Médecine générale de ville et interruption volontaire de grossesse médicamenteuse en région Grand Est,France

Background

Access to VTOP (Voluntary Termination of Pregnancy) is a national priority in France. Once legalized in 1975, several laws contributed to improve access to VTOP, such as the 2004 family planning law which enabled urban practitioners to carry out orthogenic work. This law was supplemented by the 2016 health care modernization act. On the whole, the organization for VTOP access in the Grand Est region, complies with legislation and recommendations. However, private practitioners contribute little to this activity. Since there are very few gynecologists in certain areas (whether private or hospital practitioners), general practitioners seem to be the first line actors. This study aims at describing the orthogenic work of urban, government-regulated general practitioners, in the Grand Est region of France.

Prévalence de l’hypertension artérielle en population générale à la Martinique

BackgroundSince 1996, arterial hypertension has been recognized as one of the main health priorities in Martinique. However, its prevalence in the general population has never been measured. Furthermore, obesity is increasing in many countries and studies have shown that hypertension is more frequent in obese people than in people with normal body mass index. The objective of this survey is to measure hypertension prevalence in the general population and to study the link between hypertension, weight status and socioeconomic level.MethodsCross-sectional study of randomly selected homes in randomly selected geographical islets. All household members in these homes constituted the eligible population. Arterial hypertension was defined as systolic pressure greater than 140 mmHg and/or diastolic pressure greater than 90 mmHg and/or antihypertensive treatment. Weight status was estimated using the body mass index.ResultsStudy concerned 1504 persons aged 16 years or older with a sex-ratio of 0.7 and an average age of 48.3 years for men and 48.5 years for women, p = 0.88. The prevalence rate of hypertension is 29% [IC_95%: 25.9–31.8] in the sample and declines to 22.5% [IC_95%: 20.1–25.1] using weighted data. The prevalence rate is 33.1% [IC_95%: 30.2–36.6] for overweight and 20.1% [IC_95%: 17.8–22.6] for obesity. Being overweight is more frequent among persons with hypertension than among ones with normal blood pressure, 73.0 versus 47.4%; p < 0.001. In those with hypertension, overweight does not differ significantly between men and women, but the prevalence of obesity is greater among women than among men (35.7 versus 20.6 %, p < 0.05).ConclusionThe high prevalence of both hypertension and obesity in the general Martinican population has been confirmed by this study. Prevention actions are required to decrease the cardiovascular risk in this population.     

Incompatibilités médicamenteuses et nutrition parentérale en néonatologie

Drug administration in neonatology is challenging and may lead to preparation and administration difficulties associated with a high risk of drug errors. Concomitant administration of drugs and parenteral nutrition (PN), with or without lipid emulsion, is a common practice in the neonates. There is a high risk of physico-chemical incompatibilities with rare but serious consequences such as pulmonary and renal embolism. There is a lack of data on compatibility for the majority of drugs used for co-infusions in neonates. An individualized approach is required to manage drugs and PN administrations. Clinical pharmacists may help physicians and nurses in the unit to better understand and prevent drug incompatibilities.     

Stress oxydant et maladies neurodégénératives

Oxidative stress is involved in cellular death pathways of neurodegenerative diseases. Alzheimer’s disease, Parkinson’s disease and amyotrophic lateral sclerosis are the most frequent of these affections. In each case, there are evidences of an altered oxidative status. Oxidative stress play a role in all the pathophysiological hypothesis of Alzheimer’s disease, and several anti-oxidant compounds are efficient. In amyotrophic lateral sclerosis patients, only an association of vitamin E with riluzole, a glutamate inhibitor, has shown to have a favourable effect. The pathogenesis of Parkinson's disease implies oxidative stress in the dopaminergic neuronal death of the substantia nigra. The arguments include alterations of brain iron content, impaired mitochondrial function, alterations of protective systems. The neurotoxin 1–méthyl–4–phényl–1,2,3,6–tetrahydropyridine is a Parkinson model caused by an inhibition of the complex I of the mitochondrial respiratory chain. DATATOP study, using selegiline, an inhibitor of mono-amine oxidase with anti-oxidant properties, showed a modest neuroprotective effect of this compound but a lack of effect of vitamin E.     

L’imputation multiple des données manquantes aléatoirement : concepts généraux et présentation d’une méthode Monte-Carlo

BackgroundStatistical analysis of a data set with missing data is a frequent problem to deal with in epidemiology. Methods are available to manage incomplete observations, avoiding biased estimates and improving their precision, compared to more traditional methods, such as the analysis of the sub-sample of complete observations.MethodsOne of these approaches is multiple imputation, which consists in imputing successively several values for each missing data item. Several completed data sets having the same distribution characteristics as the observed data (variability and correlations) are thus generated. Standard analyses are done separately on each completed dataset then combined to obtain a global result. In this paper, we discuss the various assumptions made on the origin of missing data (at random or not), and we present in a pragmatic way the process of multiple imputation. A recent method, Multiple Imputation by Chained Equations (MICE), based on a Monte-Carlo Markov Chain algorithm under missing at random data (MAR) hypothesis, is described. An illustrative example of the MICE method is detailed for the analysis of the relation between a dichotomous variable and two covariates presenting MAR data with no particular structure, through multivariate logistic regression.ResultsCompared with the original dataset without missing data, the results show a substantial improvement of the regression coefficient estimates with the MICE method, relatively to those obtained on the dataset with complete observations.ConclusionThis method does not require any direct assumption on joint distribution of the variables and it is presently implemented in standard statistical software (Splus, Stata). It can be used for multiple imputation of missing data of several variables with no particular structure.     

Ménétrier's disease and gastric carcinoma

The authors report 4 cases of Menetrier's disease associated with gastric adenocarcinoma and one case of low-grade dysplasia. The patients (3 men and 2 women) were aged between 53 and 81 years. In three cases the diagnosis was established by histological examination of the exicised tumor; in one case it was based on microbiopsy specimen; and in another case on a gastric tissue specimen. The authors review the anatomo-clinical features of this association and raise the problem of the relationship between Menetrier's disease, dysplasia and cancer.     

Nutrition parentérale et sclérose latérale amyotrophique (SLA)

IntroductionAmyotrophic lateral sclerosis (ALS) is a neuromuscular disease with a severe prognosis, leading to disorders that promote the occurrence of undernutrition. This is an independent factor of survival in this disease. However, the digestive tract is most often functional. For reasons of difficulty in setting up enteral nutrition, or refusal of patients, parenteral nutrition (PN) has been proposed in some cases. The objective of the study was to review literature data regarding PN during ALS.MethodThe various articles in the literature were analyzed in the framework of an interprofessional thematic workshop and a detailed review.ResultsThere were only three articles on this subject, all of French origin, mono or multicentric, and representing 161 patients. Only one article was in part prospective. Patients were selected on the usual indications of PN or the presence of a vital capacity < 50%, or the combination of frontotemporal dementia. Infusions were performed using injection sites or peripherally inserted central catheters (PICC lines). The supervision was medico-dietary. These were patients whose evolution had been long, and their life under PN was very short. The prevalence of PN-related infections was in the range of usual values, and that of thromboses was higher. The quality of life of patients was not specified.ConclusionsPN in ALS is possible in late-stage patients. The technique should be reserved for contraindications of enteral nutrition, but a case-by-case discussion is needed. The present study made proposals for practical recommendations.