The free plasma amyloid Aß1-42/Aß1-40 ratio predicts conversion to dementia for subjects with mild cognitive impairment with performance equivalent to that of the total plasma Aß1-42/Aß1-40 ratio. The BALTAZAR study.

BACKGROUND AND PURPOSE: Blood-based biomarkers are a non-invasive solution to predict the risk of conversion of mild cognitive impairment (MCI) to dementia. The utility of free plasma amyloid peptides (not bound to plasma proteins and/or cells) as an early indicator of conversion to dementia is still debated, as the results of studies have been contradictory. In this context, we investigated whether plasma levels of the free amyloid peptides Aß1-42 and Aß1-40 and the free plasma Aß1-42/Aß1-40 ratio are associated with the conversion of MCI to dementia, in particular AD, over three years of follow-up in a subgroup of the BALTAZAR cohort. We also compared their predictive value to that of total plasma Aß1-42 and Aß1-40 levels and the total plasma Aß1-42/Aß1-40 ratio. METHODS: The plasma Aß1-42 and Aß1-40 peptide assay was performed using the INNO-BIA kit (Fujirebio Europe). Free amyloid levels (defined by the amyloid fraction directly accessible to antibodies of the assay) were obtained with the undiluted plasma, whereas total amyloid levels were obtained after the dilution of plasma (1/3) with a denaturing buffer. Free and total Aß1-42 and Aß1-40 levels were measured at inclusion for a subgroup of participants (N = 106) with mild cognitive impairment (MCI) from the BALTAZAR study (a large-scale longitudinal multicenter cohort with a three-year follow-up). Associations between conversion and the free/total plasma Aß1-42 and Aß1-40 levels and Aß1-42/Aß1-40 ratio were analyzed using logistic and Cox Proportional Hazards models. Demographic, clinical, cognitive (MMSE, ADL and IADL), APOE, and MRI characteristics (relative hippocampal volume) were compared using non-parametric (Mann-Whitney) or parametric (Student) tests for quantitative variables and Chi-square or Fisher exact tests for qualitative variables. RESULTS: The risk of conversion to dementia was lower for patients in the highest quartile of free plasma Aß1-42/Aß1-40 (≥ 25.8%) than those in the three lower quartiles: hazard ratio = 0.36 (95% confidence interval [0.15-0.87]), after adjustment for age, sex, education, and APOE ε4 (p-value = 0.022). This was comparable to the risk of conversion in the highest quartile of total plasma Aß1-42/Aß1-40: hazard ratio = 0.37 (95% confidence interval [0.16-0.89], p-value = 0.027). However, while patients in the highest quartile of total plasma Aß1-42/Aß1-40 showed higher MMSE scores and a higher hippocampal volume than patients in the three lowest quartiles of total plasma Aß1-42/Aß1-40, as well as normal CSF biomarker levels, the patients in the highest quartile of free plasma Aß1-42/Aß1-40 did not show any significant differences in MMSE scores, hippocampal volume, or CSF biomarker levels relative to the three lowest quartiles of free plasma Aß1-42/Aß1-40. CONCLUSION: The free plasma Aß1-42/Aß1-40 ratio is associated with a risk of conversion from MCI to dementia within three years, with performance comparable to that of the total plasma Aß1-42/Aß1-40 ratio. Threshold levels of the free and total plasma Aß1-42/Aß1-40 ratio could be determined, with a 60% lower risk of conversion for patients above the threshold than those below.

Management of perioperative iron deficiency anemia as part of patient blood management in France: A budget impact model-based analysis based on real world data.

OBJECTIVES: Patient Blood Management (PBM) is defined as a patient-centered, systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient's own blood, while promoting patient safety and empowerment. As a corollary, it also reduces the utilization of allogeneic blood components. However, demonstrating cost-effectiveness depends on the health insurance system considered. This analysis aims to estimate the one-year budget impact of PBM in four elective surgical areas, from French National Health Insurance and hospital perspectives. METHODS: A budget impact model was developed to estimate the difference in the cost of care between scenarios with and without PBM. The impact of hematopoiesis optimization (first pillar of PBM) was studied throughout the management of preoperative anemia and iron deficiency in four types of surgeries: orthopedic, cardiac & cardiovascular, vascular & thoracic, and urologic & visceral surgery. Estimation of model's parameters was based on data collected in 10 French hospitals, literature, and on data from the French national medico-administrative database. RESULTS: A total of 980,125 patients were modeled for all four therapeutic areas. Results shows that implementation of a PBM program could generate annual savings up to €1079 M from the French National Health Insurance perspective (€1018 M from the hospital perspective), and the sparing of 181,451 red blood cells units per year. The deterministic sensitivity analysis showed that PBM generates savings for both perspectives in most parameters tested. CONCLUSION: Implementing PBM programs could result in important savings for the health care system in France.

[The role of the community and hospital pharmacist in public health prevention in France]. / Le rôle du pharmacien en officine et en pharmacie hospitalière dans la prévention en santé publique en France.

INTRODUCTION: As the healthcare system changes, the pharmacist's place does. In this context the health institutions are looking for improving prevention and so realize how well placed pharmacists were. For their competences as well as the trust patients are giving, they are serious actors in the implementation of prevention. METHODS: We sought to understand which place pharmacists take in prevention policies. Thus, we have proceeded with an analysis of bibliography of the past ten years about articles registered in Medline talking about pharmacist's places in French prevention. RESULTS: We have selected 47 articles classified according to San Marco's 3 levels of prevention: universal, oriented or targeted prevention. The pharmacist is involved in universal prevention, cancer screening or the proper use of antibiotics. In targeted prevention, they are specifically interested in the proper use of medicines and their correct prescription to patients. Finally, for targeted prevention, they offer patients therapeutic education adapted to their needs. CONCLUSIONS: We can highlight that pharmacists improve consequently the patient's quality of life. They also enhance connections between health care professionals. Thanks to pharmacists, patients can find easy access and reliable health advice and government, trustworthy support for prevention.

[Economic evaluation of porous metal cones in total knee arthroplasty]. / Étude de l'impact économique des cônes en métal poreux dans les arthroplasties totales du genou.

INTRODUCTION: The use of porous metal cones (PMC) to fill bone loss during knee replacements is increasing, but these medical devices are not reimbursed in addition to diagnosis related tariffs (DRTs). The economic impact of PMC may be significant for hospitals. MATERIAL AND METHODS: This multicenter observational study includes all patients who benefited of a total knee prosthesis, with reconstruction by PMC, between June 2014 and June 2019, in two French university hospitals. The costs of each diagnosis related group (DRG) was evaluated using the "étude nationale des coûts à méthodologie commune (ENC)". The PMC costs were compared with the amounts of DRG and with the fares perceived by the hospital from the French sickness fund (DRTs). RESULTS: 96 patients (103 stays) benefited from the implantation of 195 cones. The hospital incomes were 10,970±1401€ /stay. Spending associated with PMC represented 35% of DRGs and 44% of DRTs. The average additional cost related to the cones was 2709±1138€ /stay. If the reconstructions had been performed by allograft, the average gain for hospitals would have been 108€ /stay. CONCLUSION: If PMC have clinical benefits for surgeons in reducing the incidence of revision, this study shows the inadequacy of the funding of these devices for French hospitals. This suggests the need to expand the possibilities of supporting innovative technologies.

[Use of self-tests and rapid diagnostic tests: Survey of dispensing pharmacists in the Auvergne-Rhône-Alpes region]. / Utilisation des TROD et autotests : enquête auprès des pharmaciens officinaux de la région Auvergne­Rhône-Alpes.

OBJECTIVES: RDT and self-tests are sold in pharmacies. These are medical biology procedures that are currently reserved for biologists. Nevertheless, their use is now being reinforced by the COVID-19 pandemic. What role should the dispensing pharmacist have in relation to the patient? What role can the biologist have in this system? METHODS: A survey was carried out in pharmacies in the Auvergne-Rhône-Alpes region, as well as in Cameroon during the summer of 2020, to evaluate the use of RDT and self-tests. The answers obtained to the 10 questions were discussed after a simple statistical analysis. RESULTS: Two hundred and eighty-three pharmacies and 13 Cameroonian pharmacies participated in our survey. Pharmacists want to develop the use of RDT and self-test, but agree that training is necessary. Some tests are dispensed despite their unproven clinical usefulness. CONCLUSIONS: The delivery of TRODs and self-tests is acquired in pharmacies despite the reluctance of biologists. Pharmacists should be trained by biologists to use these tests in a relevant and appropriate manner.

[Service rendered's assessment of a pharmaceutical information center on patients care]. / Évaluation du service rendu d'un centre d'information pharmaceutique sur la prise en charge des patients.

The Question-Answer (Q/R) service of Lyon's teaching hospital, offers reliable and updated information for healthcare professionals (HP). The impact of Q/R activity on patient outcome was measured by using a survey to assess user's satisfaction and impact on HP knowledge and/or patients cares. The compatibility of this tool with daily use had been assessed too. MATERIALS AND METHODS: The survey was sent prospectively, for 9 months in 2018, to all HP whose enquiry was linked to a particular patient's care. The survey was posted 24-48h after the answer had been provided. RESULTS: 41 survey over 55 sent were returned (74.5%). The level of satisfaction measured is mostly good or excellent on all evaluated items. The HP surveyed consider that the responses provided have a potential positive impact on their professional knowledge and practices (97.6%), on the patient's care (n=36/37) and patient outcome (n=22/23). CONCLUSION: High level of satisfaction with the Q/R service and positive impact of this specialized Q/R service on improvement of HP knowledge and patient's care. This tool can be used in daily practice.

Funding breakthrough therapies: A systematic review and recommendation.

BACKGROUND: Advanced therapy medicinal products (ATMPs) are innovative therapies likely associated with high prices. Payers need guidance to create a balance between ensuring patient access to breakthrough therapies and maintaining the financial sustainability of the healthcare system. OBJECTIVE: The aims of this study were to identify, define, classify and compare the approaches to funding high-cost medicines proposed in the literature, to analyze their appropriateness for ATMP funding and to suggest an optimal funding model for ATMPs. RESULTS: Forty-eight articles suggesting new funding models for innovative high-cost therapies were identified. The models were classified into 3 groups: financial agreement, health outcomes-based agreement and healthcoin. Financial agreement encompassed: discounts, rebates, price and volume caps, price-volume agreements, loans, cost-plus price, intellectual-based payment and fund-based payment. Health outcomes-based agreements were defined as agreements between manufacturers and payers based on drug performance, and were divided into performance-based payment and coverage with evidence development. Healthcoin described a new suggested tradeable currency used to assign monetary value to incremental outcomes. CONCLUSION: With a large number of ATMPs in development, it is time for stakeholders to start thinking about new pathways and funding strategies for these innovative high-cost therapies. An "ATMP-specific fund" may constitute a reasonable solution to ensure rapid patient access to innovation without threatening the sustainability of the health care system.

Current trends in vasopressor use to the operating room: A pharmacoepidemiologic study in French teaching and military hospitals.

OBJECTIVES: Phenylephrine, ephedrine and norepinephrine are the vasopressors most commonly used in the operating room to treat anaesthesia-induced hypotension. Two new diluted forms of phenylephrine were released in 2011 (500µg/10mL and 500µg/5mL). We initiated a study to evaluate trends in the use of vasopressors in the operating room in French hospitals over the period 2011-2014. METHODS: We conducted a longitudinal, retrospective, observational study between 2011 and 2014 in French teaching and military hospitals. A questionnaire was sent in February 2015 to hospital pharmacists of each centre to retrospectively collect the consumption of each type of vasopressor. Yearly numbers of vasopressor ampoules were divided by the yearly numbers of anaesthetics recorded. For each vasopressor, we calculated the number of ampoules per 100 anaesthetics recorded (/100A). RESULTS: Thirty-two hospitals (82%) completed the questionnaire. One hundred per cent of hospitals had registered the diluted form of phenylephrine (61% had chosen the dilution 500µg/10mL), whereas concentrated ampoules were available in 68% of hospitals. Over the period, an exponential increase in the use of diluted phenylephrine was observed (from 1.0 ampoule/100A in 2012 to 31.7 in 2014), the use of ephedrine remained stable (26 ampoules and 17 prefilled syringe/100A), and use of norepinephrine trended upwards (from 6.7 to 8.2 ampoules/100A). CONCLUSIONS: The use of diluted phenylephrine has exponentially increased without reducing consumption of other vasopressors. This trend might be secondary to practice changes in hypotension treatment following the release of French guidelines in 2013 related to fluid management, the restriction of indications of hydroxylethyl-starch solutions in 2013, and a better knowledge of the benefit of blood pressure optimisation to reduce postoperative morbidity.

[Medico-economic evaluation of therapeutic strategies at hospital: A systematic review of French studies]. / L'évaluation médico-économique des stratégies thérapeutiques en milieu hospitalier : une revue systématique des travaux français.

INTRODUCTION: Therapeutic innovation contributes to the increase of health care expenditures in France. Medico-economic evaluation has still a minor role in the decision-making for the registration of drugs and medical devices in hospitals. This study aimed to systematically review published works on medico-economic studies conducted within French hospitals. METHODS: A literature review was carried out to search for medico-economic studies conducted by hospital teams on therapeutic or diagnostic strategies employed within French hospitals and published from 2010 to 2014. Quality assessment of selected studies was performed according to Drummond et al.'s checklist, which is also used within French guidelines. RESULTS: Of the 44 analyzed articles, methods for identification and measure of costs and results complied with guidelines in 95 % of cases. For results interpretation, compliance was 91 %. Costs discounting (29 %) and the use of sensitivity analysis to account for results uncertainty (70 %) were the parameters with the lowest compliance to guidelines. CONCLUSION: A good training of health professionals in using economic and statistic tools, and the transferability of results of medico-economic studies are essential and should be optimized to enable a broader use of medico-economic evaluation within the scope of decision-making in French hospitals.

[Study of parenteral iron use in a health facility and its impact in terms of hospital economics]. / Étude de l'usage du fer injectable en établissement de santé et de son impact en terme d'économie hospitalière.

INTRODUCTION: Administration of parenteral iron is a mainstay of iron deficiency treatment. Evaluation and control of this element is an issue for healthcare facilities. Study of parenteral iron use is thus to be evaluated in its impact in terms of hospital economics. MATERIALS AND METHODS: Parenteral iron administrations that took place on 2014 in our healthcare facility were retrospectively identified by pharmacists. Following data were extracted from Pharma™ and Crossway™ softwares: indication, diagnostic coding and total dose of iron received. They were then compared to the summary of product characteristics. RESULTS: Of 198 analyzed prescriptions, iron deficiency was known or suspected for 97% of patients. However, the total dose of iron administered was not in compliance for three quarters of prescriptions. Sixty-eight percent of patients appear under-dosed. Administration's traceability was found for two-thirds. Eighty-five hospital discharges did not have the right coding and 34 stays were charged like an external act instead sessions. Financial loss for the hospital is estimated at 49,300 euros. DISCUSSION AND CONCLUSION: As part of improving practice, close pharmaceutical monitoring of parenteral iron prescribed dosing regimen is essential. Effective communication with the medical information department and regular awareness raising of prescribers should also allow to give more value to this act. Hospital economics is a real tool to aid decision-making.

[Care pathway for high urinary tract infection: an update in an emergency department of a French military hospital]. / Parcours de prise en charge des infections urinaires hautes: état des lieux aux urgencies d'un établissement militaire français.

Objectives Assessing the impact of professional practices on a patient's course is an interesting way to optimize health care pathway. The aim of our study is to update and evaluate the compliance to the recommendations of the Societe de Pathologie Infectieuse de Langue Francaise with regards to professional practices and the route of patients admitted to the emergency department of a French military hospital for high urinary tract infection. Patients and methods A retrospective study was carried out on patients admitted to the emergency department and treated for high urinary tract infection from January 1st, 2015 to April 30th, 2015. Clinical and administrative data, medical exams, and antibiotic prescriptions were extracted from computerized patient medical files and from emergency medical files. Results Out of 91 medical cares, 57% were compliant with the recommendations. For 60% of the patients, blood cultures were not argued and in 70% of cases, imaging wasn't justified. Antibiotic prescriptions were not compliant in 31% of cases, mostly due to long prescription durations. Two third of patients received outpatient care. All hospitalizations were argued. Conclusions Drawing up a caring protocol, regularly raising awareness to the good use of antibiotics, as well as reinforcing a cross disciplinary approach will allow optimizing health care pathways for patients coming to the emergency department with high urinary tract infection.

[Optical quality after 2.2mm microincisional cataract surgery with bimanual I/A in 154 eyes]. / Qualité optique après phacoémulsification par mini-incision de 2,2mm associée à une I/A bimanuelle, à propos de 154 yeux.

PURPOSE: A prospective study to analyze the effects of 2.2mm microincisional coaxial phacoemulsification with bimanual irrigation/aspiration on the optical quality of the cornea and whole eye. METHODS: We compare two groups. Group A: 102 consecutive eyes undergoing this three-incision procedure and implanted with an Alcon® SN60WF IQ aspheric intraocular lens. Astigmatism, corneal and total asphericity, as well as H/B ratio were measured by OPD scann II, Nidek®, Japan, preoperatively (Day 0), 15 days postoperatively (Day 15) and 1 month postoperatively (M1). Group B: 52 eyes with corneal astigmatism greater than 1.25D, undergoing the same procedure but implanted with a Toric IOL (Alcon® Toric IQ SN6AT), followed in the same manner but with additional follow-up at 1 year. RESULTS: Corneal surgically induced astigmatism (SIA) was essentially neutral: 0.065D ± 0.86 at Day 30 in group A, and 0.06D ± 0.34 at 1 month and -0.008D ± 0.4 at 12 months in group B. Corneal topographic astigmatism underwent a mean axis shift of 29.95° ± 27.6 in group A compared to 5.3° ± 3.7 in Group B, and remained stable at 1 year. Corneal asphericity did not change significantly between Day 0 and 30 in either group. H/B ratio increased significantly in both groups, with a gain of 22 % to 24 % after surgery. CONCLUSIONS: This three-incision procedure does not degrade the optical quality of the cornea. Postoperative shift in the axis of astigmatism is only an issue in cases of low or asymmetric astigmatism and must be kept in mind for low-power toric IOL implantation.

[Impact of sugammadex on neuromuscular blocking agents use: a multicentric, pharmaco-epidemiologic study in French university hospitals and military hospitals]. / Impact du sugammadex sur les consommations de curares : étude pharmaco-épidémiologique multicentrique dans les centres hospitalo-universitaires et hôpitaux d'instructions des armées français.

INTRODUCTION: Seven Neuromuscular Blocking Agents (NMBA) are commercialized in France. Four of them have an intermediate duration of action. Sugammadex required the use of NMBA slightly employed in clinical practice in France. Its introduction in routine practice could have an impact on NMBA use in clinical practice. This study was then conducted to assess and compare NMBA use before and after the commercialization of sugammadex. MATERIALS AND METHODS: A longitudinal, retrospective, observational study was conducted between 2008 and 2011 in French university hospitals and military hospitals. The consumption data for sugammadex and NMBA were collected using a collection grid which was filled by pharmacists or anesthesiologists. Drug use was measured by the number of vials used divided by the annual number of hospitalizations in surgery and obstetrics (HSO). An overall analysis of the annual frequency of NMBA use was firstly performed, then individual data of each hospital were analyzed. Descriptive statistical analysis including mean, standard deviation, median, minimum and maximum was achieved. RESULTS: Thirty-four out of 39 hospitals participated in the study (87%) and analysis was performed on 26 of them (7%). The data of eight institutions were excluded due to missing values or because of the non-admission of sugammadex in their formulary. The NMBA mostly used were non-steroidal NMBA (75% of market share) with an increased use between 2008 and 2011 concerning atracurium (from 41 to 51 vials of 50mg atracurium used per 100 HSO). The overall analysis revealed an increase of the occurrence of rocuronium (between 2008 and 2011: from 1 to 4.8 vials of 50mg rocuronium used per 100 HSO). Individual analyses on each hospital showed a possible effect of sugammadex introduction on NMBA use in nine hospitals. DISCUSSION AND CONCLUSIONS: The commercialization of sugammadex seems to have induced a discrete increase of steroidal NMBA but non-steroidal NMBA remain the leading agent in France. A long-term follow-up is deserved.

[Imported malaria at Desgenettes Military Hospital in Lyon, France: a retrospective study of 115 cases from 2006 to 2008]. / Le paludisme d'importation à l'hôpital d'instruction des armées Desgenettes de Lyon en 2006-2008 : étude rétrospective de 115 cas.

PURPOSE: The purpose of this report is to describe the clinical, epidemiologic, and parasitological features and therapeutic modalities associated with cases of imported malaria managed at the Desgenettes Military Hospital in Lyon, France. MATERIAL AND METHODS: Review of the files of all patients treated for imported malaria in the emergency and travel medicine departments of the Desgenettes Military Hospital from January 1, 2006, through December 31, 2008. RESULTS: The study included 115 patients (13 of them French armed forces personnel). Most cases (75.6%) were due to falciparum malaria. Only 28.7% of patients had taken proper malaria prophylaxis. Severe symptoms were seen in none of the ambulatory care patients versus 22.7% of the hospitalized patients. Quinine treatment was used for 67% of ambulatory care patients and 89.4% of those hospitalized. CONCLUSIONS: The epidemiologic features observed in the patients described here are similar to those reported by the French national reference center for imported and autochthonous malaria. The frequent use of quinine for ambulatory treatment was not consistent with current guidelines recommending first-line treatment with atovaquone-proguanil or artemether-lumefantrine.

Neuropathic complications after 157 procedures of continuous popliteal nerve block for hallux valgus surgery. A retrospective study.

BACKGROUND: Continuous peripheral nerve block (CPNB), in particular at the popliteal fossa, is widely used in orthopedic surgery, allowing good postoperative analgesia. Possible neuropathic complications, however, remain poorly known. OBJECTIVE: To review the characteristics of peripheral neuropathy (PN) after sciatic CPNB at the popliteal fossa, estimating prevalence, severity, evolution and possible risk factors, especially those relating to the procedure. METHODS: Retrospective study of PN associated with popliteal fossa CPNB for hallux valgus surgery, between November 1st, 2005 and November 1st, 2009. All procedures were analyzed (type of anesthesia, approach, nerve location technique, number of procedures by operator) with, for each case of PN, analysis of clinical and electromyographic data. RESULTS: One hundred and fifty seven sciatic CPNBs were performed (92% women; mean age, 55 years). The approach was lateral (n=62), posterior (n=74) or unknown (n=21). Ultrasound guidance was combined to neurostimulation for 69 patients (44%). Three women (prevalence=1.91%), aged 19, 24 and 65 years respectively, developed associated common superficial peroneal and sural nerve injury (2), axonal on electromyography, with motor (n=1) and/or sensory (n=3) residual dysfunction. DISCUSSION: The higher prevalence found in the present study than in the literature (0 to 0.5%) raises questions of methodological bias or technical problems. The common peroneal and sural nerves seem to be exposed, unlike the tibial. Several mechanisms can be suggested: anesthetic neurotoxicity, direct mechanical lesion, or tourniquet-related ischemia and conduction block. Further studies are necessary to determine the ideal anesthetic procedure. CONCLUSION: Patients should be informed of the potential risk, however rare, even during mild surgery. The best possible technique should be implemented, with reinforced surveillance.

Natural variability and response interpretation of fecundity, vertebrate-like sex-steroid levels and energy status in the New Zealand mudsnail Potamopyrgus antipodarum (Gray).

Potamopyrgus antipodarum is a promising test organism that is often used in ecotoxicology, both in laboratory and field exposures. As no data are available on the physiological variation range of its life-traits and the biomarkers it uses, we studied the variation of fecundity, steroid levels and energy reserves over the course of a year in a field population. The reproductive cycle was described and showed seasonal activity during summer and autumn. Steroid levels (17ß-estradiol and testosterone) varied significantly during the year and were correlated with the reproductive cycle, which suggested a potential role for sex-steroids in P. antipodarum reproduction. Energy status also showed seasonal variations. Triglycerides (TG) seemed to be the main energy lipid, whereas cholesterol appeared to be mostly used as a structural lipid. Proteins were also involved in the reproductive cycle, but only when TG were not sufficient to support the reproductive strain, similar to cholesterol. Glycogen seemed to be used as an early reserve. Threshold values under which no reproduction occurred were defined in starved snails. We proposed a range of variation in the measured parameters, allowing for a better understanding and interpretation of their levels during laboratory or in situ exposures. The data suggest that the variability of fecundity in snails has not been fully appreciated in literature.

[Stopping the use of unused drugs for humanitarian purposes: Stakes and perspectives]. / Arrêt de la valorisation humanitaire des médicaments non utilisés : enjeux et perspectives.

Since the 1970s, drugs unused by French households have been collected for humanitarian aid. In 1993, the Cyclamed system was created by pharmacists in order to manage and collect unused drugs. However, experience has shown that in developing countries unused drugs caused more problems than they solved, including: poorly adapted to the needs of the population, poor quality of the collected medicines, interferences with local pharmaceutical policies, misappropriation... As recommended by the World Health Organisation, most of the humanitarian organizations stopped unused drug donations. In France this practice has been forbidden since the 1st of January 2009. Associations that still desire to send unused drugs to developing countries must develop other approaches, such as essential generic medicines or emergency health kits.

[Improvement of quality of practices for the preparation of cytotoxic drugs: results of a "before-after" study]. / Optimisation des procédures de manipulation des chimiothérapies anticancéreuses : impact des contrôles de contamination environnementaux.

Despite the publication of guidelines for handling antineoplastic agents, measurable amounts of these drugs are still found at various hospital sites. In this context, the French cancer network ONCORA supported the present study to assess the impact of environmental contamination controls on the quality of practices during the preparation of cytotoxic drugs. The first part of the study was conducted at five voluntary hospitals. A total of 65 wipe samples of objects and surfaces were taken in the drug preparation rooms and analyzed for the presence of 5-fluorouracil (5-FU). Measurable amounts of 5-FU were detected in 21 samples (32%). Many surfaces within Biological Safety Cabinets and isolators were found contaminated (36%). The worse results were obtained on gloves and on the outside of infusion bags. The same method was applied during the second part of the study, conducted six months after the end of the first audit. Global contamination was reduced to 17%. This study shows that appropriate handling helps decrease the number of samples contaminated, making it possible to recommend these controls for evaluating and improving the quality of practices. Since 2007, the network's laboratory has extended its activities to all French hospitals interested in this quality assurance programme.

[Imported mycosis: a review of paracoccidioidomycosis]. / Mycoses d'importation: le point sur la paracoccidioïdomycose.

Population migration is increasing the number of systemic mycosis cases, a condition little or not present in Metropolitan France, thus often weakly documented for medical teams. Paracoccidioidomycosis is a systemic mycosis geographically confined to Latin America. The causative agent is Paracoccidioides brasiliensis, a dimorphic fungus present at ground level. Discovering that the armadillo was a new host allowed documenting the ideal conditions for this fungus development. The mortality rate is currently 1.45 for one million people and the disease affects mainly farmers. The mode of infection is respiratory and all organs and mucous membranes can be affected by lymphatic dissemination. The chronic form with pulmonary, cutaneous and oral lesions is the most important. The diagnosis can be carried out by direct examination of samples revealing the presence of budding yeasts, as well as culture at 25 and 37 degrees C. Antifungals like the sulfamethoxazole-trimethoprime combination, amphotericin B, but especially azole derivatives are use in the therapeutic management of patients. Detection and gp 43 antigen assay is useful for the patient's follow-up.

[Lung cancer in Senegal]. / Le cancer bronchique au Sénégal.

In Africa the incidence of lung cancer is rising rapidly. The purpose of this prospective study was to analyze clinical, therapeutic, and prognostic features of lung cancer patients treated at the Principal Hospital in Dakar between 2002 and 2007. A total of 72 cases were compiled over the 5-year study period. In 88% of cases the patient was a male smoker with a mean age of 59.2 years. Histological samples were obtained in 79.1% of cases by bronchial fibroscopy (n=33), CT-guided transthoracic needle biopsy (n=17), or from a metastatic site (n=7). The histological diagnosis was squamous cell carcinoma in 23 cases, adenocarcinoma in 14, large-cell carcinoma in 17, small-cell lung cancer in 2, and bronchiolo-alveolar cancer in 1. Tumor staging demonstrated grades I-II in 6 cases, grade II in 17, and grade IV in 49. Symptomatic management was performed in 68% of patients. In the remaining cases management consisted of chemotherapy in 22 cases, radiotherapy for pain relief in 5, and surgery in 1. Ten patients were lost from follow-up. Median survival was 7 or 3 months depending on whether or not chemotherapy was performed. The much higher rate of histological diagnosis than in the sub-region is due mainly to the availability of trained personnel with access to bronchial endoscopy and CT-scan needle biopsy since September 2003. Administration of cytotoxins is feasible but the cost is excessive due to the lack of universal health care coverage: two-thirds of cases were abandoned whereas chemotherapy significantly improved median survival by 4 months (p < 0.0001). Prognosis of the disease is poor because management is undertaken at an advanced stage. Lung cancer is a health issue in Dakar, Senegal. It is urgent to develop therapeutic standards adapted to the African socio-economic setting as well as an anti-tobacco prevention policy.