[Impact of pharmaceutical interventions on antibiotic therapy of urinary tract infections in rehabilitation center]. / Impact des interventions pharmaceutiques sur l'antibiothérapie des infections urinaires en service de soins de suite et de réadaptation.

BACKGROUND: The aim of this study was to assess the impact of medico-pharmaceutical partnership on the quality of antibiotic treatment in urinary tract infection (UTI) within rehabilitation center. MATERIAL: All antibiotic prescriptions were validated by the pharmacist at the start of treatment and twice a week. All patients with symptomatic urinary tract infection between January 1, 2014 to December 31, 2015 were included in this study. Addition to awareness among specifiers to promoting the appropriate use of antibiotics, the pharmacist suggested pharmaceutical interventions (PI) in order to improve the quality of antibiotic treatments. At the same time, 3 quality indicators (QI) were followed: duration, dosage, antibiotic susceptibility. The compliance rates of this 3 QI allowed to assess the quality of the antibiotic treatment in urinary tract infection. RESULTS: The study population included 154 patients corresponding to 252 UTI. Sixty-eight PI were made by pharmacist about urinary tract infection treatment (overdosage or under-dosing, duration unknown, inadequate route of administration). These QI achieved 96.4% compliance with duration, 98.8% compliance with dosage and 99.2% with the antibiotic susceptibility. CONCLUSION: This study allowed showing the medico-pharmaceutical impact on the quality of antibiotic treatments in UTI. The awareness among specifiers with a daily validation of prescription by the pharmacist allowed to improve urinary tract infections care in rehabilitation center. LEVEL OF EVIDENCE: 4.

Influence of procalcitonin on decision to start antibiotic treatment in patients with a lower respiratory tract infection: insight from the observational multicentric ProREAL surveillance.

Procalcitonin (PCT)-guided antibiotic stewardship is a successful strategy to decrease antibiotic use. We assessed if clinical judgement affected compliance with a PCT-algorithm for antibiotic prescribing in a multicenter surveillance of patients with lower respiratory tract infections (LRTI). Initiation and duration of antibiotic therapy, adherence to a PCT algorithm and outcome were monitored in consecutive adults with LRTI who were enrolled in a prospective observational quality control. We correlated initial clinical judgment of the treating physician with algorithm compliance and assessed the influence of PCT on the final decision to initiate antibiotic therapy. PCT levels correlated with physicians' estimates of the likelihood of bacterial infection (p for trend <0.02). PCT influenced the post-test probability of antibiotic initiation with a greater effect in patients with non-pneumonia LRTI (e.g., for bronchitis: -23 % if PCT ≤ 0.25 µg/L and +31 % if PCT > 0.25 µg/L), in European centers (e.g., in France -22 % if PCT ≤ 0.25 µg/L and +13 % if PCT > 0.25 µg/L) and in centers, which had previous experience with the PCT-algorithm (-16 % if PCT ≤ 0.25 µg/L and +19 % if PCT > 0.25 µg/L). Algorithm non-compliance, i.e. antibiotic prescribing despite low PCT-levels, was independently predicted by the likelihood of a bacterial infection as judged by the treating physician. Compliance was significantly associated with identification of a bacterial etiology (p = 0.01). Compliance with PCT-guided antibiotic stewardship was affected by geographically and culturally-influenced subjective clinical judgment. Initiation of antibiotic therapy was altered by PCT levels. Differential compliance with antibiotic stewardship efforts contributes to geographical differences in antibiotic prescribing habits and potentially influences antibiotic resistance rates.

Field test comparison of two dermal tolerance assessment methods of hand hygiene products.

This study aimed to compare the sensitivity and workload requirement of two dermal tolerance assessment methods of hand hygiene products, in order to select a suitable pilot testing method for field tests. An observer-rating method and a self-assessment method were compared in 12 voluntary hospital departments (autumn/winter of 2005-2006). Three test-periods of three weeks were separated by two-week intervals during which the routine products were reintroduced. The observer rating method scored dryness and irritation on four-point scales. In the self-assessment method, the user rated appearance, intactness, moisture content, and sensation on a visual analogue scale which was converted into a 10-point numerical scale. Eleven products (soaps) were tested (223/250 complete reports for observer rating, 131/251 for self-assessment). Two products were significantly less well tolerated than the routine product according to the observers, four products according to the self-assessments. There was no significant difference between the two methods when products were classified according to tolerance (Fisher's test: P=0.491). For the symptom common to both assessment methods (dryness), there is a good correlation between the two methods (Spearman's Rho: P=0.032). The workload was higher for observer rating method (288 h of observer time plus 122 h of prevention team and pharmacist time compared with 15 h of prevention team and pharmacist time for self-assessment). In conclusion, the self-assessment method was considered more suitable for pilot testing, although further time should be allocated for educational measures as the return rate of complete self-assessment forms was poor.

Tolerance and acceptability of 14 surgical and hygienic alcohol-based hand rubs.

Tests were performed under working practice conditions to measure the tolerance and acceptability of commercially available hand rubs with proven efficacy. The products were compared with those in current use at the Hospices Civils de Lyon for surgical hand disinfection (Sterillium) and hygienic hand disinfection (Purell) to obtain information for public sector purchases. The 12 test products were Alcogel H, Assanis Pro, Clinogel, Dermalcool, Manugel Plus, Manugel Plus NPC, Manurub Liquid, Manurub Gel, Purell 85, Spitacid, Spitagel and Sterillium Gel. They were tested from mid-November to mid-April over four periods of three weeks, separated by two-week intervals during which the customary product was re-introduced. Participation of hospital wards and theatres was voluntary. Skin dryness and irritation were scored before and after each test period. Acceptability and ease of use were assessed by means of a questionnaire. Among the eight surgical hand rubs, only Manurub Liquid, Manurub Gel and Manugel Plus NPC did not cause significantly more dryness and irritation than Sterillium. For the 10 hygienic hand rubs, differences were noted depending upon the test period. Overall, Assanis Pro, Clinogel, Purell 85 and Sterillium Gel did not cause significantly more dryness and irritation than Purell. However, over the (colder) first three test periods, Assanis Pro and Sterillium Gel caused more irritation and Purell 85 caused more dryness than Purell. Responses to the questionnaires on acceptability indicated that users preferred their customary hand rubs (Sterillium and Purell). As these field tests involving many participants did not identify any superior products, previous purchase orders were renewed.

[Clinical use of bedside cerebral microdialysis: a review]. / Utilisation clinique du monitorage biochimique cérébral par microdialyse: revue de la littérature.

OBJECTIVE: To review the current data on clinical bedside use of cerebral microdialysis. DATA SOURCE: Search through Medline database of articles in French and English (keywords: microdialysis, cerebral ischaemia, head trauma, subarachnoid haemorrhage, clinical study). STUDY SELECTION: All clinical articles published between 1995 and 2005, including original papers and some case reports. DATA SYNTHESIS: Microdialysis after occlusive stroke has shown elevated levels of glutamate and lactate. When space-occupying oedema develops, biochemistry abnormalities occur first, before ICP increases. Bedside microdialysis appears to be a sensitive and earlier indicator of space occupying oedema. Most Accurate markers to monitor ischaemia induced by vasospasm are glutamate and lactate/pyruvate ratio. These markers are earlier than clinical abnormalities or pressure measurements (sensibility 82%, specificity 89%). In the field of head trauma, the same compounds were utilised. The level of these compounds correlates with outcome in a different manner whether the area studied is close to a concussion or not. Most of biochemical events are linked to global cerebral ischaemia. We can observe some abnormalities limited to the pericontusional area, which are not detected by the global monitoring. Microdialysis appears a useful tool to investigate disease mechanisms but cannot be recommended for a widespread use after head trauma. CONCLUSION: Bedside cerebral microdialysis allows clinical decisions in the setting of subarachnoid haemorrhage and ischaemic stroke. It represents a valuable tool to investigate head trauma pathophysiology.

Assessment of cerebral oxygenation in neurocritical care patients: comparison of a new four wavelengths forehead regional saturation in oxygen sensor (EQUANOX®) with brain tissue oxygenation. A prospective observational study.

BACKGROUND: Because of restricted information given by monitoring solely intracranial pressure and cerebral perfusion pressure, assessment of the cerebral oxygenation in neurocritical care patients would be of interest. The aim of this study was to determinate the correlation between the non-invasive measure regional saturation in oxygen (rSO2) with a third generation NIRS monitor and an invasive measure of brain tissue oxygenation tension (PbtO2). METHODS: We conducted a prospective, observational, unblinded study including neurocritical care patients requiring a PbtO2 monitoring. Concomitant measurements of rSO2 were performed with a four wavelengths forehead sensor (EQUANOX Advance®) of the EQUANOX® 7600 System. We determined the correlation between rSO2 and PbtO2 and the ability of the rSO2 to detect ischemic episodes defined by a PbtO2 less than 15 mmHg. The rSO2 ischemic threshold was 60%. RESULTS: During 2 months, 8 consecutives patients, including 275 measurements, were studied. There was no correlation between rSO2 and PbtO2 (r=0.016 [-0.103-0.134], r2=0.0003, P=0.8). On the 86 ischemic episodes detected by PbtO2, only 13 were also detected by rSO2. ROC curve showed the inability for rSO2 to detect cerebral hypoxia episodes (AUC=0.54). CONCLUSION: rSO2 cannot be used as a substitute for PbtO2 to monitor cerebral oxygenation in neurocritical care patients.

[Knowledge of adolescents with inflammatory bowel disease: Results of a multicenter cross-sectional survey]. / Connaissances des adolescents atteints de maladie inflammatoire chronique intestinale : résultats d'une enquête transversale multicentrique.

AIM: To assess knowledge acquired by adolescents about their inflammatory bowel disease (IBD). METHODS: An anonymous questionnaire was given during consultation to adolescents followed for IBD by pediatricians from 13 hospitals between 1 September 2012 and 1 July 2013. After parental consent, these physicians completed a form at the inclusion of each patient, in which the characteristics of IBD were detailed. The patients mailed back their questionnaire. RESULTS: A total of 124 patients from 12 to 19 years of age were included with a response rate of 82% (all anonymous); 23% of the patients thought that diet was a possible cause of IBD and 22% that one of the targets of their treatment was to cure their disease for good. Of the patients reported having Crohn disease, 46% knew the anoperineal location and 14% knew that Crohn disease can affect the entire digestive tract. Twenty-five percent of the patients were able to name one side effect of azathioprine (88% had already received this treatment), 24% were able to name one side effect of infliximab (54% had already received this treatment), 70% of the adolescents knew that smoking worsens Crohn disease, 68% declared they had learned about their IBD from their pediatrician, and 81% said they would like to receive more information. CONCLUSION: Adolescents with IBD have gaps in their general knowledge and the different treatments of their disease. Their main source of information is their pediatrician, warranting the implementation of customized patient education sessions.

Alteration of striatal dopaminergic function induced by glioma development: a microdialysis and immunohistological study in the rat striatum.

Tumoral growth effects on brain circuitry and neurochemical activities remain poorly documented. This study evaluates C6 graft effects on striatal dopaminergic afferent projections at both anatomical and functional levels. Immunohistochemistry was performed to investigate changes in neurofilament (NF), tyrosine hydroxylase (TH) and dopamine transporter (DAT) expression. Dopaminergic turnover was assessed using multiprobe microdialysis in freely-moving rat. In C6 graft striatum, dopamine (DA) catabolites were reduced in glioblastoma (DOPAC: -61%, HVA: -62%). In contrast, the DA level remained unchanged. Staining for NF, TH and DAT was drastically decreased inside the tumor. Our histological data report that striatal tumoral growth is associated with a decrease in the density of dopaminergic endings which can explain, at least in part, the decrease in DA turnover. The decrease in DAT transporter expression and the lack of change in DA level may result from an increase in DA diffusion from the peripheral areas of the tumor. In conclusion, glioblastoma growth has major consequences on the local neuronal circuitry and its neurochemistry. Changes in inter-connections and neurotransmitter turnover may result in abnormal neuronal firing activity and participate in clinical disorders associated with glioblastoma diagnosis.

[Chronic constrictive pericarditis after heart surgery. Apropos of a case]. / Péricardite chronique constrictive post-chirurgie cardiaque. A propos d'un cas.

A case of pericarditis in a 52-year old patient following aorto-coronary shunt surgery is reported which gradually developed into chronic constrictive pericarditis. In this context, the diagnostic criteria of chronic constrictive pericarditis are recalled. The clinical criteria show little specificity; Doppler ultrasound provides good diagnostic information; CT scans and nuclear magnetic imaging can confirm the diagnostic. The post-heart surgery etiology has increased in recent years. The only real treatment is surgical and consists of pericardial decortication.

Striatal energetic homeostasis under anaesthetic conditions.

The effects of anesthetics on central energetic metabolism remain poorly documented. In this study, the authors have investigated changes in energetic metabolism in the rat striatum following the systemic administration of either pentobarbital or ketamine. Changes in subcortical energetic homeostasis were compared to those in peripheral adipocyte tissue and correlated to both EEG and vital parameters (heart period, respiratory period, body temperature, glycemia). Pentobarbital induced a decrease in glucose utilisation in the striatum and peripheral tissue. Both EEG activities and vital functions were drastically affected by this treatment. Interestingly, energetics were depleted in the peripheral adipose tissue but not in the striatum. Ketamine, which increased low frequencies in EEG activities and sustained vital functions, increased glucose utilisation in the striatum. Our data, obtained in vivo, established that striatal changes in energetics following anaesthesia are drug-specific and rely on tissue-specific mechanisms. In the subcortical nucleus, energetic response to anaesthetics appears to be affected by changes in both cortical activities and autonomic status. In regard to the peri-operative treatments administrated to patients, our study stresses the importance of the choice of drug anaesthetics in order to avoid adverse effects on brain energetic homeostasis.

Occurrence of lactic Acid bacteria during the different stages of vinification and conservation of wines.

We showed that the growth of lactic acid bacteria during alcoholic fermentation depends on the composition of the must. We illustrated how the addition of sulfur dioxide to the must before fermentation and the temperature of storage both affect the growth of these bacteria in the wine. Whereas species of Lactobacillus and Leuconostoc mesenteroides were isolated from grapes and must, Leuconostoc oenos was the only species isolated after alcoholic fermentation. This organism was responsible for the malolactic fermentation. Isolates of this species varied in their ability to ferment pentoses and hexoses. The survival of Leuconostoc oenos in wines after malolactic fermentation depended on wine pH, alcohol concentration, SO(2) concentration, and temperature of storage.

A multivariate analysis of the diagnostic values of clinical examination, exercise testing and exercise radionuclide angiography in coronary artery disease.

Data of clinical examination, exercise testing and exercise radionuclide angiography in 102 patients referred for assessment of chest pain was included in a logistic regression to optimize the diagnosis of coronary artery disease with coronary arteriography as the reference investigation. None of the patients had other cardiac problems or previous myocardial infarction. In the absence of symptoms, exercise testing was continued until at least 80% of the theoretical maximal heart rate was attained. Each patient was characterized by the value of the logistic function or probability of coronary artery disease. A threshold value corresponding to 80% sensitivity of ROC graphs was determined. The significant variables were: a clinical variable--the type of chest pain as assessed by the clinical history; two radionuclide angiographic variables--the ejection fraction at peak effort and the corrected variation of ejection fraction between rest and stress, that is not taking into account possible decreases at the last increment of exercise. Coronary patients can be identified with an 80% sensitivity and 77% specificity on these criteria. This specificity is greater than that obtained by clinical examination and exercise testing alone (65%). Exercise radionuclide angiography may therefore reduce the number of unnecessary coronary arteriographies.

[3 cases of obliterating bronchiolitis during treatment of rheumatoid polyarthritis with D-penicillamine]. / Trois observations de bronchiolite oblitérante lors du traitement de la polyarthrite rhumatoïde par la D-pénicillamine.

The authors report three cases of bronchiolitis obliterans occurring during treatment of rheumatoid arthritis with D-penicillamine after 4, 6 and 8 months of treatment and when the rheumatoid arthritis was in a state of remission. None of these patients (2 sero-positive and 1 sero-negative) present any past history of pulmonary or bronchial disease. The daily dosage of D-penicillamine never exceeded 600 mg. High dose corticosteroid therapy was unable to improve the clinical signs or the respiratory function tests, which were severely disturbed. After 15 months to 3 years, the respiratory signs deteriorated in 2 of the 3 patients. The onset of dyspnea and cough, in the absence of a seasonal infection, in a subject treated with D-penicillamine should raise the possibility of this very serious complication.

Visualization of myocardial infarction six hours after injection of 111 In-antimyosin antibodies using an image subtraction technique.

111 In-antimyosin antibodies are capable of visualizing acute myocardial infarction (MI). Because of slow blood clearance, images are usually recorded 24 or 48 h postinjection. This pilot study was aimed at validating a blood pool subtraction technique, which makes it possible to visualize MI 6 h postinjection. Twenty-five patients with proven MI (16 anterior, 9 inferior) were imaged 10 minutes, 6 and 24 h after an injection of 110 MBq 111 In-labelled antimyosin antibodies, with a mean delay of two weeks after infarction. Three planar views were obtained each time. Using software which performs geometric registration, grey level normalization and subtraction of images, the blood pool image (obtained 10 minutes postinjection) was subtracted from the 6 hour image. The resulting image was the blood pool corrected 6 h image. The 24 h images and the blood pool corrected 6 h images were interpreted blindly and the number of correct, incorrect and indeterminate MI localizations were tabulated. The number of correct localizations was 19/25 for the standard 24 h images and 22/25 for the blood pool corrected 6 h images. With this blood pool subtraction method it was possible to visualize MI 6 h postinjection. Theoretically, this method could be applied six hours after myocardial infarction.

[Treatment of Paget's disease with 1-ethane-1-hydroxy-1-diphosphonate]. / Le traitement de la maladie de Paget par l'éthane-1, hydroxy-1, 1-diphosphonate (EHDP).

The authors treated 11 patients suffering from severe and/or quickly developing Paget's disease (3 of whom had leontiasis ossea), using etidronate (E.H.D.P.) at doses of 7 to 15 mg.kg/day for a period of 6 months. The patients were followed up for 18 months, on average. The following were the conclusions of the investigation: E.H.D.P. is an effective treatment of Paget's disease: the decrease in hydroxyprolinuria was greater and more durable than that of the alcalin phosphatases; a variation between these two values even seems to appear under treatment. However, although some patients responded very well to the treatment, others were less responsive; at the dosages used, E.H.D.P. reduced the scanning hyperfixation of the active pagetic areas in 6 patients: it likewise more or less markedly reduced hyperosteoclastosis, with no apparent increase in the osteoid volume; two patients suffering from upper maxillary disease regressed clinically (dentures had become too large); headache and hypacusia were not modified; the response to the treatment seems to depend on three factors: the activity of the patient, the dosage used, and an individual factor which may be linked to the severity of the osteoidosis.

[How to evaluate the activity of Paget's disease in clinical practice and which patients should be treated?]. / Comment évaluer, en pratique, l'activite de la maladie de Paget et quels malades traiter?

In patients with Paget's disease, the alkaline phosphatase level (AP) is a measure of the phosphatase activity throughout the skeleton, i.e. the activity of normal bone tissue as well as that of Pagetic bone, in proportion to their respective volumes. This test therefore greatly under-estimates the activity of Pagetic bone in localized forms of the disease. To accurately evaluate the activity of Pagetic bone, the value of AP needs to be expressed in terms of the percentage of bone tissue affected by the disease. Two tables enable us to assess this percentage approximately. It is therefore possible to evaluate the activity of Pagetic bone on the basis of the tables presented by the authors. We can see that localized forms of Paget's disease may have an alkaline phosphatase activity of 2 000 or 3 000 I.U., while the AP levels in the blood are less than 200. So, in the presence of localized forms of the disease, we are unable to say that the disease is barely active on the basis of very low values for AP. It is important to treat localizations which have a "functional" risk for the future, especially when there localizations are highly active. The histopathological and scintigraphic data are compatible with areas of ery high activity. A similar rationale should be applied to the figures obtained for urinary hydroxyproline and the results of 45Ca kinetic studies.

Infiltrado pulmonar por trastuzumab: un cuadro de difícil diagnóstico etiológico / Lung infiltrate due to trastuzumab: a picture of difficult etiologic diagnosis

• Introducción: la aparición de un infiltrado pulmonar difuso en el curso de un tratamiento antineoplásicopuede obedecer a múltiples causas, desde las propiamente debidas a la enfermedad neoplásica a las producidaspor el tratamiento citostático. La toxicidad pulmonar inducida por trastuzumab es un efecto secundarioapenas descrito• Material y método: presentamos un caso de infiltrado pulmonar bilateral en una paciente con cáncerde mama tratada con docetaxel-trastuzumab. Tras descartar otras causas, se atribuyó el cuadro clínico al trastuzumab.La paciente evolucionó favorablemente tras la suspensión del tratamiento y la administración de glucocorticoides.• Conclusiones: el diagnóstico de infiltrado pulmonar por trastuzumab es un diagnóstico de exclusión yno existe un tratamiento definido más allá de la suspensión del fármaco

• Introduction: The appearance of a bilateral lung infiltrate during an antineoplastic treatment may bedue to an important number of causes: causes related to the disease or related to the treatment.Lung toxicity is not usual during trastuzumab treatment.• Material and methods: We describe a case of lung infiltrate in a patient with advanced breast cancerduring treatment with docetaxel and trastuzumab. After excluding other causes, we attributed the case totrastuzumab. The patient had a favourable evolution with treatment discontinuation and glucocorticosteroids.• Conclusions: The diagnosis of a lung infiltrate caused by trastuzumab is an exclusion diagnosis and wedon’t know about other treatment than stopping trastuzumab administration