Pub Date : 2025-12-01DOI: 10.1016/j.revmed.2025.09.008
Jonathan Abisror , Roya Asgari , Quentin de Baynast , Christine Le Beller , Nicole Karam , Brigitte Sabatier , Thibaut Caruba
Introduction
Bleeding while on vitamin K antagonist therapy is one of the main causes of iatrogenic hospitalization. There are few reports of a drug-drug interactions resulting in a serious bleeding complications between warfarin and oseltamivir.
Case report
We report the case of a 64-year-old woman hospitalized with anemia. She was on warfarin for mechanical heart valve prostheses (usual international normalized ratio, INR: 2.5–3.5) and had moderate renal insufficiency. Treatment with oseltamivir for influenza was introduced, leading to a rapid increase in the INR value within less than a week and a recurrence of digestive bleeding. Symptomatic management (antagonization with vitamin K and prothrombin complex concentrate) led to correction of the overdose.
Conclusion
When oseltamivir is introduced in a patient receiving warfarin, we suggest close monitoring of the INR, especially in the case of renal insufficiency, from initiation to the elimination of the oseltamivir (3 days after discontinuation).
{"title":"Hémorragie digestive due à une probable interaction médicamenteuse warfarine/oseltamivir : à propos d’un cas clinique","authors":"Jonathan Abisror , Roya Asgari , Quentin de Baynast , Christine Le Beller , Nicole Karam , Brigitte Sabatier , Thibaut Caruba","doi":"10.1016/j.revmed.2025.09.008","DOIUrl":"10.1016/j.revmed.2025.09.008","url":null,"abstract":"<div><h3>Introduction</h3><div>Bleeding while on vitamin K antagonist therapy is one of the main causes of iatrogenic hospitalization. There are few reports of a drug-drug interactions resulting in a serious bleeding complications between warfarin and oseltamivir.</div></div><div><h3>Case report</h3><div>We report the case of a 64-year-old woman hospitalized with anemia. She was on warfarin for mechanical heart valve prostheses (usual international normalized ratio, INR: 2.5–3.5) and had moderate renal insufficiency. Treatment with oseltamivir for influenza was introduced, leading to a rapid increase in the INR value within less than a week and a recurrence of digestive bleeding. Symptomatic management (antagonization with vitamin K and prothrombin complex concentrate) led to correction of the overdose.</div></div><div><h3>Conclusion</h3><div>When oseltamivir is introduced in a patient receiving warfarin, we suggest close monitoring of the INR, especially in the case of renal insufficiency, from initiation to the elimination of the oseltamivir (3 days after discontinuation).</div></div>","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"46 12","pages":"Pages 733-736"},"PeriodicalIF":0.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145403488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The nurse-to-patients ratio in internal medicine and general medicine departments is not regulated by the French Public Health Code, unlike in certain acute care units. Yet this ratio has an impact not only on the quality of working life, but also on mortality and the length of stay for patients. We carried out a national survey to identify the ratios existing in internal and general medicine units.
Method
A national descriptive online survey was carried out under the impetus of the scientific council of the Conseil National Professionnel de Médecine Interne.
Results
One hundred and thirty responses were received. Of these, 63% were hospital practitioner and 14.6% were professors. Their specialty was internal medicine in 80% of cases, and 46% of them practiced in a university hospital, while 42% worked in a local hospital. The mean age of respondents was 44.8 years, 62% of whom were men. The mean number of beds per unit was 25.6, and 69.6% of patients hospitalized in internal medicine units came from emergency departments. The mean age of patients was 70.7 years. Seventy-two percent of practitioners felt that the nurse staffing should not be less than 1/8 (98%, 1/10) and 80% of practitioners felt that the auxiliary nurse staffing ratio should not be less than 1/8 (98%, 1/10). One hundred and eleven departments (85%) reported more than 8 patients per nurse, including 46 university hospital (77%) and 65 local hospital (93%), and 91 units (72%) more than 8 patients per caregiver. The average number of patients per nurse was greater in local hospitals (11,4 ± 2 versus 10 ± 1, p = 5.10−5).
Conclusion
This survey shows wide disparities in current caregiver/patient ratios. However, there is a clear consensus to identify target ratios for nurses, auxiliary nurses and auxiliary nurses.
{"title":"Enquête nationale sur le ratio de soignants par patient hospitalisé : état des lieux et attentes des services de médecine interne et polyvalente pour le compte du Collège national professionnel de médecine interne (CNPMI)","authors":"Bertrand Lioger , Ludovic Hery , Chloé Comarmond , Baptiste Gramont , Christophe Leroux , Romain Guitton , Anne Bourgarit , Laurence Bouillet , CNP de médecine interne","doi":"10.1016/j.revmed.2025.10.009","DOIUrl":"10.1016/j.revmed.2025.10.009","url":null,"abstract":"<div><h3>Introduction</h3><div>The nurse-to-patients ratio in internal medicine and general medicine departments is not regulated by the French Public Health Code, unlike in certain acute care units. Yet this ratio has an impact not only on the quality of working life, but also on mortality and the length of stay for patients. We carried out a national survey to identify the ratios existing in internal and general medicine units.</div></div><div><h3>Method</h3><div>A national descriptive online survey was carried out under the impetus of the scientific council of the Conseil National Professionnel de Médecine Interne.</div></div><div><h3>Results</h3><div>One hundred and thirty responses were received. Of these, 63% were hospital practitioner and 14.6% were professors. Their specialty was internal medicine in 80% of cases, and 46% of them practiced in a university hospital, while 42% worked in a local hospital. The mean age of respondents was 44.8 years, 62% of whom were men. The mean number of beds per unit was 25.6, and 69.6% of patients hospitalized in internal medicine units came from emergency departments. The mean age of patients was 70.7 years. Seventy-two percent of practitioners felt that the nurse staffing should not be less than 1/8 (98%, 1/10) and 80% of practitioners felt that the auxiliary nurse staffing ratio should not be less than 1/8 (98%, 1/10). One hundred and eleven departments (85%) reported more than 8 patients per nurse, including 46 university hospital (77%) and 65 local hospital (93%), and 91 units (72%) more than 8 patients per caregiver. The average number of patients per nurse was greater in local hospitals (11,4<!--> <!-->±<!--> <!-->2 versus 10<!--> <!-->±<!--> <!-->1, <em>p</em> <!-->=<!--> <!-->5.10<sup>−5</sup>).</div></div><div><h3>Conclusion</h3><div>This survey shows wide disparities in current caregiver/patient ratios. However, there is a clear consensus to identify target ratios for nurses, auxiliary nurses and auxiliary nurses.</div></div>","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"46 12","pages":"Pages 699-705"},"PeriodicalIF":0.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.revmed.2025.09.005
Isabelle Boccon-Gibod , Olivier Fain , Delphine Gobert , Sophie Debord , Magali Aubineau , Nicolas Ozanne , Federica Defendi , Anne Gompel , Gaelle Hardy , Nicolas Javaud , Audrey Lehmann , Anne Pagnier , Fabien Pelletier , Alexis Bocquet , Aurelie Du Thanh , David Launay , Laurence Bouillet , CREAK collaborators
Recurrent isolated angioedema (AE) is a diagnostic and therapeutic challenge. Only a rigorous clinical approach can rule out the most obvious diagnoses. The recent international classification recognizes 7 subgroups: mast cells induced AE (spontaneous, allergic), Bradykinin mediated AE (Hereditary or acquired C1Inh; kallikrein-kinin mutations), HAE due to vascular endothelium dysfunction, drug induced AE and AE of unknow origin. Bradykinin-mediated hereditary angioedema (BK-HAE) are rare conditions. The currently accepted incidence of HAE-C1INH is approximately 1 in 50,000 inhabitants per year. Bradykinin is released following activation of the kallikrein/kinin pathway in the vascular lumen and is rapidly degraded by kininases, the main one being angiotensin-converting enzyme. The disease manifests as subcutaneous or submucosal edema. When an attack occurs in the pharynx/larynx area, there is a high risk of asphyxia (25% in the absence of specific treatment). This risk is unpredictable and exists throughout the patient's life. AE can be localized in the abdomen and resemble a surgical emergency. The disease is more symptomatic in women, as estrogen is an aggravating factor. In AE due to C1INH deficiency, the diagnosis is based on the search for a weight and/or functional deficiency in C1 inhibitor. In the forms with normal C1 inhibitor, the diagnosis is solely genetic, such as F12, PLG, or KNG1 mutations. The prognosis for these rare diseases has changed considerably in recent years with the arrival of new, highly effective specific drugs. Patient education is an important part of management. We present here the French protocol for the diagnosis and management of bradykinin-mediated hereditary AE.
{"title":"French protocol for the diagnosis and management of hereditary angioedema","authors":"Isabelle Boccon-Gibod , Olivier Fain , Delphine Gobert , Sophie Debord , Magali Aubineau , Nicolas Ozanne , Federica Defendi , Anne Gompel , Gaelle Hardy , Nicolas Javaud , Audrey Lehmann , Anne Pagnier , Fabien Pelletier , Alexis Bocquet , Aurelie Du Thanh , David Launay , Laurence Bouillet , CREAK collaborators","doi":"10.1016/j.revmed.2025.09.005","DOIUrl":"10.1016/j.revmed.2025.09.005","url":null,"abstract":"<div><div>Recurrent isolated angioedema (AE) is a diagnostic and therapeutic challenge. Only a rigorous clinical approach can rule out the most obvious diagnoses. The recent international classification recognizes 7 subgroups: mast cells induced AE (spontaneous, allergic), Bradykinin mediated AE (Hereditary or acquired C1Inh; kallikrein-kinin mutations), HAE due to vascular endothelium dysfunction, drug induced AE and AE of unknow origin. Bradykinin-mediated hereditary angioedema (BK-HAE) are rare conditions. The currently accepted incidence of HAE-C1INH is approximately 1 in 50,000 inhabitants per year. Bradykinin is released following activation of the kallikrein/kinin pathway in the vascular lumen and is rapidly degraded by kininases, the main one being angiotensin-converting enzyme. The disease manifests as subcutaneous or submucosal edema. When an attack occurs in the pharynx/larynx area, there is a high risk of asphyxia (25% in the absence of specific treatment). This risk is unpredictable and exists throughout the patient's life. AE can be localized in the abdomen and resemble a surgical emergency. The disease is more symptomatic in women, as estrogen is an aggravating factor. In AE due to C1INH deficiency, the diagnosis is based on the search for a weight and/or functional deficiency in C1 inhibitor. In the forms with normal C1 inhibitor, the diagnosis is solely genetic, such as <em>F12, PLG</em>, or <em>KNG1 mutations</em>. The prognosis for these rare diseases has changed considerably in recent years with the arrival of new, highly effective specific drugs. Patient education is an important part of management. We present here the French protocol for the diagnosis and management of bradykinin-mediated hereditary AE.</div></div>","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"46 12","pages":"Pages 714-724"},"PeriodicalIF":0.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145411351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.revmed.2025.10.469
Wladimir Mauhin , Benjamin Subran , Anne-Laure Gérard , Hugo Toth , Pierre Hertz , Jonathan London , Olivier Lidove
Introduction
The average length of stay (ALOS) has increased in our Internal Medicine Department since 2020 and we decided to investigate its origin.
Methods
We analysed retrospective data from hospital stays between 2018 and 2024. In 2024, we also prospectively studied the hospital stays with delayed discharge defined by prolonged stays for no medical reason.
Results
Between 2020 and 2024, ALOS increased from 6.5 days to 9.3 days. Performance index based on ALOS, that allows a stratification of ALOS on patient severity, also increased linearly by 2.6 points per year (R2 = 0.84). We observed a constant reduction in the access to rehabilitative care departments (−30%). In 2024, 11.0% (96/869) of discharges were considered delayed, cumulating 1261 days of stay with no medical reason (15.7% of the activity). Among the causes of hospitalisation, the fall was associated with the highest cumulative delay of discharge (402 days for 26 stays), the psychiatric disorders were associated with the highest delay per stay (199 days for 7 stays). Delayed discharges were mainly due to delays to access to rehabilitative departments (55 stays; 760 days).
Conclusion
Improving the ALOS cannot be achieved without a global reflexion including strong social services supported by the hospital management and public policies decisions.
{"title":"Augmentation de la durée moyenne de séjour en médecine interne entre 2018 et 2024 – étude rétro-prospective des caractéristiques des séjours à partir des données médico-sociales et du PMSI","authors":"Wladimir Mauhin , Benjamin Subran , Anne-Laure Gérard , Hugo Toth , Pierre Hertz , Jonathan London , Olivier Lidove","doi":"10.1016/j.revmed.2025.10.469","DOIUrl":"10.1016/j.revmed.2025.10.469","url":null,"abstract":"<div><h3>Introduction</h3><div>The average length of stay (ALOS) has increased in our Internal Medicine Department since 2020 and we decided to investigate its origin.</div></div><div><h3>Methods</h3><div>We analysed retrospective data from hospital stays between 2018 and 2024. In 2024, we also prospectively studied the hospital stays with delayed discharge defined by prolonged stays for no medical reason.</div></div><div><h3>Results</h3><div>Between 2020 and 2024, ALOS increased from 6.5<!--> <!-->days to 9.3<!--> <!-->days. Performance index based on ALOS, that allows a stratification of ALOS on patient severity, also increased linearly by 2.6 points per year (R<sup>2</sup> <!-->=<!--> <!-->0.84). We observed a constant reduction in the access to rehabilitative care departments (−30%). In 2024, 11.0% (96/869) of discharges were considered delayed, cumulating 1261<!--> <!-->days of stay with no medical reason (15.7% of the activity). Among the causes of hospitalisation, the fall was associated with the highest cumulative delay of discharge (402<!--> <!-->days for 26<!--> <!-->stays), the psychiatric disorders were associated with the highest delay per stay (199<!--> <!-->days for 7<!--> <!-->stays). Delayed discharges were mainly due to delays to access to rehabilitative departments (55<!--> <!-->stays; 760<!--> <!-->days).</div></div><div><h3>Conclusion</h3><div>Improving the ALOS cannot be achieved without a global reflexion including strong social services supported by the hospital management and public policies decisions.</div></div>","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"46 12","pages":"Pages 706-713"},"PeriodicalIF":0.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145552529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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