[Is the asthmatic patient competent to manage his disease? A study of 280 patients in Seine-Saint-Denis, France]. / L'asthmatique est-il compétent pour gérer sa maladie ? Étude de 280 patients en Seine-Saint-Denis, France.

INTRODUCTION: The correct use of medication and the ability to assess the severity of the disease and to react appropriately in the case of exacerbation are essential objectives in the management of asthma patients. This study, conducted in a school of asthma in Seine-Saint-Denis, aims to measure the influence of socio-demographic and clinical factors, before any educational process, on these four security skills. METHODS: A prospective observational study concerning 280 consecutive patients managed between 2008 and 2011 (70 % women, mean age: 44 years [14-85 years]; deprivation: 48 %; born abroad: 39 %, low level of education: 23 %). The initial educational diagnosis was compared with the clinical and socio-demographic characteristics. RESULTS: In relation to asthma control, social characteristics (unemployment, deprivation), geographic or ethnic origin and educational level significantly influence the command of all or some of the security skills. In medical terms, a period of evolution of the disease of less than 10 years, outpatient follow-up without specialized monitoring and the absence of recent exacerbations also appear as predictors of inappropriate conduct in the management of the disease. CONCLUSIONS: This study suggests new priority targets for therapeutic education in asthma.

[Cryptococcal chorioretinitis and acquired immunodeficiency syndrome]. / Choriorétinite à cryptocoque et syndrome d'immunodéficience acquise.

We report a case of cryptococcal chorioretinitis discovered at ophthalmological examination of a 68-year-old woman with acquired immune deficiency syndrome. This localization revealed cryptococcal septicemia, without involvement of the central nervous system unlike most cases reported. Therapy with fluconazole (400 mg per day) led to gradual regression of the chorioretinal lesion.

High-performance liquid chromatographic determination of (SR)- and (RS)-enantiomers of mefloquine in plasma and capillary blood sampled on paper after derivatization with (-)-1-(9-fluorenyl)ethyl chloroformate.

A sensitive, stereoselective and rapid reversed-phase liquid chromatographic method for the determination of (SR)- and (RS)-mefloquine enantiomers in 100 microliters plasma and capillary blood collected on chromatographic paper is presented. The assay involves protein precipitation from plasma, liquid-liquid extraction of mefloquine from plasma, capillary blood with methyl tert.-butyl ether under alkaline conditions and derivatization of MQ with (-)-1-(9-fluorenyl)ethyl chloroformate. Liquid chromatographic separation of the diastereomers was performed using an C18 reversed-phase column with acetonitrile-water-acetic acid 82:18:0.07 (v/v/v) as the mobile phase, and a flow-rate of 1.0 ml/min. When using 100 microliters of plasma the limit of determination is 250 nmol/l with ultraviolet- and 10 nmol/l with fluorescence detection. The present method offers several advantages over those previously reported; very low limit of determination, small sample volume, sampling onto paper and use of an inexpensive standard achiral HPLC column. No racemization during the derivatization procedure or storage of the MQ enantiomers was found.

Enantioselective high-performance liquid chromatographic determination of (SR)- and (RS)-mefloquine in plasma using N-benzyloxycarbonyl-glycyl-L-proline as chiral counter ion.

A stereoselective HPLC method is described for the determination of (SR)- and (RS)-mefloquine in plasma. The direct chiral separation is carried out on a Hypercarb-S column (porous graphitised carbon) with N-benzyloxycarbonyl-glycyl-L-proline (L-ZGP) as a chiral counter-ion in a reversed-phase system. The sample work-up included protein precipitation by addition of zinc sulphate and acetonitrile followed by liquid-liquid extraction with methyl-tert.-butyl ether. After evaporation of the organic phase, the residue is dissolved in the mobile phase and injected onto the column. Analyses of the enantiomers in plasma after a single oral dose of mefloquine indicates that the pharmacokinetics of the two enantiomers are different. The method is validated by determining the absolute recovery, linearity, accuracy, precision and inter- and intra-assay variation.

High-performance liquid chromatographic method for the simultaneous determination of mefloquine and its carboxylic metabolite in 100-microliters capillary blood samples dried on paper.

A reversed-phase high-performance liquid chromatographic method is described for the analysis of mefloquine and its carboxylic metabolite in 100-microliters capillary blood spots dried on chromatographic paper. Each spot was cut into small pieces, and mefloquine and its metabolite were eluted with an ammonia-water solution (10:90, v/v). The compounds were extracted simultaneously after alkalization at pH 9.5 using tetrabutylammonium as ion-pairing agent and then separated on a C18 column with ultraviolet detection at 227 nm. The recovery of the drugs from spiked blood applied to paper and dried was 70-80%, and the inter-assay precision at 1.0-5.0 mumol/l (therapeutic range) was less than 10%. The correlation between extractions from venous whole blood and capillary blood applied to chromatographic paper was more than 0.94. The analytes were stable in dried blood spots for at least fifty days at -20 degrees C. The decrease of concentration was less than 10%, when the paper was stored at 37 degrees C for fifty days. The assay is reliable and easy to use for therapeutic monitoring of mefloquine with a lower limit of determination of 0.3-0.5 mumol/l.