[Quality of medication storage on hospital wards]. / Qualité du stockage des médicaments dans les unités de soins.

In order to meet regulations and limit the risks for patients, the quality of medication storage on hospital wards requires practical actions. They concern mainly the management of the emergency medication cabinets, conditions regarding supply and cold storage under controlled temperatures. Failures in the system may result in nurses carrying out risky procedures.

[Cooperations between biology laboratories of the establishments of healthcare]. / Coopérations entre laboratoires de biologie médicale des établissements de santé

In France, the cooperations between biological laboratories of the healthcare establishments increased after those realized in the private laboratories. The biologists are confronted with various hypotheses of organization. They are often complex because they may preserve the quality of the care and their continuity while realizing financial economies. These economies are mostly based on the global reduction in the staff and in the equipments by mutualising the biological tests with varying degrees. We describe the various elements to be taken into account (staff, activities, budget, quality, transport, materials) and propose many scenarios of cooperations, from a unique central shape to the transfer of very specialized tests, with their advantages and their inconveniences. The management of human aspects in these cooperations is determining to facilitate their success as well as a reliable preliminary inventory of fixtures.

Analytical performances of the Diazyme ADA assay on the Cobas® 6000 system.

OBJECTIVE: To evaluate the analytical performance of the Diazyme ADA assay on the Cobas® 6000 system for pleural fluid samples analysis. DESIGN AND METHODS: Imprecision, linearity, calibration curve stability, interference, and correlation studies were completed. RESULTS: The Diazyme ADA assay demonstrated excellent precision (CV<4%) over the analytical measurement range (0.5-117 U/L). Bilirubin above 50 µmol/L and haemoglobin above 177 µmol/L interfered with the test, inducing a negative and a positive interference respectively. The Diazyme ADA assay correlated well with the Giusti method (r(2)=0.93) but exhibited a negative bias (~ -30%). CONCLUSIONS: The Diazyme ADA assay on the Cobas® 6000 system represents a rapid, accurate, precise and reliable method for determination of ADA activity in pleural fluid samples.

[The patient billing cost in medical biology: advantages and disadvantages]. / La facturation coût-patient en biologie médicale: avantages et inconvénients.

Control of health expenditures in relation with staff reduction have led hospital or private labs to seek out growing productivity associated with limited costs. Consolidation and harmonization of equipment have to be implemented, as well as work positions, with the aid of computers. Analytical and preanalytical choices often converge towards the same manufacturer, and it is tempting to simplify also order, receipt and invoicing procedures. This cost optimization requires invoicing taking into account real activity of the lab, establishing "pay per patient" rather than "pay per kit". These changes may also apply to smaller analyzers such as those employed for haemostasis that are deployed in several sites, in aim to reduce costs. We describe the principles of this new mode of invoicing proposed by Roche Diagnostics, for which one may bring out main advantages and inconveniences.

Effects of Ramadan fasting on physical performance and metabolic, hormonal, and inflammatory parameters in middle-distance runners.

The Ramadan fasting (RF) period is associated with changes in sleep habits and increased sleepiness, which may affect physical performance in athletes, and may induce metabolic, hormonal, and inflammatory disturbances. In 8 middle-distance athletes (25.0 +/- 1.3 years), a maximal aerobic velocity (MAV) test was performed 5 days before RF (day -5), and on days 7 and 21 of RF. The same days, saliva samples were collected to determine cortisol and testosterone concentrations before and after the MAV test. Blood samples were collected before RF (P1), at the end of RF (P2), and 1 week post RF (P3). Plasma levels of interleukin (IL)-6, a mediator of sleepiness and energy availability, were determined. We also evaluated changes in metabolic and hormonal parameters, mood state, and nutritional and sleep profiles. During RF, mean body mass and body fat did not statistically change. Compared with day -5, MAV values decreased at days 7 and 21 (p < 0.05, respectively), while testosterone/cortisol ratio values did not change significantly. Nocturnal sleep time and energy intake were lower at day 21 than before RF (day 0/P1) (p < 0.05). At the end of RF (day 31), the fatigue score on the Profile of Mood States questionnaire was increased (p < 0.001). For P2 vs. P1, IL-6 was increased (1.19 +/- 0.25 vs. 0.51 +/- 0.13 pg.mL-1; p < 0.05), melatonin levels were decreased (p < 0.05), and adrenalin and noradrenalin were increased (p < 0.01 and p < 0.001, respectively). At 7 days post RF, all parameters recovered to pre-RF values. In conclusion, RF is accompanied by significant metabolic, hormonal, and inflammatory changes. Sleep disturbances, energy deficiency, and fatigue during RF may decrease physical performance in Muslim athletes who maintain training. Reduction of work load and (or) daytime napping may represent adequate strategies to counteract RF effects for Muslim athletes.

Military community: a privileged site for clinical research: Epidemiological Study of Metabolic Syndrome Risk Factors in the Military Environment.

The metabolic syndrome is considered to be an important public health problem. The Epidemiological Study of Metabolic Syndrome Risk Factors in the Military Environment is a prospective epidemiological study that is designed to identify clinical and laboratory parameters of metabolic syndrome and cardiovascular risk factors with an initial 1-year cross-sectional study followed by a 10-year follow-up and patient care. One hundred eight-five (9%) of 2,045 military personnel subjects presented at least three of the five National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) criteria. They were significantly older (42.2 +/- 8.5 years) than the other subjects (37.3 +/- 8.7 years, p < 0.001), had a higher body mass index (BMI) (29.5 +/- 3.4 vs. 24.8 +/- 2.9, p < 0.001), and a greater body weight at age 20 (75.4 +/- 11 vs. 70.4 +/- 8.5 kg, p < 0.001). Smoking, little physical activity, and family histories of diabetes and arterial hypertension were more frequent in these subjects. Total plasma cholesterol and C-reactive protein were higher. Plasma insulin and BMI (r = 0.456, p < 0.0001) and plasma insulin and waist circumference (r = 0.446, p < 0.0001) were well correlated. Plasma insulin and homeostasis model assessment increased with the number of metabolic syndrome criteria. These results demonstrate a strong association with insulin resistance. Men with several risk factors require specific care especially for hypertension and dyslipidemia that will be evaluated during the follow-up period. Genotyping of subjects having metabolic syndrome vs. controls for genes, presumably involved should enlarge the area of exploration of this syndrome.

MDR3 mutations associated with intrahepatic and gallbladder cholesterol cholelithiasis: an update.

BACKGROUND: The recurrent microlithiasis represents one of the most frequent clinical forms of lithiasis of the bile ducts. This affection is characterized by the presence of cholesterolic microgallstones on hepatic canaliculars, and belongs to a heterogeneous group of autosomal recessive liver disorders. Radiological diagnosis can be confirmed by analysis of MDR3 gene, coding a protein involved in physiologic translocation of phospholipids in bile. Discovery of MDR3 mutations is of particular interest, since normally associated with good effectiveness of medication by ursodesoxycholic acid. AIM: To review MDR3 mutations in humans associated with recurrent cholesterol microlithiasis and to suggest a practical approach for MDR3 gene analysis. RESULTS: 48 mutations of MDR3 gene have been reported in humans to date, from which 43 (89.5%) in the coding region, and 5 splice site mutations have been associated to cholesterol cholelithiasis. 21 (43.8%) of the 43 precited mutations are located in only 8 exons on 28, near transmembrane or nucleotide binding domains of the protein. From the 22 remaining described mutations, 9 (18.8%) are restricted to exon 14. We suggest therefore to start analysis of MDR3 gene by screening exons 6, 7, 9, 10, 12, 14, 17, 23 and 24 with an appropriate protocol in this diagnosis associated with effective treatment. In conclusion such therapeutic orientation is valuable, since recurrent cholesterolic microlithiasis occurs relatively early in life, and by the fact that recurrence of symptoms may occur despite cholecystectomy, or shock-wave therapy.

Comparison of systemic cytokine responses after a long distance triathlon and a 100-km run: relationship to metabolic and inflammatory processes.

Suggested mechanisms for the systemic, circulating cytokinemia observed during heavy physical exertion include inflammation and energy demand. We compared cytokine levels and examined the underlying physiological mechanisms between a long-distance triathlon and a 100-km run, two endurance races of similar duration but characterized by differences in muscle strain. Blood samples were collected from 12 triathletes (34.8 +/- 1.4 yr) and 11 runners (42.4 +/- 2.2 yr) the day before and at the end of races (T1, R1), and 24 h and 7 days post-race (R2, R3). At R1, significant race-related differences were observed, with greater increases in plasma levels of interleukins (IL)-6, IL-1ra, and IL-10 in the triathletes than in the runners, while levels of the chemokine IL-8 increased solely in the runners (P < 0.05, P < 0.05, P < 0.01, and P < 0.001, respectively). At R1, free fatty acid (FFA) levels were 119% higher in the triathletes than in the runners, who were the most liable to muscle damage in view of increased levels of the muscle-specific enzyme, creatine kinase (CK), loss of muscle flexibility and decreased physical performance. At R1, levels of heat shock protein (HSP)72 increased in the two groups but were 173% higher in the runners. For the two groups, all parameters had returned to pre-race levels by seven days post-race. Positive correlations were noted between IL-6 and FFA in the triathletes and between IL-8 and CK and HSP72 in the runners. The differences between cytokine responses after a long distance triathlon and a 100-km run suggested that IL-6 and IL-8 could be employed as respective markers of the intensity of the muscular activity required for substrate availability and vascular inflammation.

[Urinary dipsticks must not be used to detect diabetes-induced incipient nephropathy]. / Inefficacité des bandelettes urinaires dans la recherche de néphropathie incipiens chez les diabétiques.

INTRODUCTION: Microalbuminuria is an early indication of diabetic nephropathy in patients with Type 1 diabetes and a marker of cardiovascular in patients with type 2 diabetes. It must therefore be assessed annually in these patients. We sought to determine whether semiquantitative determination of proteinuria with urinary dipsticks was useful for this purpose. METHOD: This analysis of consecutive urinary samples among diabetic patients excluded those with dipstick results positive either for leukocyturia or nitrituria, to avoid false positives due to urinary infection. We assessed the reliability of the dipsticks in comparison with conventional microalbuminuria and proteinuria assays. RESULTS: The study included 230 patients. Positive dipstick results had good positive (95.7%) and negative (93.9%) predictive values. Low levels of microalbuminuria, however - those that lead to early adjustment of treatment, were much more difficult to identify: the negative predictive value was only 73.7% and proteinuria was no longer correlated with microalbuminuria. DISCUSSION: Urinary dipsticks cannot replace conventional assays for microalbuminuria or proteinuria.

Analytical performance of the Albumin Cobalt Binding (ACB) test on the Cobas MIRA Plus analyzer.

Recently a new biological marker, Ischemia Modified Albumin (IMA), measured by the Albumin Cobalt Binding (ACB) test, was introduced for detection of myocardial ischemia. During ischemia, the metal binding capacity of albumin for certain transition metals like cobalt is reduced. The precise mechanism of action for producing IMA is not known but appears to be related to the production of reactive oxygen species that modify the metal binding sites. The ACB test is a quantitative assay that detects IMA by measuring the cobalt binding capacity of albumin in human serum. We evaluated the analytical characteristics of the ACB test, and reagent and specimen stability, using the Cobas MIRA Plus instrument. Coefficients of variation for within-run and between-run assays were <4%. No significant interference was observed for concentrations of triglycerides and hemoglobin up to 7 mmol/l and 3.8 g/l, respectively. No interference was apparent with bilirubin. Measures from paired samples of heparinized plasma and serum were not equivalent. The assay is validated for commercial use with serum, therefore our study reported results for serum specimens only. All assays were completed within 5 hours after blood withdrawal. The one-sided upper 95th percentile, calculated for the ACB test in 150 healthy subjects, was 87.00 U/ml. There was no observed difference between men and women or with age. We conclude that the ACB test adapted on the Cobas MIRA Plus analyzer is satisfactory, but strict attention to sample handling procedures is necessary to maintain stability of the analyte.

Immune and hormonal changes following intense military training.

This study was designed to determine whether the immune and hormonal systems were affected by a 5-day military course following 3 weeks of combat training in a population of 26 male soldiers (mean age, 21 +/- 2 years). The combination of continuous heavy physical activity and sleep deprivation led to energy deficiency. At the beginning of the training program and immediately after the combat course, saliva samples were assayed for secretory immunoglobulin A and plasma samples were assayed for interleukin-6, dehydroepiandrosterone sulfate, prolactin, catecholamines, glucocorticoids, and testosterone. Secretory immunoglobulin A was lower and circulating interleukin-6 was increased by the end of the course, which was attributed to sympathoadrenergic stimulation. Dehydroepiandrosterone sulfate, prolactin, and testosterone levels fell significantly. These results suggest that prolonged and repeated exercise such as that encountered in a military training program induces immune impairment via a decrease in mucosal immunity and a release of interleukin-6 into the circulation. The impaired secretion of dehydroepiandrosterone sulfate and prolactin, two immunomodulatory hormones, was thought to be a response to the chronic stressors. Lowered testosterone reflects a general decrease in steroid synthesis as a consequence of the physical and psychological strain.

Rapid identification of atypical variant of plasma butyrylcholinesterase by PCR.

Human butyrylcholinesterase is the enzyme responsible of mivacurium and succinylcholine metabolism, which may be significantly impaired when mutation Asp70Gly is found in patients. We describe a simple PCR method for the detection of this variant. Thirteen out of sixteen patients tested after prolonged apnea were positive for the presence of this mutation (50.0% homozygotes and 31.3% heterozygotes), suggesting that this test contributes to the explanation of some clinical events and to their prevention in relatives of these patients.

[Sexual abuse and chemical submission, a present-day problem]. / Agressions sexuelles et soumissions chimiques, un problème d'actualité.

CHEMICAL SUBMISSION: Certain forms of sexual abuse have recourse to molecules in order to obtain the victim's submission. These fast-acting, muscle-relaxing and sedative molecules, provoke anterograde amnesia that makes subsequent legal enquiries difficult. These products can be combined with alcohol or other addictive substances, therefore facilitating their administration, without the victim knowing, and enhancing their effects. THE MOLECULES USED: Among these molecules, hydroxybutyrate and its derivatives as well as benzodiazepines, with flunitrazepam, are frequently mentioned and detected. However, many other sedative molecules can be used to obtain chemical submission. MANAGEMENT OF THE VICTIMS: Knowledge of the facts and concomitant symptoms facilitates the medical and medico-legal management of the victims, generally encountered in hospital emergency wards. The quality and quantity of toxicological samples permit the use of efficient and validated techniques in organizing medico-legal enquiries.