[Medication reconciliation in a department of internal medicine and infectious and tropical diseases: Feedback after one year practice]. / Conciliation médicamenteuse d'entrée en service de médecine interne : retour d'expérience après un an de pratique.

Since April 2015, medication reconciliation is performed in our Department. The objective of this study is to assess the impact of this activity on patients' care after one year of practice. METHODS: All patients who received medication reconciliation between April-October 2015 and June-December 2016 were included in this retrospective study. Undocumented unintentional discrepancies (DNIND) which result from the comparison between the patient's usual treatments and the medication prescribed at admission were collected. Then, a multidisciplinary discussion was initiated to correct them. The gravity of each DNIND was determined a posteriori. RESULTS: A statistical comparison between the two studies (2015 vs. 2016) showed the following significant results: decrease in DNIND (0.9 vs. 0.43), in percentage of patients with at least one DNIND (43% vs 31% P <5.10-6), in reconciliation time (43min vs. 23min) and no significant difference in the distribution of DNIND typology. The main therapeutic classes are: metabolism-diabetes-nutrition (21%), cardiology (18%), pneumology (17%) and neurology-psychiatry (15%). Drugs mainly concerned with DNIND are inhaled anti-asthmatics (13% of the medicines with DNIND), vitamins (8% of DNIND) and the levetiracetam antiepileptic drug (5% of DNIND). CONCLUSION: The implementation of the reconciliation medication allowed a significant reduction of the DNIND that permits to improve the patient healthcare pathway.

[Contribution of teledermatology in a hospital pediatrics department]. / Apport de la télédermatologie dans un service de pédiatrie hospitalière.

The hospital of Versailles no longer has a dermatologist; consequently the pediatrics department suggested assess to the system put in place in 2015 based on the telemedicine software platform WebDCR developed throughout the hospital. The acceptability of this was based on its implementation as well as speed and ease of use. METHODS: In 2015, 47 reviews were submitted. RESULTS: No patient refusal was noted. The answer was obtained in 100 % of cases on the day the requests were made, during the week. A diagnosis was made in 36 % of cases and one or more hypotheses were formulated in the 64 % of the remaining cases. The review resulted in a further consultation in 28 % of cases, and in one case to transfer to the dermatology department. The quality of the data collected was considered good or excellent in 96 % of cases. DISCUSSION: This first teledermatology experiment seems to show its utility in terms of the services provided. Given the successful deployment of the system, it was extended to the pediatric emergency department. The response time was reduced to 1h. CONCLUSION: This first teledermatology experiment seems to show its real value in terms of services rendered. However, it is necessary to have more experience to confirm the contribution of this tool, and to reassess the sustainability and economic relevance of the device.

[Cannabinoid hyperemesis syndrome: about 6 cases]. / Syndrome d'hyperémèse cannabique : à propos de 6 cas.

INTRODUCTION: The cannabinoid hyperemesis syndrome (CHS) is characterized by cyclic episodes of nausea, vomiting, and abdominal pain, and occurs in young adults with long-term cannabis use. The feature of this syndrome is the relief of symptoms with hot showers. We report here six cases report. CASE REPORTS: Three women and 3 men, chronic consumers of cannabis, presented with typical features of the CHS, but the syndrome remained undiagnosed until then: nausea, vomiting, abdominal pain with morning ascendancy and loss of weight occurring in adult's of less than 50 years. The symptoms were improved by taking repeated hot showers. The medical investigations were negative. After addictologist care and cannabis weaning, digestive symptoms disappeared. CONCLUSION: The CHS is based on a clinical diagnosis. When undiagnosed, clinical presentation leads to a medical wandering and to the realization of repeated, expensive, and sometimes invasive exams. The physiopathology is not clear. The treatment relies on the definitive cannabis weaning.

[Aspergillus galactomannan assay for the management of histoplasmosis due to Histoplasma capsulatum var. duboisii in HIV-infected patients: education from a clinical case]. / Intérêt du dosage de l'antigène galactomannane dans le diagnostic et le suivi de l'histoplasmose disséminée à Histoplasma capsulatum var. duboisii au cours du VIH : enseignement à partir d'un cas clinique.

The diagnosis of histoplasmosis due to Histoplasma capsulatum var capsulatum is based on a direct examination identifying encapsulated yeast with narrow-based budding. Galactomannan antigenemia facilitates diagnosis, as well as the monitoring of patients receiving treatment. The case of a HIV-positive patient from Congo-Brazzaville with a disseminated form of African histoplasmosis highlighted the positive galactomannan antigen in this disease due to Histoplasma capsulatum var duboisii. Galactomannan antigenemia remained high with a very slow decrease during antifungal therapy and slow regression of clinical lesions. African histoplasmosis is a rare disease that is difficult to diagnose and rarely described in immunocompromised patients, in whom differential diagnosis can be common. This observation underlines the importance of the galactomannan antigen assay in patients who have travelled to endemic areas. As in the case of Histoplasma capsulatum var capsulatum, the positivity of the Aspergillus galactomannan antigen is very useful in the diagnosis and monitoring of African histoplasmosis.

[Bordetella holmesii bacteremia in a 26-year-old patient with sickle cell disease]. / Bactériémie à Bordetella holmesii chez un patient drépanocytaire de 26 ans.

Bordetella holmesii is a rare cause of bacteremia. It occurs mainly in hyposplenic patients, such as those affected by sickle cell anemia. The most frequent clinical signs are not very specific: fever, cephalalgia, cough, dyspnea, vomiting, etc. B. holmesii is frequently isolated from blood cultures. We describe the case of a 26-year-old sickle cell patient, presenting with dry cough and fever caused by a B. holmesii blood stream infection, identified by 16S rRNA gene sequencing. The outcome was favorable with amoxicillin. It is useful to know about B. holmesii, especially for physicians managing sickle cell or hyposplenic patients, because of its variable susceptibility to beta-lactams.

[Impact factors and bibliometrics of science. Does pure science really exist?]. / Impaktové faktory a scientometrie. Existuje skutecne cistá veda?

The impact factor is an artificially created indicator which when applied separately does not achieve the value attributed to it. In its assessment a number of different influences are projected which cause partial mistakes with a cumulative effect. It can have an even worse effect if the impact factor is incorrectly conceived or inadequately handled. Only in a long-term review using specific corrections it can serve to determine really top class periodicals but only within the framework of a single scientific discipline. It is not suitable for comparison of interdisciplinary journals. It should be used very carefully in the evaluation of authors. However it is still used in various types of administrative management. From the submitted paper it may seen that with a certain amount of overstatement it is personified and acts on its own. Its personification is homo sapiens scientometricus who evaluates himself as well as his environment which is represented by mere homo sapiens scientificus. In addition to the impact factor the authors discuss also other indicators and some aspects of scientometry.

Effect of Diuron on aquatic bacteria in laboratory-scale wastewater treatment ponds with special reference to Aeromonas species studied by colony hybridization.

Six laboratory-scale wastewater treatment ponds were filled with sediment and water obtained from a reference pond (a wastewater treatment plant located in a rural environment at Montel-de-Gelat, Puy-de-Dôme, France). They were kept at 20 degrees C, with alternative light and dark periods (12 h-12 h), and fed with raw effluent supplied weekly. Three of them were treated with Diuron (dissolved in DMSO) at a final concentration 10 mg/l, while the other three received only DMSO. Physico-chemical parameters, total bacteria, cultivable bacteria, and Aeromonas spp. were measured periodically until 41 days after the Diuron contamination. Total bacteria were treated with 4,6-diamidino 2-phenylindole (DAPI) and counted by epifluoroscence microscopy. The cultivable bacteria were quantified on plate count agar medium and Aeromonas spp. using colony hybridization. In the contaminated pilots, biochemical oxygen demand (BOD5), chemical oxygen demand (COD), suspended solids (SS), volatile suspended solids (VSS), ammonium, phosphorus, and bacteria increased, but dissolved oxygen decreased. The abundance of total bacteria, cultivable bacteria (multiplied by 30), and Aeromonas spp. increased for two weeks after Diuron introduction, reverting to initial values three weeks later. The percentage of cultivable bacteria relative to total bacteria was 0.2% in controls and 1.2% in treated pilots, while the percentage of Aeromonas spp. relative to cultivable bacteria decreased from 6-10% to 2%. Our results suggest that Diuron, which acts on the photosystem II of phototrophs, supports the development of cultivable bacteria through new carbon sources derived from the decomposition of photosynthetic micro-organisms, but does not specifically support Aeromonas spp.

Conversion disorder presenting in a patient with an implantable morphine pump and an epidural abscess resulting in paraplegia.

Conversion disorders are symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological or medical condition. The psychological symptoms associated with the medical condition must be preceded by conflict or other stressors. We present an individual who developed conversion disorder and paraplegia secondary to a sterile epidural abscess near the tip of her surgically implanted, epidural morphine infusion pump. She manifested at varying times both transient bilateral blindness and pseudoseizures consistent with a diagnosis of conversion disorder. Neurological evaluation for seizure activity and meningitis were negative. The etiology of the sterile epidural abscess remained unknown. The essential features of conversion disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, are discussed. Treatment of patients diagnosed with conversion disorder remains primarily supportive, with the focus on consistency and behavioral management. Extreme caution is suggested in regards to further investigations.

[Percutaneous transluminal angioplasty of the renal artery in transplanted kidneys]. / Perkutánní transluminální angioplastika tepny transplantované ledviny.

UNLABELLED: The objective of the work was to evaluate the contribution of percutaneous transluminal angioplasty (PTA) to treatment of hypertension and the graft function of a transplanted kidney. Angioplasty of the graft artery was performed in 39 patients. Technical success rate: 85%. COMPLICATIONS: 13%--in particular during the first years after introduction of the method. Twenty seven patients were followed up on a long-term basis. Changes of the median arterial pressure (MAP) were evaluated as well as glomerular filtration (GF) assessed by creatinine clearance. Mean values: [table: see text] A statistically significant (p < 0.01) reduction of the median arterial pressure (drop by > 10 mm Hg) along with reduction of the number of antihypertensive drugs was recorded in 70% of the patients during the first year and in 80% kidney recipients in investigations extending beyond one year. A significant increase of glomerular filtration (by > 20%) was found in 40% of the patients, on average the rise was insignificant. During the follow up period 13 kidney recipients were transferred to a dialyzation programme due to failure of the grafts as a result of rejection. CONCLUSION: Percutaneous transluminal angioplasty of a stenosis of the graft artery is the method of first choice in the treatment of hypertension. It is of fundamental importance also in rare cases in order to preserve or improve graft function and thus delay dialyzation treatment.

[Renal hemodynamics and albuminuria in patients with arterial hypertension]. / Renální hemodynamika a albuminurie u nemocných s arteriální hypertenzí.

BACKGROUND: The cause of hyperalbuminuria in hypertonic patients can be functional or irreversible structural changes. The objective of the present investigation was an attempt to differentiate these two possibilities by comparing data of hypertonic patients with normal albuminuria (albumin excretion < 20 micrograms/min) and those with microalbuminuria in patients with renovascular hypertension by comparing findings after successful percutaneous transluminal angioplasty of the renal arteries (n = 8). METHODS AND RESULTS: The authors examined 20 patients with normal albuminuria (12 men and 8 women, mean age 46 years) and 20 patients with microalbuminuria (12 men and 8 women, mean age 49 years). Of these patients 8 were examined repeatedly after angioplasty. The examination was made in the morning, renal haemodynamics were assessed by the infusion technique (clearance of polyfructosan and paraaminohippuric acid), in blood and urine the albumin and IgG concentration (bromcresol purpur-Lachema Brno and immunoturbidometrically-Tina-quant Boheringer Mannheim). In hypertonic patients with microalbuminuria a significantly higher (p < 0.001) IgG excretion was found (14.1 as compared with 5.12 micrograms/min.) and a reduced ratio of IgG clearance to albumin clearance (p < 0.001), 0.73 as compared with 1.60. After successful angioplasty of the renal arteries there was a significant drop of the blood pressure (p < 0.05) and of the renal vascular resistance as well as a significant decrease of albuminuria (p < 0.05) on average from 137 to 48 micrograms/min. The quantitative improvement of albuminuria, however, did not go beyond the discrimination value for microalbuminuria. CONCLUSIONS: The results suggest that microalbuminuria in hypertensive patients is as a rule a manifestation of structural renal changes, while also functional and reversible changes participate. The asset of treatment of hypertension by angioplasty of the renal arteries was manifested not only in the renal haemodynamics but also by reduced albuminuria.

[Bilateral sensorineural hearing loss after general anesthesia]. / Surdité bilatérale de perception après anesthésie générale.

A bilateral sensorineural (perceptive) deafness occurred in a 12-year-old girl, following laparoscopic appendicectomy under general anaesthesia not comprising nitrous oxide and low insufflation pressures and a normal haemodynamic status. There was neither a personal nor a familial history of hearing disturbances nor a preoperative intake of ototoxic drugs. The initial loss of 50 dB has been substantiated by evoked auditive potentials. The treatment consisted of hyperbaric oxygenotherapy and vasodilators. The girl recovered completely. Finally the etiology of this complication remained unrecognized. Possibly the CO2 insufflated into the abdominal cavity could be considered. However, its causative effect remains to be proven.

[Coronary surgery at the Institute of Clinical and Experimental Medicine]. / Koronární chirurgie v IKEM.

In 1971-1991 in the Institute of Clinical and Experimental Medicine 2386 operations on account of IHD were performed. 2154 aortocoronary bypasses, 6 Vineberg operations, 51 valvular prostheses and aortocoronary bypasses, 128 resections of left ventricular aneurysms and 47 closures of post-infarction perforations of the interventricular septum. The mortality from aortocoronary bypasses during the entire period was 6.9%. The authors discuss different periods, changes of the operative technique and contemporary views on surgical treatment of IHD.

[Precordial S-T stress mapping in the evaluation of the effects of percutaneous transluminal coronary angioplasty]. / Prekordiální zátezové S-T mapy pri hodnocení úcinku perkutánní transluminální koronární angioplastiky.

The morphological impact of percutaneous transluminal angioplasty (PTCA) on the treated artery is closely checked by coronary arteriography. Indirect non-invasive evaluations are made possible by electrocardiography, isotope methods and echocardiography which are the commonest visualization methods. The authors used a precordial S-T load map. After complete revascularization following PTCA there was a significant drop of the sum of S-T depressions and in some members of the group it reached normal values. The S-T load map is a suitable non-invasive procedure for monitoring the effect of PTCA.

[Complications of percutaneous transluminal coronary angioplasty]. / Komplikace perkutánní transluminální koronární angioplastiky.

The most frequent complication of percutaneous transluminal coronary angioplasty is acute obstruction of the artery to be dilated. The authors present their experience with the solution of this situation. In a group of 154 consecutive patients with chronic stable angina pectoris a sudden occlusion was observed in 7.7%, infarction in 5.8% and the necessity of operation arose in 5.2%. A significant position in the solution if these complications is held by cardiosurgical revascularization. As to pharmacological treatment, it is useful to administer a combination of nitrates, calcium channel antagonists and thrombolytic treatment.

[Therapeutic embolization of the venous bed using Vilan 500 in animal experiments]. / Terapeutická embolizace zilního reciste Vilanem 500 pri pokusech na zvíreti.

The experiment in four dogs verified a suitability of the Czechoslovak preparation Vilan 500, a copolymer of polyvinyl acetate - polyvinyl alcohol in 93% ethanol, for the embolism of venous vascular bed in the percutaneous, transfemoral catheterization way. In all four cases there was a complete occlusion of embolized spermatic or pararenal veins, verified by a control angiography after one hour and after three months. The prepared venous samples were also examined by histology and changes indicating intraluminar thrombotization and subsequent fibrous reconstruction were observed. In view of the results reached it may be concluded that the catheterization technique and the use of Vilan 500 is suitable as an alternative of non-surgical solution of varicocele.