[Alcohol withdrawal delirium: What's new for an old disease?] / Delirium tremens : quoi de neuf pour une vieille maladie ?

The management of alcohol withdrawal syndrome is a frequent work in both community medicine and hospital wards. One of the most severe complications of alcohol withdrawal is Delirium Tremens (DT). The purpose of this development is to update knowledge on this complication in terms of diagnosis, evaluation and therapeutic approaches. It also proposes a reflection on the trajectory of care during and after DT.

Transisthmian differentiation in the tree-climbing mangrove crab Aratus H. Milne Edwards, 1853 (Crustacea, Brachyura, Sesarmidae), with description of a new species from the tropical eastern Pacific.

The tree-climbing mangrove crab Aratus pisonii (H. Milne Edwards, 1837) (Brachyura, Sesarmidae) is considered to have a transisthmian distribution, due to its presence in mangroves of the Western Atlantic as well as the Eastern Pacific. We here present evidence, based on the morphologies of male gonopods and on genetic data, that populations from these two coastlines are morphologically and genetically distinct and require the description of a new species, Aratus pacificus n. sp., as the sister-species of Aratus pisonii. The corresponding speciation event can be regarded as the outcome of differentiation following the closure of the Isthmus of Panama. As these coastal brackish species were probably among the last ones to become separated, the speciation can thus be dated to a time frame of no more than 3.1 million years.

[Alcohol withdrawal delirium: a retrospective case series of 39 patients]. / Delirium tremens : étude rétrospective de 39 observations.

INTRODUCTION: Alcohol withdrawal delirium (AWD) is one of the most serious complications of alcohol withdrawal. The daily practice of linking activity in addiction shows that this condition is not uncommon. PATIENTS AND METHODS: We extracted from the hospital database patients' admissions for which a diagnosis of AWD (F104) was registered between 2004 and 2009. The review of discharge reports allowed to select the patients for which the medical records were analyzed. RESULTS: Thirty-nine patients admitted for DT were selected. Mean age was 48 years (male 89.7%). A majority of patients (89.7%) were admitted through the emergency department. In about a half of cases (51.3%), blood alcohol concentration was null at admission. The main reasons for the admission were alcohol withdrawal syndrome (17.9%), fall/malaise (15.4%), and generalized seizures (12.8%). Approximately one-third of the patients had a medical history of seizures and 23.1% of AWD. No patient had severe liver failure. Six patients (15.4%) were transferred to intensive care. Two patients developed AWD after surgery. No deaths have been observed. CONCLUSION: Improving medical knowledge of AWD is a way to make this complication even more uncommon.

[Study of hospitalizations for pneumococcal pneumoniae in Centre region, 2004-2008]. / Étude des séjours pour pneumopathie à Streptococcus pneumoniae entre 2004 et 2008 en région Centre.

BACKGROUND: Streptococcus pneumoniae is a significant cause of morbidity-mortality: leading agent of community-acquired pneumonia and the first cause of death due to infectious diseases in France. Vaccines are available for children and adults, avoiding serious complications. We studied hospitalizations for pneumococcal pneumonia in Centre region in 2004-2008, using the 2004-2008 national hospital discharges database and assessed vaccine coverage of a sample population. METHODS: Hospital discharges with diagnosis of pneumococcal pneumonia were selected, using the corresponding code (J13) in the French Diagnosis-Related Group coding system. We analysed hospitalization and patient data using linkage of the inpatient stays with their anonymous identification number. We analysed hospitalization and patient data: number and length of stay/patient, co-morbid factors and pneumococcal immunisation status. RESULTS: One thousand five hundred and forty-one hospitalisations were found for pneumococcal pneumonia in Centre Region, in 2004-2008. The time pattern showed an annual increase in hospital stays: winter hospitalisations were most frequent. The median age was 58 years, range: 2 months-106 years. The sex ratio M/F of the 1417 distinct inpatients was 1.43. The hospital impact was substantial, with prolonged length of stay (mean=9.9 days), frequent stays in intensive care unit (20%) and high death rate (6%). The vaccine coverage of the population with pneumococcal pneumonia was only 23%. CONCLUSION: Using the national hospital discharges database, this study presents a snapshot of pneumococcal pneumonia in one French region and demonstrates the local major clinical impact, as found in France. It shows that the hospital discharge database is a potential tool for epidemiology despite its possible bias. This type of study could be useful for organizing a regional vaccination campaing due to the better knowledge of the disease.

[Risk factors for delirium tremens: a literature review]. / Facteurs de risque du delirium tremens : revue de la littérature.

Delirium tremens (DT) is the most severe complication from alcohol withdrawal. Risk factors for DT (before the withdrawal begins) and early predictive factors for the development of the withdrawal syndrome towards DT (once withdrawal has started) are not clearly established. We reviewed the literature from PubMed/Medline database to identify risk factors for DT. Twenty-one studies were been selected. Three only were prospective. The most commonly identified risk factors included personal history of DT, seizures, presence of acute somatic comorbidity especially infectious, presence of early withdrawal symptoms, and genetic predisposition. Most of these risk factors are still debated and prospective studies might appear useful considering the DT prevalence and the absence of consensual both diagnostic and therapeutic protocols.

[Antenatal screening for HIV: knowledge, attitudes, beliefs and practices of pregnant women. Analysis of current practices and the impact of setting up an informative brochure]. / Dépistage anténatal du VIH: connaissances, attitudes, croyances et comportements des femmes enceintes. Analyse des pratiques actuelles et impact de la mise en place d'un dépliant informatif.

OBJECTIVES: To assess the impact of an information leaflet on the behavior and knowledge of pregnant women about the risks of HIV infection during pregnancy. PATIENTS AND METHODS: Comparative prospective study conducted in two phases from March 1 to September 30, 2007 on patients presenting for the first time in antenatal care at the Maternity Hospital of Tours (n=539). During the first phase, only a self-questionnaire was given during the second an informative brochure has been attached to the questionnaire. RESULTS: Currently 25.1% of pregnant women have not made a test during their pregnancy. This rate decreases to 12.9% when the test is routinely offered. It falls to 8.2% with the introduction of an informative brochure. The test was imposed in 28.7% of patients. Some risks of transmission of HIV, including those specific to pregnancy, are undervalued. A negative test before the pregnancy is the main reason for refusal of antenatal screening. A high level of education was the only risk factor identified for refusal. They are better informed as shown by the higher rate of correct answers about the risks of HIV transmission and antenatal screening. We hypothesize that the women who pursued graduate studies evaluate the risk of infection before accepting or refusing the test. CONCLUSION: The study shows that the distribution of an informative brochure on advanced prenatal screening, increased the number of women performing the test and improved their knowledge about risks of transmission, especially from mother to the child.