[Early detection of COPD in occupational medicine in the Alpes-Maritimes]. / Détection précoce de la BPCO en milieu professionnel dans les Alpes-Maritimes.

INTRODUCTION: This study evaluated a standardized procedure aiming at early detection of COPD in a consecutive population of employees visiting occupational medicine. METHODS: A total of 2818 employees were included by 22 occupational physicians in 5 centers. Respiratory symptoms, smoking status, occupational exposures and socioprofessional categories were collected. Subjects with at least one symptom and/or risk factor underwent spirometry. RESULTS: In this population aged 39±12 years, 2603 patients were free of known asthma or COPD. The presence of at least one symptom was observed in 23.6 % of employees and was significantly associated with smoking status, occupational exposure to organic dust, gas fumes and vapors, and agriculture (P<0.0001). Airflow obstruction (FEV1/FVC < 0.70) was detected in 1.7 % of 1605 employees who underwent spirometry. With the inclusion of known COPD subjects (n=22), the prevalence reached 2.38 %. COPD was significantly associated with smoking intensity. Information on subsequent diagnosis was obtained in only two cases. The quality of spirometry was inadequate in 30 % of cases. Thirty-three percent of detected COPD subjects did not report any respiratory symptoms. CONCLUSION: The strategy used in this study (specific questionnaire plus spirometry) allowed detection of a few cases of previously undiagnosed COPD. Occupational physicians need specific training in spirometry and a better follow-up of care pathways is required to obtain diagnostic confirmation.

Fear-avoidance beliefs about back pain in patients with subacute low back pain.

The fear-avoidance beliefs of patients with subacute low back pain (LBP) considered at risk for chronic disabling LBP are not well known. The objectives of this cross-sectional descriptive survey, conducted in secondary care practice, were to assess fear-avoidance beliefs about back pain in patients with subacute LBP and to seek an association between physician or patient characteristics and level of fear-avoidance beliefs. A total of 286 rheumatologists completed a self-administered questionnaire assessing physicians' demographic, professional data, personal history of back pain, and back pain fear-avoidance beliefs (on the Fear-Avoidance Belief Questionnaire [FABQ]) and 443 patients with sLBP completed one on pain, perceived handicap and disability (Quebec Back Pain Disability Scale), anxiety and depression (Hospital Anxiety Depression questionnaire), and back pain beliefs (FABQ). Mean FABQ scores for rheumatologists for physical activities (FABQ Phys) and occupational activities (FABQ Work) were 9.2+/-4.4 (range 0-21) and 16.7+/-6.9 (range 2-37), respectively, and patient scores were 16.7+/-5.2 and 19.3+/-12.4, respectively. A total of 68% of patients and 10% of physicians had a high rating on the FABQ Phys (>14). Patients' fear-avoidance beliefs about physical activity were associated with low level of education (odds ratio [OR] 4.19; 95% confidence interval [CI] 1.83-9.57), patients' perceived disability (OR 1.05; CI 1.03-1.07), and physicians' high FABQ Phys score (OR 5.92; CI 1.31-26.32). Here we show that fear-avoidance beliefs about back pain were high in patients with subacute LBP and their rheumatologists.

In vitro effects of Uriage spring water on the apoptosis of human eosinophils.

The influx of eosinophils in tissues plays a central role in the pathophysiology of allergic diseases such as allergic rhinitis, allergic asthma or atopic dermatitis. The death of eosinophils by apoptosis is an important factor for the resolution of hypereosinophilia. In the present study, we have shown that Uriage spring water induced in vitro the apoptosis of IL-5-primed eosinophils. This effect was dose-dependent and was statistically significant at Uriage water concentrations above 20%. The induction of apoptosis was related to the Ca2+ content of Uriage water. Indeed, Ca2+ at the same concentration as in Uriage water mimicked the apoptotic effect of the spring water. Furthermore, EGTA reversed the apoptotic effect of Uriage water. These results suggest that topically applied, Uriage water could contribute to the resolution of eosinophilic inflammation.

[In vitro activity of a new quinolone, NM 394, against Chlamydia trachomatis]. / Activité in vitro d'une nouvelle quinolone, le NM 394, vis-a-vis de Chlamydia trachomatis.

A study of antimicrobial susceptibility of Chlamydia trachomatis was performed with a new quinolone, NM 394 (Laboratoire Dr. Bouchara). Ten C. trachomatis strains of four different genovars (3G, 4E, 2D, IDv) were grown in confluent McCoy cells on coverslips in multidishes (24 wells). For each C. trachomatis strain, two multidishes were prepared, one for MIC, one for MBC. Three inoculum titrated from 100 to 10000 IFU/ml were inoculated into wells. After incubation 48 h at 37 degrees C, the cultures were fixed in methanol and examined for inclusions after staining with fluorescein-conjugated anti-Chlamydia antibody. The MIC was defined as the lowest antibiotic concentration at which no inclusion formation was observed. For the determination of MBC, the culture media was replaced with sucrose phosphate buffer (2SP) and the cultures were incubated without antibiotic for 48 h and stained. The MBC was the lowest antibiotic concentration at which no inclusion formation was observed after one passage without antibiotic. The increase of the inoculum from 10(3) to 10(5) IFU/ml did not affect significantly the activity of NM 394. All strains were inhibited by 16 mg/l of NM 394. The IC 50 and 90 were 2 and 8 mg/l respectively. The MIC and the MBC values were similar.

A population pharmacokinetic study of alminoprofen penetration into synovial fluid.

The pharmacokinetics of alminoprofen in plasma and synovial fluid (SF) at steady state (300 mg t.i.d.) was studied in 45 patients with knee effusion. Plasma and SF samples, one each per patient, were obtained. Six groups were made according to the time of sampling after ingestion of the 13th dose: 1 h (n = 7), 2 h (n = 7), 4 h (n = 7), 6 h (n = 10), 8 h (n = 6), 12 h (n = 8). A three-compartment model was used to describe alminoprofen kinetics in plasma and SF, with two parameterizations, a 'classical' and a 'physiological' one. The non-linear mixed effect model approach was used to estimate the mean and variance of the pharmacokinetic parameters. The mean +/- SE of the estimates (coefficient of variation of interindividual variability as a percentage) were volume of distribution, 11.0 +/- 1.711 (12%); elimination rate constant, 0.236 +/- 0.025 h-1 (18%); absorption rate constant 2.80 +/- 0.31 h-1 (464%), clearance of influx into SF, 0.29 +/- 0.14 mL min-1; clearance of efflux into plasma, 0.56 +/- 0.25 mL min-1. These two clearances were not significantly different, which indicates that passive diffusion occurs in both directions. The mean +/- SD alminoprofen concentration versus time curve in plasma and SF at steady state was simulated and showed that the mean +/- SD maximal concentration in SF was 8.1 +/- 6.3 mg L-1 and was obtained 4 h after dose administration.