[Distinctive tabard: A solution to avoid work interruptions in the blood transfusion?] / Gilet distinctif : une solution pour éviter les interruptions de tâche dans le domaine transfusionnel ?

AIM: In the blood transfusion, the interruption of work (IW) can lead to serious incidents and/or adverse effects. The aim of our work is to evaluate the wearing of a distinctive tabard in the IW. METHODS: Several voluntary departments from 5 establishments of health in the Center-Val de Loire region have participated in this work from October to December 2017. The survey was given to nurses (identified by the first three letters of the first name) before and after wearing the tabard (for 2 months) for all transfusions realized in their respective department. We matched the survey by nurse and by department. The Student t test was conducted to evaluate the contribution of the tabard during IW. RESULTS: One hundred and one survey (31 in surgery, 70 in medicine) were collected before wearing and 91 (27 in surgery, 64 in medicine) after wearing the tabard. Before wearing the tabard, the number of nurse having or not IW was the same. After wearing the tabard, 42% had an IW and 58% didn't had IW (P=0.43; χ2). Sixty-four surveys were matched (27 exclusions : different IDEs) according to IW before and after wearing the tabard. The wearing of the tabard allows a statistically significant decrease IW (z=2.61, P=0.009, student test). CONCLUSION: Wearing the tabard during blood transfusions is statistically significant means of reducing IW. It's probably a first solution to increase the security of the act, to which must be added other means (poster, phone management, poster and information campaign). It's easier to eliminate IW than to manage.

[1997-2007, 10 years of monitoring the evolution of resistance of Streptococcus pneumoniae to antibiotics in the region Centre; review of the Pneumococcus network]. / 1997-2007, dix ans de suivi de l'évolution de la résistance de Streptococcus pneumoniae aux antibiotiques en région Centre; bilan de l'observatoire du pneumocoque.

Regional pneumococcal observatories in region Centre, created in 1997, participate with the others pneumococcal observatories alongside the National Reference Center for Pneumococci and the Institut de Veille Sanitaire at the monitoring of the evolution of resistance of pneumococci to antibiotics in France. Between 1997 and 2007, 2427 strains of Streptococcus pneumoniae were isolated in part from cerebrospinal fluids, blood and middle ear fluid, from children and adults. The prevalence of pneumococci with a decreased susceptibility to penicillin (PDSP) decreased strongly in region Centre: 56.8 % in 2001, 39.6 % en 2007. These data are similar to the French national data over the same period.

[The Pneumococcal Observatory for the Central Region, 1 April 1999 to 31 March 2000]. / Observatoire du Pneumocoque de la Région Centre, du 1er avril 1999 au 31 mars 2000.

Seven hundred and ninety six strains of pneumococcus were collected in the Centre region, from 15 laboratories, between 1st April 1999 and 31st of March 2000. Data were processed, using 4th dimension software, and concerned age, file number, consultation/hospitalisation, sample type, susceptibility to oxacillin (5 micrograms), results of the E-test for benzylpenicillin, amoxicillin, cefotaxime and results of the routine disc diffusion test. Strains with reduced susceptibility to benzylpenicillin (PRSP) were collected by the co-ordinating centre to perform MICs by the reference agar dilution test and serotyping. Out of 796 strains, 450 strains (56.7%) were categorised as PRSP and 400 of them were studied by the co-ordinating centre. Forty two percent of the samples originated from lungs, followed by 19.5% from blood samples, 15% from ear pus (85.7% PRSP) and 2.5% from CSF. Thirty nine percent of the patients were female. 36.6% were children under sixteen (70.1% PRSP) and 62.4% were adults (49.2% PRSP). Out of 400 PRSP 106 (26.5%) were characterised as resistant and 294 (73.5%) as intermediate to benzylpenicillin. Compared to the agar dilution test, 90% of the PRSP studied by E-test had a MIC value for benzylpenicillin within +/- 1 dilution. Thirty six strains of PRSP were resistant to amoxicillin (9% of the PRSP) and 10 (2.5% of the PRSP) to cefotaxime. Serotyping was done on 375 strains. The serotypes encountered were the following: 23 (26.9%), 14 (22.1%), 19 (19.5%), 6 (12.8%), 9 (9.9%) and 15 (5.1%).

[Stability of 5-fluorouracil-folinic acid mixture: influence of concentrations, container and form of folinic acid]. / Stabilité du mélange 5-fluoro-racil-acide folinique: influence des concentrations, du contenant et de la forme de l'acide olinique.

Since the discovery of the superiority of the combination 5-fluorouracil (5FU)-folinic acid (FA) in comparison to 5FU alone in the treatment of gastrointestinal cancers, the interest of this association has been demonstrated in many other tumors. In the treatment of advanced colorectal carcinoma, FA is usually administered in 1 or 2 h infusion before 5FU. In treatment of other cancers, the two drugs are generally mixed together in the same container and administered as a continuous intravenous infusion over several days. Many studies have demonstrated the stability of 5FU alone in different vials, but results about compatibility of 5FU with AF in racemate (d,l) or levogyre (l) forms are conflicting. The aim of our study was to determine the influence of the container, the concentrations of the two drugs and the form of folinic acid (d, l or l) on the stability of the 5 FU-FA admixtures. Based on drug concentrations corresponding to current 5FU-FA chemotherapeutic protocols, 5FU was used at 50 mg/ml and 6.5 mg/ml in association with equitherapeutic and equimolar doses of FA respectively. Each association has been studied in three types of containers. For all combinations with 5FU 50 mg/ml, flocculation was noted, whatever form or concentration of FA which associated. No influence of the type of containers was noted. No precipitate was observed with the combinations 5FU 6.5 mg/ml. The evolution of the concentrations of 5FU and FA with time have been compared with a regression straight corresponding to a loss of product of 10% in 96 h. The mixtures 5FU 6.5 mg/ml with FA (d,l) 4 mg/ml and FA (l) 2 and 4 mg/ml remained stable in the three types of container. When a precipitate was noted (with 5FU 50 mg/ml), the concentration of 5FU decreased with time, whereas FA was stable in racemate and levogyre forms. Analysis of the precipitate showed that principally 5FU and equal parts of FA and calcium constituted it. Our results allowed to conclude that 5FU mixed with FA (d,l or l) 2 mg/ml and 4 mg/ml remained stable during 96 h in glass vials, PVC infusion bags and cassettes for portable pump in normal conditions of temperature and light. A precipitate of 5FU appears systematically with the concentration 50 mg/ml. These findings do not confirm those obtained in previously published studies. It seems that the precipitation is more a result of the decline of 5FU solubility at high concentrations than the form of folinic acid associated.

Effects of diltiazem on netilmicin-induced nephrotoxicity in rabbits.

Aminoglycoside nephrotoxicity remains a common clinical problem and is the major cause of acute toxic renal failure in hospitalized patients. In recent studies, calcium channel blockers gave controversial results in the prevention of acute ischemic or toxic renal failure. The aims of the study were (i) to describe a rabbit model of mild renal failure (50% reduction in glomerular filtration rate with a mean value of 1.78 +/- 0.46 ml/kg/min) induced by netilmicin given intramuscularly at 20 mg/kg of body weight every 8 h for 5 days, (ii) to investigate the protective effect of diltiazem given at a therapeutic dose (1 mg/kg given intramuscularly every 8 h for 5 days), and (iii) to investigate the mechanisms of this protection through evaluation of function tests, optic histology, and glomerular morphometry. Animals treated with netilmicin and diltiazem exhibited an unchanged glomerular filtration rate compared with controls (3.39 +/- 0.58 versus 3.68 +/- 0.78 ml/kg/min, respectively). This protective effect was not associated with any change in systemic or renal hemodynamics (i.e., no change in renal plasma flow) or changes in the pharmacokinetics of netilmicin, as assessed by fractional excretion and cortical uptake. Netilmicin-induced tubular toxicity was unchanged by diltiazem. Our results suggest that (i) netilmicin exhibits a toxic effect at both the glomerular and the tubular levels, (ii) diltiazem, a calcium channel blocker, when given at low therapeutic doses, is able to prevent the aminoglycoside-induced renal failure through a potential glomerular mechanism. The precise mechanisms of the protection remain to be elucidated. These results deserve clinical evaluation in high-risk patients.

Limited protection by small unilamellar liposomes against the renal tubular toxicity induced by repeated amphotericin B infusions in rats.

Amphotericin B (AMB), either alone or incorporated into small unilamellar vesicles of pure dipalmitoylphosphatidyl choline (DPPC SUV-AMB), was administered intravenously to male Sprague-Dawley rats once daily for 5 days. Either 1.5 or 3.5 mg of AMB or DPPC SUV-AMB per kg was given, since these concentrations corresponded, respectively, to the lowest nephrotoxic dose and the sublethal dose of AMB in our model. Tubular functions were evaluated daily, and AMB concentrations in plasma, urine, and tissues were measured by high-performance liquid chromatography. AMB at both doses induced tubular toxicity, hyposthenuria being the earliest symptom. DPPC SUV-AMB at 1.5 mg/kg/day was atoxic, but the tubular alterations induced by 3.5 mg of DPPC SUV-AMB per kg were similar to those observed with 3.5 mg of AMB per kg, except that the ability to concentrate urine was partly restored 72 h after the last infusion. Incorporating AMB into DPPC SUV did not influence the pharmacokinetics of the drug. Using this lipidic AMB formulation, we thus observed a beneficial effect toward limiting the renal tubular toxicity of repeated low doses of AMB but, unexpectedly, not that of high doses. These results indicate that tubular renal functions and electrolyte serum values should be closely monitored in patients treated with AMB liposomal formulations, especially high-dose regimens.

Lymphocyte percentage and counts provided by Coulter Counter S+II: comparison with optical method and three automatical leukocyte analyzers (Hemalog D, H 6000, Diff 3).

The Coulter Counter Model S+II is an automatic analyzer designed to measure the routine hematological parameters and to carry out distribution curve analysis of platelets, erythrocytes and leukocytes. The leukocyte histogram analysis is used as a basis for calculation of both lymphocyte percentages and absolute counts. In this study, we compared the differential count obtained by light microscopy studies of 2355 blood smears with the percentage of lymphocytes in the leukocyte population as determined by the S+II. A comparison was also performed between the S+II and Hemalog D, H 6000, and Diff 3 System on a smaller sample number. There was a good correlation between lymphocyte percentages and counts given by the S+II and other methods. Furthermore, reproducibility studies, performed with the Coulter Counter Model S+II, suggested that the lymphocyte percentage given by this instrument was accurate, except for extreme values. Lack of calculation of lymphocyte parameters by the instrument was often found to correspond to spontaneous platelet aggregation and/or to abnormalities of differential counts. It is suggested that lymphocyte analysis provided by the S+II may be used as a basis for a new approach to white blood cell (WBC) analysis, which could exclude differential counts in most routine cases.