Lyme borreliosis and other tick-borne diseases. Guidelines from the French Scientific Societies (I): prevention, epidemiology, diagnosis.

Lyme borreliosis is transmitted en France by the tick Ixodes ricinus, endemic in metropolitan France. In the absence of vaccine licensed for use in humans, primary prevention mostly relies on mechanical protection (clothes covering most parts of the body) that may be completed by chemical protection (repulsives). Secondary prevention relies on early detection of ticks after exposure, and mechanical extraction. There is currently no situation in France when prophylactic antibiotics would be recommended. The incidence of Lyme borreliosis in France, estimated through a network of general practitioners (réseau Sentinelles), and nationwide coding system for hospital stays, has not significantly changed between 2009 and 2017, with a mean incidence estimated at 53 cases/100,000 inhabitants/year, leading to 1.3 hospital admission/100,000 inhabitants/year. Other tick-borne diseases are much more seldom in France: tick-borne encephalitis (around 20 cases/year), spotted-fever rickettsiosis (primarily mediterranean spotted fever, around 10 cases/year), tularemia (50-100 cases/year, of which 20% are transmitted by ticks), human granulocytic anaplasmosis (<10 cases/year), and babesiosis (<5 cases/year). The main circumstances of diagnosis for Lyme borreliosis are cutaneous manifestations (primarily erythema migrans, much more rarely borrelial lymphocytoma and atrophic chronic acrodermatitis), neurological (<15% of cases, mostly meningoradiculitis and cranial nerve palsy, especially facial nerve) and rheumatologic (mostly knee monoarthritis, with recurrences). Cardiac and ophtalmologic manifestations are very rarely encountered.

[Newly diagnosed multiple myeloma: Do we need to propose thromboprophylaxis?]. / Myélome multiple de novo : faut-il proposer une prophylaxie antithrombotique ?

The incidence of venous thromboembolism in multiple myeloma depends on the disease characteristics that include recent diagnosis, persistent or recurrent multiple myeloma, patient characteristics, and the type of treatment received such as thalidomide or lenalidomide especially in combination with high-dose dexamethasone, or combined chemotherapy. Currently, recommendations could be challenged by the results of the first randomized study evaluating aspirin, low molecular weight heparins and vitamin K antagonists in the antithrombotic prophylaxis. The recent data from the literature show that it is not possible to propose a therapeutic management for venous thromboembolism prophylaxis in multiple myeloma and that the use of antithrombotic prophylaxis may not be mandatory.

[Doctor Knock lives at Wall Street. The new targets of pharmaceutical industry]. / Le docteur Knock habite à Wall Street. Les nouvelles cibles de l'industrie pharmaceutique.

INTRODUCTION: The aim of this paper is to inform clinicians about some new commercial practices of the pharmaceutical industry. EXEGESIS: Drug promotion nowadays involves sophisticated marketing strategies, in which the prescribing physician is not necessarily a central actor. Pharmaceutical advertising is more and more directed towards the general public (consumers), contributes to define and popularise disease categories, and encourages the medicalisation of everyday life. CONCLUSION: Doctors should be aware of the consequences of these new commercial strategies.

[Screening for depression in patients with medical hospitalization. Comparison of two self-evaluation scales and clinical assessment with a structured questionnaire]. / Dépistage de la dépression chez les patients hospitalisés en médecine. Comparaison de deux échelles d'autoévaluation et du jugement des cliniciens à un questionnaire structuré.

The aim of this study was to determine, in a population of medical inpatients, the sensitivity, specificity, positive and negative predictive values of two self-rating depression scales, and of the physicians' judgment, compared to a structured interview derived from the Composite Interview Diagnostic Interview (CIDI) designed to assess the diagnosis of major depressive episodes. The setting of the study was a general internal medicine inpatient ward of a French university hospital. Patients between 15 and 75 were asked to fill, within the first week of their hospitalization, two self-rating depression scales: the Beck Depression Inventory - short form (BDI-short form), a 13-item scale with established reliability and validity; and the Center for Epidemiologic Studies-Depression Scale (CES-D), a 20-item scale designed for epidemiological use in the general population, recently translated in French. Patients were then interviewed by a psychologist, blind to the results of the self-rating scales, using a slightly simplified version of the depression section of the CIDI. The ward physicians' recognition of depression was assessed six months later by a careful chart review, conducted by an investigator blind to the results of depression scales and structured interview. One hundred consecutive patients were studied: 63% were women, mean age was 53.6 +/- 16.5 years. According to the results of the CIDI, the prevalence of current major depression was 29.7%, and the lifetime prevalence of major depression was 59.8%. The correlation between BDI-short form and CES-D was +0.81. BDI-short form proved to have a slightly better acceptability than the CES-D.(ABSTRACT TRUNCATED AT 250 WORDS)

Fatigue in primary care: prevalence, psychiatric comorbidity, illness behavior, and outcome.

OBJECTIVES: To identify the prevalence, psychiatric comorbidity, illness behavior, and outcome of patients with a presenting complaint of fatigue in a primary care setting. METHODS: 686 patients attending two family medicine clinics on a self-initiated visit completed structured interviews for presenting complaints, self-report measures of symptoms and hypochondriasis, and the Diagnostic Interview Schedule (DIS). Fatigue was identified as a primary or secondary complaint from patient reports and questionnaires completed by physicians. RESULTS: Of the 686 patients, 93 (13.6%) presented with a complaint of fatigue. Fatigue was the major reason for consultation of 46 patients (6.7%). Patients with fatigue were more likely to be working full or part time and to be French Canadian, but did not differ from the other clinic patients on any other sociodemographic characteristic or in health care utilization. Patients with fatigue received a lifetime diagnosis of depression or anxiety disorder more frequently than did other clinic patients (45.2% vs. 28.2%). Current psychiatric diagnoses, as indicted by the DIS, were limited to major depression, diagnosed for 16 (17.2%) fatigue patients. Patients with fatigue reported more medically unexplained physical symptoms, greater perceived stress, more pathologic symptom attributions, and greater worries about having emotional problems than did other patients. However, only those fatigue patients with coexisting depressive symptoms differed significantly from nonfatigue patients. Patients with fatigue lasting six months or longer compared with patients with more recent fatigue had lower family incomes and greater hypochondriacal worry. Duration of fatigue was not related to rate of current or lifetime psychiatric disorder. One half to two thirds of fatigue patients were still fatigued one year later. CONCLUSIONS: In a primary care setting, only those fatigue patients who have coexisting psychological distress exhibit patterns of abnormal illness cognition and behavior. Regardless of the physical illnesses associated with fatigue, psychiatric disorders and somatic amplification may contribute to complaints of fatigue in less than 50% of cases presented to primary care.