[Knowledge and perceptions of biosimilar medicines by health professionals in Tunisia]. / Connaissances et perceptions des médicaments biosimilaires par les professionnels de santé en Tunisie.

INTRODUCTION: Biosimilar drugs occupy a strategic place in the global pharmaceutical market. However, there are brakes on their use. The objective of our study is to assess the knowledge and perceptions of healthcare professionals on biosimilar drugs in a developing country. MATERIAL AND METHODS: This is a prospective survey via an anonymous 18-question multiple-choice questionnaire developed and published online through the "Google Forms" application over a period of one month. This questionnaire is intended for Tunisian pharmacists and doctors of all ranks. RESULTS: A total of 240 health professionals responded to this questionnaire, including 158 pharmacists and 82 physicians. Among them, 73 are not informed about the biosimilar drugs and were excluded from the rest of the questionnaire. Questions regarding the definition of biosimilar drugs and their differences from generic drugs obtained the best rate of 76 % of correct answers. In contrast, the questions that generated the most errors mainly concerned the regulation of biosimilar drugs. Participants felt that they were under-informed about biosimilar drugs in 65 % of the cases. In addition, 92 % were in favor of the development of this class of drugs and 85 % estimated significant to very significant savings related to their use. CONCLUSION: Our study confirms the lack of information of pharmacists and physicians on biosimilar drugs. Sensitization of healthcare professionals on the safety and effectiveness of the use of these drugs seems to be necessary in order to allow their development.

A comparison of low versus high radioiodine administered activity in patients with low-risk differentiated thyroid cancer.

Post-surgical therapeutic management of differentiated thyroid cancer (DTC) is still a controversial subject. Indeed, there is no consensus on the dose of 131I to be administered, although the current trend towards therapy easing through mini-cures for patients with good prognosis. To confirm the non-inferiority in terms of effectiveness of an ablative mini-cure from 1.11 to 1.85 GBq, over a cure of 3.7 GBq, in patients with DTC operated for low and very low risk. We retrospectively studied 157 patients with very low and low risk DTC, followed in the Nuclear Medicine Department of the Salah Azaiez Institute between 2002 and 2012. These patients had a complementary radioiodine therapy with either low dose (group A) or high dose (group B) with an evaluation at 6 months post treatment and in long-term. The study took place at a referral center. The average age was 42.8 ± 13.7 years with a female predominance (86.7 %). The DTC papillary represented the most common etiology (95 %) with a predominance of pure papillary (68 %) on the follicular variant (27 %). The first cure evaluation did not show statistically significant difference between the two approaches in terms of therapeutic ablative efficiency (p = 0.13). The overall success rate was 77 % (121/157), with 83 % (54/65) in group A and 72.8 % (67/92) in group B. The likelihood of having a remission from the first cure was 1.83 times greater for patients treated with low doses (OR = 1.83, 95 % CI 0.23-1.29). At the end of follow, we have noted one case of refractory disease. The male gender (adjusted OR = 2.71, 95 % CI 0.51-4.23, p = 0.03), and the baseline Tg ≥ 10 (ng/ml) (adjusted OR = 3.48, 95 % CI 1.25-9.67, p = 0.01) were significantly independent predictors of successful first cure ablation. The results provide that mini-dose protocol is not less effective for ablation of the thyroid remnant than 3.7 GBq activity.

Creatinine clearance estimation after kidney transplantation: an analysis of three methods.

Surveillance of glomerular filtration rate (GFR) is essential for the management of kidney transplant recipients. We compared the performance of estimation equations with (99m)Technetium ((99m)Tc)-DTPA clearance (TcGFR) in 32 of our patients, using the Modification of Diet in Renal Diseases (MDRD), Nankivell (NK), and Cockcroft-Gault (CG) formulas. All patients were adequately hydrated before study. (99m)Tc-DTPA was injected intravenously (maximal dose = 37 MBq). A second syringe was prepared for an aliquot of the study ("standard"). Blood was sampled at 120 and 240 minutes in various sites. After centrifugation, 1.0 mL plasma was transferred into a counting vial. Both the samples and the "standard" were measured in a well counter. The mean time from transplantation to TcGFR was 47.9 months (range, 4-143 months). The mean serum creatinine level was 124 micromol/L (range, 70-371 micromol/L). The mean TcGFR was 58.6 mL/min/1.73 m(2) (range, 14-100 mL/min/1.73 m(2)). The MDRD equation showed a median difference of 1.4 mL/min/1.73 m(2) with 81.2% of estimated GFR within 20% of TcGFR. Median differences were 8.94 and 11.47 mL/min/1.73 m(2) for NK and CG formulas, respectively. The precision of the NK and CG was such that only 56.25% and 62.5% of estimations, respectively, fell within 20% of TcGFR. In this study, the MDRD equation demonstrated the best overall performance among the 3 tested methods. It should be sufficient for routine clinical practice in kidney transplantation.

[Pulmonary scintigraphy with MAA-Tc 99m perfusion in the diagnosis of pulmonary embolism]. / La scintigraphie pulmonaire de perfusion AU MAA-TC 99M dans le diagnostic de l'embolie pulmonaire.

Perfusion lung scintigraphy is vital to guide the diagnosis even without a ventilation scintigraphy. A customised strategy could be useful to optimise the use of perfusion scintigraphy when not coupled with a ventilation scintigraphy. We report about a retrospective study on 300 patients received in our department for suspected lung migrations. The patients underwent a perfusion scintigraphy only: a normal scintigraphy would discard the diagnosis when achieved between 6 and 72 hours after the accident. On the other hand, the evidence of one or two perfusion defects would allow to maintain the pulmonary embolism suspicion and establish an effective heparinic treatment. A second control comparative scintigraphy, a few weeks after the first one, very often confirms the diagnosis, allows the assessment of the heparinotherapy and if necessary, indicate to stop it.