Therapie最新文献

Introduction

Incidence of hospitalisations related to psychoactive substance (H-PS) intoxication has been strongly decreased during the coronavirus disease 2019 (COVID-19) pandemic especially in young adult and French region of Nouvelle-Aquitaine was mostly concerned. This study aimed to describe (i) the incidence of H-PS in Bordeaux teaching hospital during and after the first 2020 lockdown in adults aged 18–29 years or 30+ then (ii) their characteristics specifically associated with the pandemic period by comparing 2020 with 2017–2019 baseline period.

Material and methods

This historical cohort study was conducted in adults admitted to the Bordeaux teaching hospital with main or associated diagnosis codes of intoxication with benzodiazepine, methadone, buprenorphine, codeine, morphine, heroin, cocaine, ecstasy and alcohol. Data were collected locally through the discharge database. Incidence and characteristics of H-PS were described according to patients’ age, in 2020 before (01/01–16/03), during (17/03–10/05), and after the first lockdown (11/05–31/07).

Results

Among the 5,824 stays included over the study period, PS most involved were alcohol and benzodiazepines. Compared to baseline, the decrease in H-PS's incidence was more important in young adults (−40%; n_baseline = 450) in comparison to those aged 30+ (−18%; n_baseline = 1,101) during the pandemic period, especially during the lockdown compared to 2017 (−59%; n₂₀₁₇ = 145 vs. −35%; n₂₀₁₇ = 166) with far decrease in alcohol and ecstasy intoxications. Seriousness of hospitalisation indications was increased regardless of age during the pandemic. Particularly in young adults, the proportion of suicides attempts increased during lockdown compared to the baseline period (almost 50% vs. 29%) and the period after lockdown was associated with 1.7 more-time road accident increased and 3 more-time fights compared with pre-lockdown period.

Discussion/conclusion

The period following lockdown should be considered at risk H-PS due to accident. Recreational use of alcohol and ecstasy could be a target for minimize serious consequences associated to PS use in young adult.

Antiepileptic drugs (AED) are widely used in therapy. They are mainly indicated in the treatment of epilepsy and some psychiatric pathologies as well as for their analgesic action. Their cutaneous adverse effects (CAE) are common, often mild but sometimes serious. The aim of this work was to study the epidemiological and clinical features of CAE occurring in adults and elderly patients (aged over 20 years-old) and to identify the most implicated AED. We conducted a descriptive retrospective study over a period of five years from January 2017 to December 2022 about CAE of AED in adults and elderly patients notified to The National Center Chalbi Belkahia of Pharmacovigilance (Tunis,Tunisia). All cases were analyzed according to the updates French methods of imputability. We collected 71 cases of patients aged over 20 years old who presented CAE to AED. The age ranged from 20 to 79 years (mean age = 44.8 years). The sex ratio F/M was 0.7. AED were indicated for neurological pathology in 70.5% of cases, for psychiatric pathology in 15.9% of cases and for their analgesic action in 12.9% of cases. Epilepsy was the first indication (51.1% of cases). The most notified CAE in our study were drug reaction with eosinophilia and systemic symptoms (DRESS syndrome; 34% of cases), maculopapular exanthema (MPE; 26% of cases), erythematous rash (8% of cases) and photosensitivity in 5% of cases. Severe cutaneous adverse reactions were accounted for 37% of all CAE. The most implicated AED were carbamazepine (52%), phenobarbital (24%) and lamotrigine (18%). However, further study with a larger number of patients and in collaboration with prescribing physicians are needed to better clarify features of CAE associated with AED intake and specify the risk factors, specific to our Tunisian population.

Acute generalized exanthematous pustulosis (AGEP) is a severe and life-threatening cutaneous adverse reaction. Drug-induced AGEP is mainly related to antibiotics. More recently, AGEP following spider bites has been increasingly described. Treatment includes withdrawal of the offending drug and supportive care. In Tunisia, data concerning severe cutaneous adverse reactions (SCARs) in general and especially AGEP is lacking. Herein, we conducted a retrospective study to investigate the epidemiological, clinical characteristics and etiologies of AGEP referred to the Dermatology department. Our study included 32 cases of AGEP. AGEP cases occurred in overall 8.9% of all SCARs referred to the department during the same period study. The majority were females (24 women and 7 men). The median age of the patients was 33 years. A history of psoriasis was reported in 16.1% of patients. All patients presented with an extensive erythematous rash with pinhead pustules. Neutrophil hyperleukocytosis (greater than 7000/mm³) was noted in 17 patients (63% of cases). It was associated with hypereosinophilia exceeding 500 elements/mm³ in 8 cases (29.6%). Drug-induced AGEP was reported in 53% of cases. Antibiotics were implicated in the majority of cases. Delay in onset ranged from 15 hours to 7 days, with an average of 2.8 days. A non-drug-induced etiology was considered if the pharmacological investigation was negative, or if a clear non-drug trigger was found. It was retained in ten cases (48.4% of all observations). Spider bites were revealed in 8 cases. AGEP represents a severe, usually drug-related skin reaction. It is classified as a type IVd reaction mediating T cell-related sterile neutrophilic inflammatory response. It typically occurs within 24–48 h of ingestion of the offending drug. Antibiotics are the most common drug family to cause AGEP. Spider bites were involved in 25.8% of cases in our study, as important as antibiotic-induced AGEP. Analysis of the particularities of AGEP according to etiology, whether drug-induced or not, revealed the presence of an initial escarotic lesion (P = 0.01) and the finding of blood hypereosinophilia (P = 0.014) in the non-drug AGEP group were the distinguishing features. Blood hyperesoniophilia, more frequent in the non-drug AGEP group, suggests a pathophysiology probably different from that of the drug AGEP group. Clinicians should be aware of both etiologies. Our study focuses on the importance of AGEP associated with spider bite as a potential triggering factor in Tunisia.

Les admissions des personnes âgées pour cause d’évènement iatrogène médicamenteux sont fréquentes à l’hôpital. Cependant, il n’existe pas à ce jour de méthode validée en langue française pour les identifier. L’objectif de ce travail a été de valider la version francophone de l’outil AT-HARM10 pour une utilisation à l’admission des patients dans nos structures de soins. Il se présente sous la forme de 10 questions fermées. Une réponse positive à l’une des 3 premières questions met en évidence une admission non liée au médicament. Une réponse positive à l’un des 7 items suivants définit une cause iatrogène probablement en lien avec l’hospitalisation. Nous avons effectué une validation sémantique et linguistique par validation croisée sous forme d’allers-retours entre experts. Pour valider cliniquement le questionnaire, nous avons réalisé une étude rétrospective sur les dossiers de patients de plus de 65 ans admis en unité d’hospitalisation de courte durée (UHCD) et en chirurgie orthopédique et traumatologie au sein de deux établissements hospitaliers. La fiabilité inter-opérateur était élevée (taux d’accord initial entre évaluateurs = 87 %, coefficient kappa de Cohen = 0,75). Nous avons analysé 266 dossiers de 166 patients admis en UHCD (âge moyen 86,0 ± 5,7 ans; sexe ratio 0,66; nombre moyen de médicaments prescrits 7,7 ± 3,8) et 100 patients admis dans les services de chirurgie orthopédique et traumatologie (âge moyen 85,2 ± 6,1 ans; sexe ratio 0,43 ; nombre moyen de médicaments prescrits 6,4 ± 3,6). Nous avons identifié 55 % d’admissions en lien probable avec le médicament en UHCD et 76 % dans les unités d’orthopédie (P < 0,05). L’item du questionnaire le plus représenté était P5 dans les deux groupes. L’outil AT-HARM10 validé est désormais intégré à nos pratiques de pharmacie clinique et des bilans de médication sont proposés en priorité aux patients admis pour motif iatrogène.

Admissions of the elderly related to medication errors are frequent in hospital, more than half would be avoidable, but there is currently no validated method in French to identify them. The objective of this work was to validate the French version of the AT-HARM10 tool in order to use it for patients admitted in our healthcare facilities. The tool has 10 questions. A positive response to any of the first 3 questions identify admissions that are unlikely to be drug-related. A positive response to one of the following 7 questions identify possible medication-related admissions. For semantic and linguistic validation, we performed cross-validation with forward-backward translation. To clinically validate the method, we conducted a retrospective study including patients over 65 admitted to short-stay units (UHCD) and to orthopedic surgery units in two French hospitals. Two hundred and sixty-six (266) pati