[Use of dronabinol in the treatment of resistant neuropathic pain: Feedback from patients followed in a multidisciplinary pain center]. / Utilisation du dronabinol dans le traitement des douleurs neuropathiques réfractaires : retour d'expérience des patients suivis dans un Centre d'évaluation et de traitement de la douleur.

INTRODUCTION: Dronabinol is a drug composed of synthetic delta-9-tetrahydrocannabinol. In France, dronabinol requires a named Temporary Utilisation Authorisation (TUA), for the treatment of refractory neuropathic pain. Few data currently exist concerning its efficacy and tolerance. We present our feedback on its use for chronic pain patients, the multidisciplinary supervision and the monitoring set up by the clinical pharmacist. METHOD: This retrospective monocentric study presents Patients Global Impression of Change and tolerance data from patients treated with dronabinol in a pain center between October 2020 and July 2021. We present their satisfaction towards the care process. RESULTS: Nineteen patients were treated with dronabinol during the study period. - The clinical pharmacist issued 180 advices for patients and doctors. Patients reported a positive impact of the telephone follow-up carried out by the clinical pharmacist. - 75% (n=9/12) of patients who continued treatment for more than 3 months reported improvement in their health. - 74% (n=14/19) of patients had at least one adverse event, six patients needed to discontinue the treatment. DISCUSSION-CONCLUSION: Dronabinol represents an alternative that can improve the quality of life of some patients suffering from refractory neuropathic pain. Nevertheless, as with any medicine, its initiation requires a rigorous evaluation of the benefit-risk balance. The close collaboration between the physician and the clinical pharmacist allows a secure management patients and makes this complex drug circuit easer.

Auditoría de la cirugía de catarata senil en Cádiz: resultados visuales y complicaciones / Audit of cataract surgery in Cadiz: visual outcomes and complications

OBJETIVO: Dar a conocer los resultados y complicaciones de la cirugía de catarata senil en Cádiz. A falta de auditorías nacionales, comparamos nuestros resultados con la más reciente auditoría europea EUREQUO (2013) y con la auditoría británica RCOphth NOD (2015). MÉTODOS: Estudio longitudinal, prospectivo, antes-después de 312 pacientes intervenidos de cataratas en los Hospitales Universitarios Puerta del Mar y Puerto Real, en 2013-14. Variables recogidas: características sociodemográficas, agudeza visual (AV), síntomas secundarios a la catarata, comorbilidad ocular, tiempo de espera, preparación del cirujano (adjunto vs. residente), tasa y tipos de complicaciones quirúrgicas. RESULTADOS: La edad media de los pacientes fue de 73,92 ± 7,31 años. El 98,3% partieron de una AV ≥ 0,60 logMAR (≤ 0,25 decimal). La AV media preoperatoria fue de 1,01 logMAR (0,92-1,10), equivalente a 0,20 decimal (0,18-0,21). La tasa de complicaciones fue del 6,7%, con un 3,8% de roturas de cápsula posterior y un 2,8% de descompensaciones corneales. No se registraron casos de endoftalmitis. La AV media postoperatoria fue de 0,28 logMAR (0,22-0,33), equivalente a 0,67decimal (0,64-0,70). El 78,8% de los pacientes intervenidos adquirieron una AV ≤ 0,3 logMAR tras la cirugía (≥ 0,50 decimal), y el 27,6% una AV ≤ 0,0 logMAR (≥1,0decimal). CONCLUSIONES: Obtuvimos resultados inferiores a los del EUREQUO y a los del RCO phth NOD, donde se reporta una AV posquirúrgica ≤ 0,3 logMAR (≥ 0,50 decimal) en el 98 y en el 89% de los pacientes, respectivamente. Sin embargo, las poblaciones estudiadas son diferentes. Esperamos con nuestro estudio animar a otros hospitales públicos españoles a realizar auditorías y compartir resultados, como herramienta de autocrítica y mejora

OBJECTIVE: To publish the outcomes and complications of age-related cataract surgery in Cadiz (Spain). Due to the lack of national audits, a comparison was made between the results obtained here and those of the most recent European audit, EUREQUO (2013), and the British audit RCOphth NOD (2015). METHODS: A prospective, longitudinal, before-after study of 312 patients undergoing cataract surgery in the University Hospitals of Puerta del Mar and Puerto Real (Cadiz), in 2013-14. Outcome measurements included sociodemographic characteristics, visual acuity (VA), symptoms secondary to cataract, ocular comorbidity, waiting time, expertise of surgeon (consultant vs. trainee), rate and type of surgical complications. RESULTS: The median age at surgery was 73.92 ± 7.31. Almost all (98.3%) of patients at consultation had a VA ≥ 0.60 logMAR, with a mean pre-surgical VA of 1.01logMAR (0.92-1.10). There was a 6.7% complication rate, with 3.8% posterior capsule ruptures and 2.8% corneal decompensations. No cases of endophthalmitis occurred. The mean post-operative VA was 0.28 logMAR (0.22-0.33). More than three-quarters (78.8%) of cases achieved a post-operative VA ≤ 0.3 logMAR, and 27.6% of cases achieved a VA ≤ 0.0 logMAR. CONCLUSIONS: Our success rate was inferior to the EUREQUO and RCOphth NOD studies, with the percentage of patients acquiring a postoperative VA ≤0.3 logMAR being 98% and 89%, respectively. However, the populations were not comparable. It is hoped that this study will encourage other public hospitals in Spain to undertake audits and share their results, in order to provide a tool for constructive criticism and quality improvement initiatives

Audit of cataract surgery in Cadiz: visual outcomes and complications. / Auditoría de la cirugía de catarata senil en Cádiz: resultados visuales y complicaciones.

OBJECTIVE: To publish the outcomes and complications of age-related cataract surgery in Cadiz (Spain). Due to the lack of national audits, a comparison was made between the results obtained here and those of the most recent European audit, EUREQUO (2013), and the British audit RCOphth NOD (2015). METHODS: A prospective, longitudinal, before-after study of 312 patients undergoing cataract surgery in the University Hospitals of Puerta del Mar and Puerto Real (Cadiz), in 2013-14. Outcome measurements included sociodemographic characteristics, visual acuity (VA), symptoms secondary to cataract, ocular comorbidity, waiting time, expertise of surgeon (consultant vs. trainee), rate and type of surgical complications. RESULTS: The median age at surgery was 73.92±7.31. Almost all (98.3%) of patients at consultation had a VA ≥0.60logMAR, with a mean pre-surgical VA of 1.01logMAR (0.92-1.10). There was a 6.7% complication rate, with 3.8% posterior capsule ruptures and 2.8% corneal decompensations. No cases of endophthalmitis occurred. The mean post-operative VA was 0.28logMAR (0.22-0.33). More than three-quarters (78.8%) of cases achieved a post-operative VA ≤0.3logMAR, and 27.6% of cases achieved a VA ≤0.0logMAR. CONCLUSIONS: Our success rate was inferior to the EUREQUO and RCOphth NOD studies, with the percentage of patients acquiring a postoperative VA ≤0.3logMAR being 98% and 89%, respectively. However, the populations were not comparable. It is hoped that this study will encourage other public hospitals in Spain to undertake audits and share their results, in order to provide a tool for constructive criticism and quality improvement initiatives.

In vitro pharmacodynamic parameters of sordarin derivatives in comparison with those of marketed compounds against Pneumocystis carinii isolated from rats.

Pneumocystis carinii pneumonia remains one of the most serious complications of immunosuppressed patients. In this study, the in vitro pharmacodynamic parameters of four sordarin derivatives (GM 191519, GM 237354, GM 193663, and GM 219771) have been evaluated by a new quantitative approach and compared with the commercially available drugs pentamidine, atovaquone, and trimethoprim-sulfamethoxazole (TMP-SMX). In vitro activities and in vivo therapeutic efficacies of sordarin derivatives against P. carinii were also evaluated. In vitro activity was determined by the broth microdilution technique, comparing the total number of microorganisms in treated and drug-free cultures by using Giemsa staining. The in vitro maximum effect (E(max)), the drug concentrations to reach 50% of E(max) (EC(50)), and the slope of the dose-response curve were then estimated by the Hill equation (E(max) sigmoid model). Sordarin derivatives were the most potent agents against P. carinii, with EC(50)s of 0.00025, 0.0007, 0.0043, and 0. 025 microg/ml for GM 191519, GM 237354, GM 193663, and GM 219771, respectively. The EC(50)s of pentamidine, atovaquone, and TMP-SMX were 0.025, 0.16, and 26.7/133.5 microg/ml, respectively. The results obtained with this approach showed GM 237354 and GM 191519 to be approximately 35- and 100-fold more active in vitro than pentamidine, the most active marketed compound. All sordarin derivatives tested were at least 5,000-fold more active in vitro than TMP-SMX. The three sordarin derivatives tested in vivo-GM 191519, GM 237354, and GM 219771-showed a marked therapeutic efficacy, defined as reduction of cyst forms per gram of lung. GM 191519 was the most potent (daily dose reducing 50% of the P. carinii burden in the lungs [ED(50)], 0.05 mg/kg/day) followed by GM 237354 and GM 219771 (ED(50)s, 0.30 and 0.49 mg/kg/day, respectively). Good agreement between in vitro parameters and in vivo outcome was obtained when P. carinii pneumonia in rats was treated with sordarin derivatives.

Towards a model of host-parasite relationships.

The question asked in this article is: "what is a parasite?". Defining a parasite requires defining its host at the same time. A difficult question therefore arises about host-parasite relationships. The object of general parasitology is in fact to study the relationship between a host and its parasite. The initial question "what is a parasite?" has to be reformulated within a conceptual framework, that of "relationship". This article is an attempt to transpose into parasitology some concepts which have been profitable in the fields of physics and chemistry. The studies of R. Thom about the individual are also used. Concepts like that of field and principles like that of minimization are probably operational on a high level of organization. The description of host-parasite relationships could benefit from these concepts.

Current in vitro culture systems for Pneumocystis.

Although Pneumocystis continuous culture systems have not yet been developed, efficient short-term in vitro methods allowing the production of infectious forms of Pneumocystis can now be employed. The quality of the inoculum will influence the in vitro development of P. carinii. For this reason, efficient extraction and cryopreservation techniques are considered in this section. In vitro growth and limited passage were obtained by inoculating freshly extracted parasites onto fibroblast- or epithelial-like cell monolayers cultivated in ordinary tissue culture flasks, culture plates, microcarrier beads or other culture devices. Cultures were usually maintained in an atmosphere of 5% CO2 at 35-37 degrees C. The results obtained in these different systems were surprisingly similar: the number of parasites increased about 6-10 times within the first 3-4 days post-inoculation, then remained stationary until day 7-14 and decreased rapidly. If passages were attempted, the growth decreased gradually and no growth was recorded after 2-3 passages. Proof of the in vitro Pneumocystis attachment to feeder cells has been furnished by electron microscopy. Two currently used feeder cell culture systems were selected in this subchapter. The first system is a co-culture of monolayer lung epithelial-like cells with Pneumocystis. After trypsin treatment and passage of cells with attached parasites to culture bottles containing fresh medium, 3 or more new culture bottles can be plated. A 2-4-fold increase in parasite number can be obtained but, interestingly, cultured parasites were more infectious to the nude rat than freshly extracted lung parasites. In the second system, the spinner flask culture method, Pneumocystis is cultivated on cell coated microbeads in slow stirring vessels, in order to exploit the beads' huge surface where microorganisms can transiently adhere and grow and from where they can be easily detached by simply leaving the beads to settle down. This culture system has ensured 10(8)-10(9) viable trophozoites in each harvest after 7-10 days of slow stirring incubation.

[Epidural lipomatosis: complication of long-term corticotherapy. Apropos of 2 cases]. / La lipomatose épidurale: une complication de la corticothérapie au long cours. A propos de deux cas.

Spinal epidural lipomatosis (SEL) is defined as the deposition of loose fat tissue in the epidural space. Two cases are reported which illustrate the main features of this uncommon disease. Most frequently SEL is revealed by neurologic manifestations such as an acute chronic spinal cord compression. Corticosteroid therapy and obesity are the main factors able to induce the disease. The common location of the SEL at the thoracic spine is explained by the physiologic abundance of fat and by the relative narrowness of the spinal canal at this level. An osteoporotic vertebral crush fracture which reduces the diameter of the canal frequently reveals the SEL. MRI confirms the diagnosis of SEL and shows the extent in the spinal canal. The treatment of SEL is difficult. The decrease or the stop of corticosteroid therapy has allowed the recovery in a few cases with chronic neurologic symptoms. The risks of a surgical procedure are important in these patients and the medical or surgical treatment should be discussed taking into account the clinical symptoms of SEL, its location and extent, and the risks of recurrence if corticosteroid therapy must go on.

The blood-stages of Plasmodium georgesi, P. gonderi and P. petersi: course of untreated infection in their natural hosts and additional morphological distinctive features.

In the blood of a Cercocebus albigena and of a C. galeritus agilis monkey, the infection with Plasmodium gonderi was found to follow its well-known chronic course; P. georgesi seemed to occur as a relapsing type of malaria parasite; P. petersi was found for only a few days and at a low level in C. albigena (end of an attack?). As shown by using polarized light, the pigment granules appeared mostly as fine dots in P. georgesi, short rods in P. gonderi and long needles in P. petersi. The three species can be distinguished by the morphological appearance of the nucleus of the young trophozoites, and also by the measurement of its surface area (Sa): small round nucleus (Sa = 0.81 +/- 0.06 microns 2) in P. gonderi, large 2-coloured nucleus (Sa = 1.43 +/- 0.21 microns 2) in P. petersi, and long crescent-shaped nucleus (Sa = 2.18 +/- 0.25 microns 2) in P. georgesi. The first colour illustrations of the blood-stages of P. georgesi are presented. The dynamics of single and mixed blood infections in primate malaria parasites are discussed, with a proposal to classify them into 3 types.

Pneumocystitis carinii organisms from in vitro culture are highly infectious to the nude rat.

Many in vitro systems have been used to cultivate Pneumocystis, but only limited parasite growth has been obtained by different authors. A reliable in vitro system enabling a sustained propagation of Pneumocystis appears to be an important condition for a better definition of the transmission of P. carinii pneumonia. In this work, Pneumocystis in vitro culture was performed on monolayers of L2 rat lung epithelial-like cells. Ultrastructural assessment revealed that culture parasites were structurally intact. Pneumocystis culture samples were intratracheally inoculated into corticosteroid-treated nude rats (nonlatently infected by P. carinii), which developed P. carinii pneumonia at 40 days postinoculation. The infectious power of parasites obtained in vitro was 7-10 times higher than that of parasites freshly extracted from parasitized rat lung. In summary, the present results show that it is possible to obtain in vitro highly infectious Pneumocystis forms, and this study provides a promising infectivity test for use by investigators working on Pneumocystis in vitro systems.

Kinetic study of antifungal activity of amphotericin B, 5-fluorocytosine and ketoconazole against clinical yeast isolates using liquid-phase turbidimetry.

The fungal growth of clinical yeast isolates and of VW32 clone of Candida albicans were measured in vitro using a liquid-phase turbidimetric system (Bioscreen from Labsystems, France) in defined conditions. Cultures were performed in Shadomy's liquid medium and the fungal growth automatically evaluated every 10 minutes for 24 hours using various concentrations of drugs. The system made it possible to test 200 culture samples in one experiment. Yeast sensitivity to drugs was also measured by using our routine semi-automatic turbidimetric system. We observed that kinetic patterns of activity of each antifungal agent were typical. The in vitro tests showed that of 927 clinical yeast isolates 99.2% were sensitive to amphotericin B, 94.4% to 5-fluorocytosine and 69.7% to ketoconazole.

Individual evolution of digestive tract colonization of holoxenic mice by Candida albicans.

Oral administration of various concentrations of Candida albicans to 6-day-old mice established colonization of the digestive tract without mortality. After being weaned (day 21), the development of colonization was studied in a group of mice by daily counting of the number of CFU contained in the feces of each animal. Two features concerning the development of colonization were noted. The course of colonization in individual mice was highly erratic and lead to either transitory or sometimes long-lasting colonization. These results show the importance of a dynamic study of colonization, a condition necessary for any experimental study.

[Effect of glucose and nitrogen concentrations on the morphology of Candida albicans and the formation of chlamydospores in synthetic culture media]. / Influence de la concentration du glucose et de l'azote sur la morphologie de candida albicans et la formation de ses chlamydospores dans un milieu de culture synthétique.

Candida albicans was grown in the darkness, at 28 degrees C, in a synthetic medium in which glucose and nitrogen concentrations were varied. Numeric appraisal of the chlamydospore index was possible only in the medium where glucose concentration was 0,08 g/1 or less. When the glucose concentration raised, pseudomycelial thalli bore numerous chlamydospores but sometimes also chains of cells with a dense granular content. These thalli bud yeast cells which separate and bud again in the medium. The different morphological aspects of the cultures are decribed, illustrated and classified according to the glucose and nitrogen concentration of the medium.

[Chlamydosporulation in "Candida albicans". Course of the morphogenesis; influence of light and sowing density (author's transl)]. / Chlamydosporulation de Candida albicans: déroulement de la morphogenèse; influence de la lumière et de la densité d'ensemencement.

Candida albicans is cultivated on rice cream decoction with glucose for chlamydospore production. A developmental stage refered as readiness is recognized. At this stage, the pseudomycelial thalli are able to produce chlamydospore in water without further stimulus by the sporulation medium. The greater the inoculum, the earlier appears the readiness. During the growth phase up to the readiness, the light is inhibiting the chlamydosporulation and favorising the yeast development. After the readiness, light still inhibits chlalmydospore formation.

[Chlamydosporulation in "Candida albicans": influence of sowing density and glucose, nitrogen, biotin and mineral salts concentration in rice-cream decoction (author's transl)]. / La chlamydosporulation de Candida albicans: influence de la densité d'ensemencement et de la concentration de glucose, d'azote, de biotine et de sels minéraux dans une décoction de crème de riz.

Chlamydospore production by Candida albicans was investigated in rice cream decoction inoculated with a blastospore suspension. Effects of glucose, KH2PO4, (NH4)2SO4 and biotin addition were estimated using a "chlamydospore index" i.e. the mean-number of mature chlamydospores produced from a single blastospore development. If no other component was added, it appeared that better sporulation was obtained with both glucose concentration and inoculum size optimum (0.5 g/l and 7.8 X 10(3) blastospores/ml respectively). In glucose-KH2PO4 enriched medium, chlamydosporulation was the best with 0.5 g/l glucose and 0.5 g/l KH2PO4. The addition of biotin reduced the chlamydospore index at the concentrations tested (0.6 to 20 microgram/l). When glucose and (NH4)2SO4 were added together, it seemed that one of the C or N component had to be in low concentration for a good sporulation. The action of salts was also investigated; and finally a synthetic medium is proposed. The improvement of this medium is now in progress.

[Study of the Sporothrix schenkii (yeast forms) extract. Electrophoretic and immunoelectrophoretic analyses: characterization of enzymatic activities]. / Etude d'un extrait de Sporothrix schenckii (forme levure). Analyse électrophorétique et immunoélectrophorétique; caracterisation des activités enzymatiques.

An extract from living yeast forms of S. schenckii was prepared. The yeasts originated from a shake culture in B.H.I. broth (Difco) incubated for 3 days at 35 degrees C in darkness; they were harvested, washed and disrupted with glass beads in a model MSK Braun mechanical cell homogenizer; a freezing-thawing was added to improve the extract. After electrophoretic separation in agarose gel, the extract's components were characterized by their enzymic activity; with this technique, 30 bands were revealed. These enzymic activities were also investigated on the antigenic fractions of the extract revealed by a rabbit hyperimmunserum: 16 among 22 immunoprecipitates are identified by their catalytic properties. Study of the earliest precipitating antibodies (appearing-order and enzymic caracterization) in rabbits just immunized completes this work. How to ameliorate the quality of the extract by culture and extraction conditions is also specified.

[Growth and sexual reproduction of the dermatophyte Arthroderma vanbreuseghemii Takashio (Trichophyton mentagrophytes (Robin blanchard) on a synthetic medium]. / Croissance et reproduction sexuée du champignon dermatophyte Arthroderma vanbreuseghemii Takashio (Trichophyton mentagrophytes (Robin blanchard) sur un milieu de culture synthétique

A synthetic medium without agar is proposed for the growth and the sexual reprpduction of the dermatophyte Arthroderma vanbreuseghemii (Trichophyton mentagrophytes). The determinations of mycelium dry weight showed that this species grew poorly with only one amino-acid as nitrogen source. A. vanbreuseghemii grew weakly on a mixture of glutamic and aspartic acid and serin. A small amount of aromatic amino-acids added to this mixture, increased the growth rate comparable to that obtained on peptone. The sexual reproduction was induced on synthetic medium with a propicious balance between carbon and nitrogen sources. Addition of 0.5 or 1g/1 of glucose to 50 mg N/1 supplied by the amino-acids mixture (including the aromatics) gave the optimal ratio. Using these conditions, many cleistothecia was produced by crossing two semi-compatible strains.