceride levels, related to an augmented hepatic production of VLDL and a reduction of both VLDL and IDL catabolism (in Type 2 diabetes), and decreased HDL-Cholesterol levels due to an accelerated HDL catabolism. The main qualitative abnormalities include large VLDL particles (VLDL₁), relatively rich in triglycerides, small dense LDL particles, increase in triglyceride content of LDL and HDL. Moreover, glycation of apolipoproteins and increased susceptibility of LDL to oxidation are observed in Type 2 diabetes. Although plasma LDL-cholesterol level is usually normal in Type 2 diabetic patients, LDL particles show significant kinetic abnormalities, such as reduced turn over, which is potentially harmful. The pathophysiology of lipid abnormalities in Type 2 diabetes is not yet totally explained. However, insulinresistance and the "relative" insulin deficiency, observed in patients with Type 2 diabetes, are likely to play a crucial role since insulin has an important function in the regulation of lipid metabolism. In addition, it is not excluded that adipocytokines, such as adiponectin, could play a role in the pathophysiology of lipid abnormalities in Type 2 diabetes.     

Borréliose de Lyme : quel est le suivi nécessaire après le traitement ?

The post therapeutic follow-up of Lyme borreliosis is managed according to clinical and serological data. The evolution of antibody rates is such that it doesn't constitute the best element to rely on for follow-up. Indeed, after a sometimes transitory increase of this rate during or after antibiotherapy, the decrease is very slow, sometimes several months, and often incomplete. The follow-up should thus be made according to clinical symptoms and their resolution. Resolution of some but not all symptoms must lead to discussing two options. The first is that of administrating a complementary antibiotherapy with a different mode of action than the first antibiotic used. The second is that this may be due to recontamination, especially in highly endemic zones, given that antibodies present have no protecting effect. In this case, a new antibiotherapy must of course be initiated.     

Place des méthodes biologiques dans le diagnostic des différentes manifestations de la borréliose de Lyme. Quelles sont les techniques ? Quelles sont celles disponibles actuellement ?

The biological diagnosis of Borrelia burgdorferi sensu lato infection is usually made by antibody detection in patient sera. Thus, serological testing (Elisa, immunoblotting) is essential for a biological diagnosis. Specific antibody detection is usually done in serum and CSF of patients suspected of Lyme borreliosis. Laboratories must follow European recommendations to validate these assays in routine practice. Antibody detection lacks sensitivity in the early cutaneous phase of the infection. Therefore, serological testing is not recommended for the diagnosis of erythema migrans. The interpretation of serology must take into account the variability of Elisa sensitivity and specificity and the lack of standardization for Western-blotting in Europe. Besides these indirect diagnosis techniques, there is also direct detection of spirochetes by culture or by in vitro DNA amplification but these require adequate samples. These molecular tests must not be performed routinely, but only for specific clinical situations and in specialized laboratories only.     

L'isolement septique des patients colonisés–infectés par Acinetobacter baumannii est-il totalement superflu,utile ou indispensable ?

Until 2001, the infection control department of the Besançon university hospital (France) recommended isolation precautions for all patients colonized–infected by Acinetobacter baumannii (Ab) whatever the antibiotic susceptibility of the strain. These systematic isolation procedures were given up at the beginning of 2002 since the number of colonized–infected patients remained stable from 1998 to 2001.ObjectiveThe aim of this study was to evaluate the impact of this decision on the risk of Ab infection.MethodIncidence rates of colonization–infections that were observed during years 2002 and 2003 were compared with expected incidence rate, based on data from 1998–2001 period. Infection control practices and antibiotics consumption were evaluated for each ward of hospitalisation. Genotyping made it possible to determine diversity of clones inside each unit and the whole hospital.ResultsThe expected incidence per 1000 patients-days was 0.22 in comparison with observed data in 2002, 0.34 (CI_95% [0.28–0.42]), and in 2003, 0.53 (CI_95% [0.45–0.63]). The expected number of Ab bloodstream infections, about two per year compared with the observed numbers in 2002 and 2003 respectively seven and 17. The number of unit with more than three cases per year increased from seven in 1999 to 18 in 2003. Antibiotics consumption did not change significantly.ConclusionGenotyping results show the importance of cross-transmission in these units. Finally, observed results suggest that some measures of isolation precautions in addition to standard precautions are needed to prevent outbreaks of Ab.     

Traitement antibiotique des pneumonies communautaires de l'adulte – apport des nouvelles molécules ; place des traitements de durée abrégée ; données pharmaco-économiques

There have been relatively few well-designed clinical trials comparing new antibiotics; mainly quinolones with enhanced in vitro activity against Streptococcus pneumoniae – and valid comparators. Quinolones are at least as efficient as comparators. But trials are of limited value in choice assistance for the empirical treatment of community-acquired pneumonia, since they are not stratified according to the severity of pneumonia and risk factors. The potential toxicity and ecological damage do jnot favor a large utilization of quinolones.     

Certains symptômes cliniques aspécifiques ont-ils une origine borrélienne ?

Chronic manifestations (knee arthritis, encephalomyelitis, axonal polyneuropathy) may occur in the late phase of Lyme disease. Contrasting with such well-defined manifestations, the "post-Lyme syndrome" includes symptoms such as fatigue, algia, malaise, cognitive disorders, after treatment of a documented Lyme disease. The analysis of clinical, neuropsychological, bacteriological, immunological, epidemiological, quality of life, and treatment data does not support the reality of such a syndrome. Moreover, no physiopathological data can relate Borrelia infection to such symptoms in patients without previously documented Lyme disease symptoms but who are seropositive (or even sometimes without serodiagnosis as for instance in the Munchausen by proxy, or Gulf war syndromes).     

L'hypomagnésémie : causes,manifestations et traitement

Magnesium plays a major role in energetic and protein metabolism and in the homeostasis of electrolytes. Magnesium deficiency or hypomagnesemia implicate always a subjacent pathology. It is often secondary to digestive or renal loss. Hypomagnesemia is a frequent finding in hospitalised patients especially in reanimation and intensive care units. Little of literature data concerning treatment of hypomagnesemia in different situations. Tolerance and efficacy of different salts of magnesium are also not well-known. We try in this paper to resume the different causes and aspects and to propose a therapeutic approach of hypomagnesemia.