Alteration of glutamate/GABA balance during acute alcohol withdrawal in emergency department: a prospective analysis.

AIMS: Animal studies suggest that in alcohol withdrawal the balance of neurotransmitters gamma aminobutyric acid (GABA) and glutamate is altered. To test this in humans, we aimed to measure plasma levels of glutamate, GABA and glutamate/GABA ratio in alcoholic patients presenting with complicated AWS with the same values in non-alcohol abuser/dependent controls and to determine prognostic factors for severe withdrawal. METHODS: 88 patients admitted to the emergency room for acute alcohol intoxication (DSM-IV) were prospectively included. Measurements of GABA and glutamate were performed on admission (Time 1, T1) and after 12 ± 2 h (T2). The experimental group (EG) was composed of 23 patients who presented at T2 with a severe AWS. The control group (CG) consisted of healthy subjects paired with the EG (gender and age). Logistic regression was performed in order to compare associated clinical and biological variables that could predict severe withdrawal. RESULTS: The concentration of GABA in the EG at T1 was significantly lower than that in the CG. The concentration of glutamate in the EG at T1 was significantly higher than that in the CG. The glutamate/GABA ratio in the EG at T1 was significantly higher than the ratio in the CG. With a multivariate logistic regression model, glutamate level at admission remained the only criterion identified as a predictor of AWS at 12 h. CONCLUSION: Decreased synthesis of GABA and increased synthesis of glutamate might be related to withdrawal symptoms experienced on brutal cessation of chronic alcohol intake.

[Prevalence of asthma in children in Auvergne: a safe region?]. / Prévalence de l'asthme chez l'enfant en Auvergne: une région préservée?

UNLABELLED: The aim of our study was to determine the prevalence of asthma in the Auvergne region. PATIENTS AND METHODS: Two thousand and nine pupils from primary (five-six years old) and secondary (14-15 years old) schools were given a questionnaire when attending their compulsory medical examination and asked to return it completed. RESULTS: The response rate was 82%. The prevalence of asthma was 5.6%. There was no difference neither between the two age groups nor between sexes. In contrast, there was a significant difference in prevalence according to whether the child lived in a town (7.3%) or in the countryside (4.6%) (p = 0.01). In the department of the Puy-de-Dôme, this difference was even more distinct, with a prevalence of 10% in urban areas and 4.0% in the countryside (p = 0.001). Twelve percent of the children had experienced wheezing over the previous 12 months. The prevalence of bronchitis was higher in rural areas (17.3%) than in towns (11.8%) but not to a significant degree. Passive smoking significantly increased this risk (18.9% and 14%, p = 0.003). CONCLUSION: The prevalence of asthma in the Auvergne region is low in both age groups compared to other regions in France and to Europe. The difference of prevalence between town and countryside may evidence of the influence of environmental factors.

[Acute abdominal dilatation, a serious complication in the case of anorexia nervosa]. / Distension abdominale aiguë, une complication à redouter en cas d'anorexie mentale.

INTRODUCTION: The prognosis of anorexia nervosa (AN) is severe (death in 2 to 5% of cases). AN is closely linked to episodes of bulimia. OBSERVATION: A 25 year-old woman suffering from anorexia nervosa was hospitalised for an occlusive syndrome with vomiting, presence of abdominal cramps, absence of hydroaeric sounds and suspension of stools and gas. The biological examinations were normal. The abdominal scan revealed voluminous gastric dilatation. The diagnosis of functional occlusive syndrome was retained. With medical treatment and follow-up in intensive care the gastric dilatation progressively regressed. DISCUSSION: The periods of restricted nourishment during NA are interspaced by episodes of bulimia and at the origin of sometimes severe digestive complications. The abnormalities in gastric motility can lead to major dilatation of the stomach with the risk of perforation. The onset of abdominal pain in the context of AN during an episode of bulimia must evoke the diagnosis of acute gastric dilatation with major risk of perforation.