[Interleukin-1, inflammasome and autoinflammatory diseases]. / Interleukine-1, inflammasome et maladies auto-inflammatoires.

Interleukin-1 is a major cytokine of innate immunity and inflammation. It exerts various systemic effects during the inflammatory response, such as fever induction, thrombopoiesis and granulopoiesis, or leukocyte recruitment. Its involvement has been demonstrated in many inflammatory-mediated diseases, such as diabetes or gout. Moreover, interleukin-1 plays a pivotal role in some autoinflammatory diseases, such as cryopyrinopathies or familial Mediterranean fever. In these diseases, a constitutional defect of the inflammasome, a protein complex responsible for the activation of interleukin-1, explains the hypersecretion of interleukin-1. Other autoinflammatory diseases have a more complex pathophysiology involving deregulation of the interleukin-1 pathway, upstream or downstream of the inflammasome, or through more complex mechanisms. In this review, we are detailing the synthesis, the activation, the signalling, and the regulation of interleukin-1. We then describe the autoinflammatory diseases or related-diseases where the pathological role of interleukin-1 has been demonstrated.

Drug administration error related to computerized prescribing.

INTRODUCTION: One of the main reasons for the implementation of computer-based prescribing was to reduce medication errors. However, the risk has not fallen to zero and new kinds of errors have been detected. SETTING: the following case relates one of these medication errors involving a preparation of vincristine. This antineoplastic drug was injected to a patient via a subcutaneous route of administration instead of an intravenous bolus injection. RESULTS: consequently, a cutaneous erythema appeared. This incident resulted from an error in the programming of the administration route of the protocol operated by a pharmacist and a physician. The pharmacist, who was responsible for the validation of the computerized medical order and then for the compounding and the dispensing of the drug, did not detect the error. CONCLUSION: this case highlights the need of improved and irreproachable therapeutic protocols. Recorded in a database, they must be validated pharmaceutically and medicinally to secure computer-based prescribing, drug handling, dispensing, and administering of the antineoplastic drugs. Even if the pharmaceutical analysis of prescriptions is made easier with computerization, we encourage the training of nurses and the evaluation of their knowledge as well as the necessity for pharmacists to learn to detect new kinds of errors and to verify periodically protocols.

In vitro selection and efficacy of topical skin protectants against the nerve agent VX.

Against highly toxic chemicals that are quickly absorbed in the skin, topical formulations could adequately complement specific protective suits and equipments. In this work, we evaluated in vitro and compared the skin protection efficacy against the nerve agent VX of four different topical formulations: oil-in-water and water-in-oil emulsions, a perfluorinated-based cream and a hydrogel. Semi-permeable silicone membrane, pig-ear and human abdominal split-thickness skin samples mounted in diffusion cells were compared as in vitro permeation tests. The results showed that silicone membrane could be used instead of skin samples to screen for potentially effective formulations. However, the results indicated that due to potentially significant interactions between formulations and skin, relevant ranking of formulations according to their protective efficacy could require tests with skin samples. The main phase of emulsions, water or oil, was not found to be critical for skin protective efficacy against VX. Instead, specific film-forming ingredients such as perfluorinated-based polymers and silicones could significantly affect the skin protective efficacy of formulations. We showed that a hydrogel containing specific hydrophilic polymers was by far the most effective of the formulations evaluated against VX skin permeation in vitro.

Evaluation of in vitro tests to assess the efficacy of formulations as topical skin protectants against organophosphorus compounds.

Prevention of exposure to the neurotoxic organophosphorus compounds (OP) is a major concern both for pesticide users and soldiers. Skin barrier creams are being developed to complement or replace uncomfortable chemical protective suits. Quick evaluation of formulations efficacy mainly relies on in vitro tests which lead to consistent, complementary and relevant results. The objectives of this work were to determine the consistency of results from in vitro tests and importance of the formulation composition in the skin protective efficacy. The efficacy of three formulations, i.e. oil-in-water and water-in-oil emulsions and perfluorinated compounds-based cream, was evaluated against the OP paraoxon in vitro. Our results indicated that the least effective formulations could be quickly identified by performing in vitro permeation tests with silicone membrane and by evaluating interfacial interactions between formulations and OP. Among the tested formulations, the perfluorinated compounds-based cream could have a broader spectrum of efficacy than emulsions against OP and other toxic chemicals.

[Medication dispensing errors detected in medication cassettes intended for in-hospital patients]. / Erreurs de dispensation des médicaments détectées dans les piluliers destinés aux patients hospitalisés.

BACKGROUND AND OBJECTIVE: Many dispensing errors occur in hospital pharmacies and can harm patients if they are not intercepted. The aim of this study was to determine the incidence and the primary types of medication dispensing errors at a French military hospital. METHOD: The check of unit dose medication cassettes was performed by nurses. From February 2007 to April 2007, detected dispensing errors were systematically recorded and classified into 6 categories: unauthorized drug, wrong dosage-form, improper dose, omission, wrong time, and deteriorated drug errors. The overall error rate was calculated. RESULTS: During the study, 5112 medication cassettes were checked. 106 dispensing errors have been detected by nurses for a total of 45,573 filled (n=45,518) and omitted (n=55) unit doses. An overall error rate of 0.23% was found. There were approximately 0.02 detected dispensing errors per medication cassette. The most common error types were omission errors (n=55, 51.88%) and improper dose errors (n=30, 28.30%). DISCUSSION-CONCLUSION: The results of this study showed that a check performed by nurses after the dispensing process is necessary to detect the dispensing errors. Many causes may explain the occurrence of dispensing errors and must be corrected. Because some dispensing errors may remain undetected, there is a requirement to develop strategies in order to reduce or eliminate these errors, such as the implementation of a computerized prescribing system. The pharmacy staff is widely involved in this duty.