Adverse Drug Reactions Due to Opioid Use in Oldest-Old Patients Visiting the Emergency Unit of the Geneva Geriatric Hospital.

Opioid use has much increased in several countries during the last two decades, accompanied by a rise in associated morbidity and mortality, especially in the United States. Data on a possible opioid crisis are scarcer in Europe. We performed a study aiming to assess the frequency of adverse drug reactions (ADR) related to opioids in patients presenting to the emergency unit (EU) of a geriatric tertiary Swiss University Hospital. This particular setting is intended for patients aged 75 and older. Our retrospective, monocentric survey of opioid use and related ADR was conducted over two months in 2018. The main and secondary outcomes were the frequency of EU visits considered due to an opioid ADR and insufficient pain relief, respectively. Current opioid use was identified in 20.3% (n=99) of the 487 included EU visits (mean age 86). An ADR was the suspected cause of the EU visit in 22 opioid users, mainly fall-related injury and gastrointestinal disorders. All these patients had at least one comorbid condition. In 19/22 cases (86%) of ADR, a drug-drug interaction might have been involved. In 12 opioid users (12%), insufficient pain relief was suspected as the cause of the EU visit. In conclusion, one-third of opioid users visiting a geriatric EU consulted for a problem related to its use mainly adverse drug-related reaction (22%) followed by insufficient pain relief (12%).

Pharmacoepidemiological characterisation of zolpidem and zopiclone usage.

PURPOSE: Zolpidem and zopiclone are two widely used non-benzodiazepine hypnotics whose usage seems to be associated to pharmacodependence. However, to our knowledge, there has as yet been no published epidemiological study which has compared their abuse or dependence potential. We used a pharmacoepidemiological approach to identify and characterise zolpidem and zopiclone users in real life situations. METHODS: Regular users of zolpidem or zopiclone were identified in the database of a French regional health insurance organisation. A latent class analysis (LCA) was used to identify different subgroups of users of these two hypnotics. RESULTS: The study cohort comprised 25,168 patients who regularly used zolpidem and 21,860 who regularly used zopiclone. The results of the latent class analysis, which enables subgroups with similar patterns of response to be identified, revealed four clinical subtypes of users of zolpidem: non-problematic users, users with associations with hypnotics/anxiolytics or with associated mental disorders, and problematic users. Only three subgroups were identified for zopiclone, and LCA did not discriminate a special class of problematic users for this drug. CONCLUSION: Our analysis indicates that there is a subclass of zolpidem user suggestive of abuse; this was not the case for zopiclone. This methodology is very interesting because it allows analysis of databases and determination of a specific signature of drugs potentially leading to abuse or dependence.

[Epidemiological study on addictive behaviours during pregnancy in a universitary department]. / Étude de prévalence des conduites addictives chez les femmes enceintes dans une maternité universitaire.

OBJECT: Epidemiological study on addictive disorders during pregnancy. METHODS: An epidemiological study about addictive disorders has been led in the maternity of the University Hospital of Nantes in 2008 on a sample of 300 women, just after childbirth. The prevalence of consumption of drugs was assessed on declared consumption of legal and illegal substances and on the Fagerström questionnaire, the AUDIT questionnaire and the CAST questionnaire. Diagnostic of eating disorders was based on DSM IV criteria of mental anorexia and bulimia nervosa. RESULTS: At the beginning of pregnancy, 34% of women used tobacco, 63% alcohol and 8% cannabis. Among the women of the study 0.7% had criteria for mental anorexia, 2.3% for bulimia nervosa and 9% for sub clinic forms. After the first trimester, 22% of women declared using tobacco, 20% alcohol and 3% cannabis. The use of various drugs during pregnancy concerned 6.3% of women, and 38% used at least one drug after the first trimester. CONCLUSION: The high prevalence of addictive disorders during pregnancy should incite professional of prenatal care to improve their screening methodology and not only when tobacco or alcohol is suspected.

[The course of prolactinomas in adolescents]. / Evolución de prolactinomas en adolescentes.

Results of treatment and long and short-term follow up of 13 patients (8 girls, 5 boys), aged 14-20 years (x:16.5) with prolactinomas, were assessed. Most frequent initial symptoms were: cephalea, puberty arrest or delay, galactorrhea and visual impairment. Pre-treatment evaluation showed variable and discordant responses of LH and FSH to LR-RH test, while results of TRH (TSH) test were normal in 8/9 patients (one girl had a primary hypothyroidism). Basal prolactin (PRL) levels were high in all patients (77 and 1150 ng/ml; mean +/- SD: 378 +/- 285), without further increase of TRH (mean: 25%). Eight patients had initially been operated; 7 remained hyperprolactinemic, requiring bromocriptine (BEC) after surgery. Five patients received BEC initially; CT scanning showed the absence of a substantial reduction of tumor size in 4 patients and there was no change in 1 girl. They all underwent surgery. Follow-up of 11 patients lasted between 2 and 12 years. Of those initially operated, 1 had a spontaneous return to normal gonadal function, and 5 patients required concomitant treatment. Of the 5 patients initially treated with BEC, 1 girl spontaneously resumed her cycles and became pregnant 10 months later, 1 girl completed her puberal development and at present she menstruates normally; 1 girl required concomitant progesterone treatment and the boy resumed his gonadal function. The secondarily operated girl remains normoprolactinemic, although without menstruation.(ABSTRACT TRUNCATED AT 250 WORDS)

Evolucion de prolactinomas en adolescentes / The course of prolactinomas in adolescents

Se presentan los resultados del tratamiento y seguimiento a mediano y largo plazo en 13 pacientes (8 niñas y 5 varones) de 14.2 a 20 años (x:16,5) portadores de prolactinoma. En el momento de la consulta los signos clínicos, más frecuentes fueron: cefaleas, detención o retraso de la pubertad, galactorrea y alteraciones visuales. La evaluación pretratamiento mostró respsuestas variables y discordantes de LH y FSH al ensayo de LH-RH, mientras que la prueba de TRH (TSH) resultó normal en 8/9 casos (una joven mostró un hipotiroidismo primario asociado). Los niveles de prolactina (PRL) basales estaban elevados en todos los casos entre 77 y 1150 ng/ml (x ñ SD : 378 ñ 285), sin incremento luego del TRH (x : 25%). En 8 casos, la cirugía constituyó el tratamiento inicial; 7 de ellos persistieron hiperprolactinémicos y requirieron bromocriptina (BEC) postquirúrgica. Cinco enfermos recibieron BEC como tratamiento primario; la TC mostró desaparición o importante reducción tumoral en 4 y ausencia de modificaciones en 1 niña por lo que se indicó cirugía secundariamente. La evolución pudo seguirse en 11 pacientes entre 2 y 12 años. De los operados inicialmente, 1 recuperó espontáneamente la función gonadal y 5 casos requirieron tratamiento complementario. De los 5 casos tratados primariamente con BEC, una recuperó ciclos espontáneamente logrado embarazo a los 10 meses, una completó el desarrollo puberal y presenta sangrados periódicos, una requirió tratamiento complementario con progesterona y el varón recuperó la función gonadal. La niña que fue secundariamente operada persiste normoprolactinémia sin recuperar sus ciclos. Concluimos que: 1) la PRL basal, junto con la evaluación radiológica, constituyen los elementos fundamentales en el diagnóstico de prolactinoma; 2) las evidencias clínicas y radiológicas abonarían en favor de una mayor rapidez evolutiva en los varones; 3) la BEC constituye un recurso valioso en el tratamiento primario o complementario de los prolactinomas en pacientes infantojuveniles

Evolucion de prolactinomas en adolescentes / The course of prolactinomas in adolescents

Se presentan los resultados del tratamiento y seguimiento a mediano y largo plazo en 13 pacientes (8 niñas y 5 varones) de 14.2 a 20 años (x:16,5) portadores de prolactinoma. En el momento de la consulta los signos clínicos, más frecuentes fueron: cefaleas, detención o retraso de la pubertad, galactorrea y alteraciones visuales. La evaluación pretratamiento mostró respsuestas variables y discordantes de LH y FSH al ensayo de LH-RH, mientras que la prueba de TRH (TSH) resultó normal en 8/9 casos (una joven mostró un hipotiroidismo primario asociado). Los niveles de prolactina (PRL) basales estaban elevados en todos los casos entre 77 y 1150 ng/ml (x ñ SD : 378 ñ 285), sin incremento luego del TRH (x : 25%). En 8 casos, la cirugía constituyó el tratamiento inicial; 7 de ellos persistieron hiperprolactinémicos y requirieron bromocriptina (BEC) postquirúrgica. Cinco enfermos recibieron BEC como tratamiento primario; la TC mostró desaparición o importante reducción tumoral en 4 y ausencia de modificaciones en 1 niña por lo que se indicó cirugía secundariamente. La evolución pudo seguirse en 11 pacientes entre 2 y 12 años. De los operados inicialmente, 1 recuperó espontáneamente la función gonadal y 5 casos requirieron tratamiento complementario. De los 5 casos tratados primariamente con BEC, una recuperó ciclos espontáneamente logrado embarazo a los 10 meses, una completó el desarrollo puberal y presenta sangrados periódicos, una requirió tratamiento complementario con progesterona y el varón recuperó la función gonadal. La niña que fue secundariamente operada persiste normoprolactinémia sin recuperar sus ciclos. Concluimos que: 1) la PRL basal, junto con la evaluación radiológica, constituyen los elementos fundamentales en el diagnóstico de prolactinoma; 2) las evidencias clínicas y radiológicas abonarían en favor de una mayor rapidez evolutiva en los varones; 3) la BEC constituye un recurso valioso en el tratamiento primario o complementario de los prolactinomas en pacientes infantojuveniles (AU)

Evolución de prolactinomas en adolescentes. / [The course of prolactinomas in adolescents]

Results of treatment and long and short-term follow up of 13 patients (8 girls, 5 boys), aged 14-20 years (x:16.5) with prolactinomas, were assessed. Most frequent initial symptoms were: cephalea, puberty arrest or delay, galactorrhea and visual impairment. Pre-treatment evaluation showed variable and discordant responses of LH and FSH to LR-RH test, while results of TRH (TSH) test were normal in 8/9 patients (one girl had a primary hypothyroidism). Basal prolactin (PRL) levels were high in all patients (77 and 1150 ng/ml; mean +/- SD: 378 +/- 285), without further increase of TRH (mean: 25

). Eight patients had initially been operated; 7 remained hyperprolactinemic, requiring bromocriptine (BEC) after surgery. Five patients received BEC initially; CT scanning showed the absence of a substantial reduction of tumor size in 4 patients and there was no change in 1 girl. They all underwent surgery. Follow-up of 11 patients lasted between 2 and 12 years. Of those initially operated, 1 had a spontaneous return to normal gonadal function, and 5 patients required concomitant treatment. Of the 5 patients initially treated with BEC, 1 girl spontaneously resumed her cycles and became pregnant 10 months later, 1 girl completed her puberal development and at present she menstruates normally; 1 girl required concomitant progesterone treatment and the boy resumed his gonadal function. The secondarily operated girl remains normoprolactinemic, although without menstruation.(ABSTRACT TRUNCATED AT 250 WORDS)