[Smoking prevalence among nursing students and nursing assistants in Mâcon: 2021 survey and evolution over 13 years]. / Prévalence du tabagisme parmi les étudiants infirmiers et aides-soignants de Mâcon: enquête 2021 et évolution depuis 2008.

INTRODUCTION: Smoking is a public health issue in France, especially among the young. Its specificities for caregivers and health students are part of a nationwide "Tobacco-free health place" strategy, underlining the importance of individual choices and the clinical roles of future health professionals. METHOD: Prospective survey by online questionnaire, conducted in 2021 among 238 nursing students and nursing assistants in Mâcon, concerning their smoking habits, vaping and the impact of the Covid-19 health crisis, the objectives being to assess the prevalence of smoking in this population, and compare it to previous surveys and data from the literature. In addition, smoking-related behavior was observed. RESULTS: One hundred and fifty-seven out of 238 students (66%), 95% of whom were women, responded to the questionnaire, with an average age of 25.1 years (SD: 7.7). Smoking prevalence was measured at 22%. This rate has fluctuated without declining in the surveys undertaken since 2008. Vaping was practiced by 8% of respondents, three-quarters of whom were also smokers. The health crisis appeared to have aggravated smoking habits among the future caregivers, two-fifths of whom considered it embarrassing for a caregiver to smoke, whatever their own smoking status. CONCLUSIONS: Smoking prevalence has not declined in this predominantly female student population, with results similar to those elsewhere in France, Young generations of caregivers will be challenged from the standpoints of personal health and professional skills in their treatment of smokers, which it would be desirable for them to ensure without undue cognitive dissonance.

[Can one talk of benzodiazepine "drunkenness"? About acute benzodiazepine intoxication, without suicidal or mortiferous tendencies]. / Peut-on parler d'ivresse benzodiazépinique ? À propos d'intoxications benzodiazépiniques aiguës, ni suicidaires ni mortifères.

BACKGROUNDS: When we refer to "drunkenness", more often than not, we think of alcohol or cannabis being the instigator rather than pharmacological drugs, even if outside the toxic origins, "drunkenness" may also occur without any substance intake: one can be drunk on love, poetry, music and even mania. Benzodiazepine "drunkenness" is not a classical notion in medicine. But the concept of addictology allows one to enlarge different approaches and to consider the relationship with psychoactive substances according to the same references. So, in a single fashion, between use and misuse, is it possible to resort to the same concepts for pharmacological drugs, including "drunkenness"? CLINICAL FINDINGS: Any intake of a psychoactive substance, limited in time, which will take the consumer some time to recover from, can be called simple use, intoxication or drunkenness. Intoxication is rather a classical medical concept linked with poisoning, and hence the toxicological aspects prevail particularly through the concept of a toxidrome. However, little research has been done on "drunkenness" in other medical aspects, neither psychological aspects nor sociological aspects. If poisoning is defined as soon as a poison is introduced into the body, the intoxication arises after a threshold (that toxicology usually defines), but no means are available to measure the onset of the inebriation, neither any ingested amounts nor any toxic concentration in the body. It is hard to define "drunkenness" simply. At first, it is most often seen as a pathology in medicine, unlike in every day life. "Drunkenness" can be the result of physiological disturbances, notably through the effects of substances and can therefore be the manifestation of a cerebral dysfunction. Alternatively, it can arise from a variation of emotional or sensorial stimuli. If the feelings associated with drunkenness are positive and pleasant a repetition will occur in the search to reproduce enjoyable effects in reference to neurophysiological models of reward systems of the brain, and can tend to be limited to a search for pleasure. Moreover, "drunkenness" may be considered as a leak, a regression or a kind of renouncement. It may sometimes be a search for sedation, for conscious sleep, or to avoid reality. And, finally, "drunkenness" may be suicidal. Since the launch of benzodiazepines on the market during the sixties, their prescription has developed, making them so readily available in France that they are nearly as easy to obtain as alcohol. The widespread diffusion of these psychoactive substances, obtained with or without medical prescription, renders them one of the principle means of chemically modulating thought and consciousness that has become accessible to all. One of the first reasons for this is the easy and wide prescription of these drugs by almost all practitioners. Choosing between benzodiazepines or alcohol (or associating both substances) is not fortuitous. Besides intoxication with pharmacological drugs, whether voluntary or otherwise, medication overdose and iatrogenic effects, there is an incidence of a substantial use of over the counter psychoactive drugs in order to trigger other effects than suicide or self-harm. This use of pharmacological drugs, sometimes referred to as "entertaining", can lead to massive intake with dramatic behavioural response. Is it then possible to use the same term "drunkenness" for a pharmacological drug-induced state as for a state provoked by other psychoactive substances with addictive potential ? The clinical presentation of benzodiazepine "drunkenness" resembles the pharmacological effects of these drugs. If we link alcoholic and benzodiazepine "drunkenness", we can draw a parallel between the properties, the action mechanisms, the effects and the risks incurred by the consumption of these two classes of psychotropics. The similarities concern the existence of a preclinical phase, of the same biochemical or neurophysiological basis, of the same properties, notably complex relationships with anxiety. They also have the same amnesiac effects, possible paradoxical effects, or sedation potentialities that may lead to coma, respiratory depression and death. But differences exist for benzodiazepines, in the lack of disinhibition effects, the lack of cerebellar effects, the variability of elimination kinetics according to the molecules, the rarity or the lack of "recreational" intakes, and the lack of easy blood level measurements. CONCLUSION: An attempt is made to outline the definition of benzodiazepine "drunkenness", including sociological, psychological, and medical dimensions beyond the sole toxicological aspects. So, studying the misuse of benzodiazepines in more detail including the acute effects such as "drunkenness", except suicidal or mortiferous tendencies, can allow further development of its recognition, screening and prevention.

[Life-events incidence in Alzheimer disease: preliminary study on the ABORD program]. / Incidence des évènements de vie dans la maladie d'Alzheimer : étude préliminaire sur le programme Abord.

INTRODUCTION: Alzheimer disease has been studied according to several approaches: neurological, cognitive, or psychodynamic. Investment in the latter is sparse although it provides an essential clinical overview for global understanding of the disease. OBJECTIVES AND METHODS: This study followed the Alzheimer Observation Bank of Research and Data (ABORD) programme, which began in the 1980s. Fifty-nine subjects suffering from Alzheimer disease were compared to 31 control subjects, in order to search for an association between vulnerability factors linked to the life story and future clinical outbreak of Alzheimer disease. The study was carried out with an 11-item questionnaire on difficult life events. They concerned childhood, stress inductive situations, separation or bereavement experiences, family background or psychiatric history. RESULTS: Control subjects experienced less difficult events (Chi(2)=5.87; P<0.05). An accumulation of deleterious life events can impact on psychic economy. Pathogenic factors appear, sick people have more often been placed before the age of 10 (Chi(2)=5.06; P<0.01), and recognize more psychiatric family history and/or psychic vulnerability (Chi(2)=5.06; P<0.05). Difficult life events can impact on the subject's ability to grieve, and so the elaboration of losses linked with ageing can become difficult and exceed the psychic ability of the subject, which can be further disrupted by cerebral lesions or pathogenic factors. Hence, the subject could make an unconscious choice of a rescue mental running, which appears in the development of Alzheimer. A protective factor has been found: spiritual practice referring to a form of faith or philosophical adherence (Chi(2)=5.64; P<0.05).

[Acute alcoholic intoxication at the hospital: a clinical stake. A prospective study of one year in a general hospital]. / L'intoxication éthylique aiguë à l'hôpital : un enjeu clinique. Etude prospective sur un an en hôpital général.

INTRODUCTION: Acute alcoholic intoxications (AAI) are frequent in hospitals. This entails some difficulties to caregivers and their clinical approach is little developed in France. This study aimed at estimating perception of alcohol consumption of hospitalized people with positive alcohol blood test at admission. Alcohol measurements were nonsystematic and ordered by a physician. Then this study assessed the role of a clinical interview the day after an AAI. METHODS: Each person admitted with a positive alcohol blood test was systematically met by a professional in addictology, referring to a procedure in process for 10 years in this hospital. A prospective collection of the data was performed during 2006. RESULTS: Nine hundred and seventy-three episodes were identified corresponding to 758 persons (78% of men and 22% of women). The average alcohol blood level was 2.06+/-1.18g/L. Eighty-five percent of those patients were admitted and 52% were interviewed. Damage due to alcohol was identified for 69% and a misuse of alcohol for 92% (19% abuse, 73% dependence according to the DSM IV), without significant correlation to alcohol blood level. CONCLUSION: Blood alcohol level assay at the hospital admission, when the test has been medically recommended, targets a misusing alcohol group of people. These patients need addictologic care, after a first toxicological stage. This study confirms that in such a case a discussion offer is possible and agreed by diseased people. This offer is a first step towards people who could not express explicitly their need for help and constitute an opportunity to care.

[Delusional parasitosis or Ekbom's syndrome]. / Le délire de parasitose ou syndrome d'Ekbom.

INTRODUCTION: Ekbom's syndrome or delusional parasitosis is a disorder in which the patient believes that he/she is infected by a parasite. Epidemiologic, nosologic, psychopathologic and therapeutic data can barely be interpreted, as delusional parasitosis has mostly been described in either isolated cases or small cohorts. An extensive literature review is recommended to better understand common features associated with this syndrome. EXEGESIS: Ekbom's syndrome is a chronic disorder that may occur at any age but is more common in the elderly, particularly in females. International classifications have included this syndrome in non-schizophrenic delusions. However, it has also been reported in schizophrenia, affective disorders, and organic or induced psychosis. Treatment is based on antipsychotic agents, psychotherapy, and cooperation between dermatologists and psychiatrists. CONCLUSION: Pimozide is currently the most effective treatment. It requires careful monitoring, as it has several adverse effects. For patients with concomitant depressive symptoms, the use of antidepressants is recommended.

[Duodenal tuberculosis: a difficult diagnosis]. / Tuberculose duodénale: un diagnostic difficile.

BACKGROUND: The polymorphous clinical presentation of tuberculosis located in the duodenum may mislead diagnosis. CASE REPORT: A 69-year-old man had duodenal stenosis associated with calculous common bile duct obstruction. Crohn's disease was initially diagnosed and the patient was treated with corticosteroids. Two months later, the diagnosis was rectified when pulmonary tuberculosis developed. DISCUSSION: This case emphasizes the lack of specific clinical, radiological, endoscopic and histological signs of duodenal tuberculosis.

[Fluoxetine dependence and tolerance. Apropos of a case]. / Dépendance et tolérance à la fluoxétine. A propos d'une observation.

The authors relate a single case of fluoxetine misuse of a 31-year-old woman, with a previous history of multi drug addiction, and who weaned of all illicit substance and alcohol intake for several months. From a medical fluoxetine prescription at a dose of 20 mg per day, the patient increased to 280 mg per day within few months. Tolerance and dependency to the substance (according to DSM IV) and withdrawal syndrome occurred following fluoxetine discontinuation. This misuse keeps on for more than one year, and no symptom of a "serotonin syndrome" has ever been found. In our understanding, this exceptional case-report seems to be the first one related either in medical literature or drug monitoring centers.

[Diagnostic and therapeutic approach to plasma cell granuloma of the lung. Apropos of a case of favourable course under antibiotics]. / Approche diagnostique et thérapeutique du granulome plasmocytaire du poumon. A propos d'un cas d'évolution favorable sous antibiotiques.

Plasma cell granulomas are more often solitary benign tumoral lesions, which need early surgery both for diagnostic and therapeutic reasons. The authors report a case of multiple plasma cell granuloma, diagnosed on biopsies obtained by thoracoscopy, and with a good response to a long-term antibiotic treatment. A review of the literature shows that this behaviour may represent an interesting alternative to systematical surgery in some cases.