[Medication reconciliation on admission: One year of practice in health care institutions during the COVID-19 pandemic]. / Conciliation médicamenteuse à l'admission : bilan d'une année d'activité en établissement de santé durant la crise COVID-19.

OBJECTIVES: Medication reconciliation is a key point of the v2020 certification. The main objective of this study was to evaluate this activity over one year, including the first epidemic wave at COVID-19. The secondary objectives were to identify the obstacles and levers and to evaluate doctor satisfaction. METHODS: This was a retrospective study of drug reconciliations performed on admission during 12 months of the emergence of COVID-19. Patients aged 65 years and older from orthopedic and visceral surgery, acute hospitalization and conventional medicine units were included. Unintentional discrepancies were analyzed. The obstacles and levers were identified by means of a focus group. Doctors' satisfaction was collected using online quiz. RESULTS: A total of 760 patients were conciliated, of which 27% (n=208) by hospital pharmacy technicians. A decrease in activity was observed during the first epidemic wave. An unintentional discrepancy was found in 77% of patients, and only 48% were corrected by the prescriber. These results were impacted by the pandemic. The pharmaceutical team was mobilized in the logistical management of the crisis, but it was able to adapt in order to perpetuate the activity. Doctors are satisfied with the process. CONCLUSIONS: Medication reconciliation on admission is essential for the prevention of iatrogeny, particularly with the impact of the COVID-19 pandemic in healthcare institutions.

[Nasal administration of fentanyl: prevention of medication-related errors by using REMED-method]. / REMEDier à une erreur médicamenteuse par le retour d'expriénce: à propos du fentanyl en pulvérization nasale.

REMED stands for a "MEDication Errors Review". The REMED method aims at implementing and monitoring actions to improve patient medical care. This approach is part of the continuing healthcare quality and safety improvement and professional practice evaluation. REMED uses methodology and tools. Thus we use this methodology in the context of a drug errorwhich occurred in the dermatology department of our hospital. After this event description, related to a sensitive drug product, Instanyl (transmucosal fentanyl), the drug error is described, then the different causes are analyzed. These last are numerous and occur at any stage of patient medical care. They must allow us to show actions in order to improve patients' safety.

[FAV-Africa: a polyvalent antivenom serum used in Africa and Europe]. / FAV-Afrique: un sérum antivenimeux polyvalent employé en Afrique et en Europe.

FAV-Afrique is a polyvalent snake antivenom, elaborated by immunisation of horses with venom from 10 different snake species among the most dangerous in Africa and belonging to Elapidae and Viperidea families. Only F(ab')2 fragments are kept and purified. This serum is able to decrease the quantity of circulating venom and therefore its toxicity. Its use is indicated as soon as the first signs of poisoning are observed (local oedema). Twenty millimetres are administrated via intra-venous route whatever the weight of the patient. Re-administration may be performed if improvement is not sufficient. Treatment should be initiated as soon as possible but can be realized as long as the symptoms are present. Side effects (allergy) should be considered but balanced with the seriousness of poisoning. There is no absolute contraindication or drug interaction reported with FAV-Africa. It is authorized and distributed in several African countries and has a temporary regulatory approval in France. The major limits to its use are high cost and storage conditions (maximum 36 months between +2 degrees C and +8 degrees C). In the future, the new serum Antivipmyn Africa, available as a freeze-dried product, which can be preserved at room temperature, should improve storage conditions and availability of treatment, especially in rural Africa.

Basal insulin therapy is associated with beneficial effects on postoperative infective complications, independently from circulating glucose levels in patients admitted for cardiac surgery.

BACKGROUND: Although hyperglycemia is a strong predictor of postoperative infective complications (PIC), little is known about the effect of basal insulin therapy (BIT) per se on PIC. AIM: To evaluate if there is an association between BIT, independent of glucose levels, and a possible improvement of PIC during the perioperative cardiosurgery period (PCP). METHODS: In 812 patients admitted for cardiac intervention and treated with a continuous intravenous insulin infusion (CIII) for hyperglycemic levels (>130 mg/dl), a retrospective analysis was performed during the PCP (January 2009-December 2011). Upon transfer to the cardiac surgery division, if fasting glucose was ≥130 mg/dl, a basal + premeal insulin therapy was initiated (121 patients, group 1); for <130 mg/dl, a premeal insulin alone was initiated (691 patients, group 2). FINDINGS: Compared with group 2, group 1 showed reductions in PIC (2.48% vs 7.96%, p < 0.049; odds ratio: 0.294; 95% CI: 0.110-0.780), C-Reactive Protein (p < 0.05) and white blood cell (p < 0.05) levels despite glucose levels and CIII that were higher during the first two days after surgery (179.8 ± 25.3 vs 169.5 ± 10.6 mg/dl, p < 0.01; 0.046 ± 0.008 vs 0.037 ± 0.015 U/kg/h, p < 0.05, respectively). Normal glucose levels were achieved in both groups from day 3 before the discharge. The mean length of hospital duration was 18% lower in group 1 than in group 2 (7.21 ± 05.08 vs 8.76 ± 9.08 days, p < 0.007), providing a significant impact on public health costs. CONCLUSIONS: Basal + preprandial insulin therapy was associated with a lower frequency of PIC than preprandial insulin therapy alone, suggesting a beneficial effect of basal insulin therapy on post-surgery outcome.

Timing waveform analysis.

This article provides a description of correct balloon pump timing as well as the potential timing errors that can occur. There are many factors in addition to timing that can affect the altered arterial waveform during balloon pumping. When analyzing the waveform for appropriate timing, it is important to consider factors associated with the patient, the IAB, and the IABP console. Patient treatment decisions should be based on the complete clinical picture, not solely on the characteristics of the altered arterial waveform.

[Scabies: A world plague]. / La gale : un fléau mondial.

Scabies is a ubiquitous contagious disease, and its prevalence is growing. Diagnostic difficulties vary according to the patient's age and health. Benzyl benzoate and ivermectin are the reference drugs in France. Decontamination of the patients' bedding, clothing, and environment is essential for successful treatment.

[Lethal aortic endocarditis due to Gemella morbillorum in a Djiboutian khat user]. / Endocardite aortique fatale due à Gemella morbillorum chez un consommateur de khat de Djibouti.

We report a 22-year-old man who presented in January 2009 in Djibouti for an aortic-abscessed endocarditis due to Gemella morbillorum (G. morbillorum). A voluminous aortic abscess that extended to the perimembranous ventricular septum was fistulized into the right atrium. Atrioventricular conduction abnormalities were observed. The portal of entry was dental with multiples caries and a periodontitis attributed to khat chewing. The patient died within few days. Diagnosis, severity and management of endocarditis due to this rare bacterium are discussed.

[Chromium binding to leukocytes]. / Ricerche sul legame del cromo con i leucociti.

The experiment has been done on 63 patients affected by allergic contact dermatitis and sensitized to potassium dichromate and on 76 non allergic subjects to control: if leukocytes (separated in emagel), mononuclear cells (separated in lymphoprep) and T-lymphocytes (separated through rosettes with neuraminidase) bind the 51Cr, if this binding depends on the valence (Cr3+ and Cr6+) and on the type of cells and if it is conditioned by the hypersensitivity. Through incubation of the cells with the tracing at 4 degrees C and in different times, it has been demonstrated that the binding takes place, it depends on the valence and, in certain conditions it is bigger for the mononuclear cells and the T-lymphocytes in allergic subjects.

Effects of supplementation with unsaturated fatty acids on plasma and membrane lipid composition and platelet function in patients with cirrhosis and defective aggregation.

BACKGROUND/AIMS: Defective platelet aggregation and reduced platelet production of thromboxane A2, a metabolite of arachidonic acid, are common findings in patients with cirrhosis. We evaluated the effects of dietary supplementation with two combinations of unsaturated fatty acids on platelet function and plasma and membrane fatty acids in patients with liver cirrhosis. METHODS: In a double-blind study, 15 patients with cirrhosis and defective aggregation were randomized to receive a 6-week supplementation with gamma-linolenic and linoleic acid (1 g/day of each fatty acid) or with oleic acid and linoleic acid (groups GLA and OA, respectively). RESULTS: Under baseline conditions, patients showed elevated concentrations of monounsaturated fatty acids and a reduction in polyunsaturated fatty acids. The product/precursor ratios for delta6 and delta5 desaturases, two key enzymes in the pathway leading to arachidonic acid, were significantly reduced in the group of patients. In the GLA group, a significant increase in the levels of dihomo-gamma-linolenic acid (20:3omega6) was observed in plasma and membranes, together with a parallel decrease in the 20:4/20:3omega6 ratio after supplementation. No significant changes were observed in the OA group. The levels of arachidonic acid did not change significantly in either group of patients. Platelet aggregation to collagen was unchanged in the GLA group, but significantly improved in the OA group. CONCLUSIONS: These results show that supplementation with precursors of arachidonic acid is ineffective in elevating plasma or membrane arachidonate levels and does not improve platelet aggregation, suggesting that synthesis of arachidonic acid through the delta5 desaturase cannot be correspondingly activated or that incorporation/retention of the produced fatty acid into lipids is impaired. The increased platelet aggregation in the OA group is likely to be explained by the effect of oleic acid contained in the diet, the effects of which may have been counteracted by the elevation in 20:3omega6, a source of anti-aggregatory prostanoids, in the GLA group.