Suspected community-acquired pneumonia in an ambulatory setting (CAPA): a French prospective observational cohort study in general practice.

BACKGROUND: Few studies have addressed the pragmatic management of ambulatory patients with suspected community-acquired pneumonia (CAP) using a precise description of the disease with or without chest X-ray (X-ray) evidence. AIMS: To describe the characteristics, clinical findings, additional investigations and disease progression in patients with suspected CAP managed by French General Practitioners (GPs). METHODS: The patients included were older than 18 years, with signs or symptoms suggestive of CAP associated with recent-onset unilateral crackles on auscultation or a new opacity on X-ray. They were followed for up to 6 weeks. Descriptive analyses of all patients and according to their management with X-rays were carried out. RESULTS: From September 2011 to July 2012, 886 patients have been consulted by 267 GPs. Among them, 278 (31%) were older than 65 years and 337 (38%) were at increased risk for invasive pneumococcal disease. At presentation, the three most common symptoms, cough (94%), fever (93%), and weakness or myalgia (81%), were all observed in 70% of patients. Unilateral crackles were observed in 77% of patients. Among patients with positive radiography (64%), 36% had no unilateral crackles. A null CRB-65 score was obtained in 62% of patients. Most patients (94%) initially received antibiotics and experienced uncomplicated disease progression regardless of their management with X-rays. Finally, 7% of patients were hospitalised and 0.3% died. CONCLUSIONS: Most patients consulting GPs for suspected CAP had the three following most common symptoms: cough, fever, and weakness or myalgia. More than a third of them were at increased risk for invasive pneumococcal disease. With or without X-rays, most patients received antibiotics and experienced uncomplicated disease progression.

[Vitamin D insufficiency and deficiency: epidemiology, measurement, prevention and treatment]. / Insuffisance et déficit en vitamine D: épidémiologie, indications du dosage, prévention et traitement.

Vitamin D has been traditionally considered as important for skeletal health. However, during the past decade, numerous research findings have revealed that vitamin D may have beneficial effects on extraskeletal tissues as well. Vitamin D deficiency is now recognized as a worldwide issue. The prevalence of vitamin D deficiency or insufficiency depends on the threshold used to define vitamin D deficiency or insufficiency. However, whatever the threshold (20, 30 or 40 ng/mL), the prevalence is high in France as elsewhere. Vitamin D status is now based on the measurement of 25-hydroxyvitamin D [25(OH)D] concentration. This assay does not seem justified in most situations encountered in clinical practice, and its overprescription generates a significant cost to public health. This is why Official Clinical Societies try to define: (a) target populations for which a determination is required (every situation in which the therapeutic goal requires an optimal serum 25(OH)D level for an appropriate medical care) and which require specific treatment; (b) target populations for which the risk of deficit is important (due to insufficient daily intake) and may benefit from preventive pharmaceutical supplementation without prior testing (infants, pregnant women, patients over 65...).