[Healthcare professionals' perception of advanced nursing practice in Ehpad with regard to the risk of drug iatrogenicity in heart failure patients]. / Perception des professionnels de santé sur la pratique avancée infirmière en Ehpad au regard du risque d'iatrogénie médicamenteuse chez l'insuffisant cardiaque.

Medication iatrogenia is a real public health problem. Elderly people are particularly at risk, due to their multiple pathologies, including heart failure; residents of residential care facilities for the dependent elderly (Ehpad) are no exception. Studies show that this risk is avoidable in 60% of cases, and that advanced practice nurses (APNs) can play a pivotal role in preventive measures. How would the role of the APN be perceived by other healthcare professionals working with these heart failure patients institutionalized in Ehpad?

[Restraint in intensive care: between patient safety and respect for autonomy]. / Contention en réanimation : entre sécurité du patient et respect de son autonomie.

The use of physical restraint in the context of medical resuscitation is relatively frequent. Although temporary or prolonged physical restraint is justified by patient safety (possibility of self-extubation, etc.), this practice is itself a source of risk, leads to suffering on the part of the patient, and raises dilemmas and ethical questions within teams. Inherent to the working conditions and training of professionals, restraint must nevertheless be balanced and lead to the search for alternatives.

Cerebral Tuberculosis After Therapy With Adalimumab for Hidradenitis Suppurativa: A Rare Case.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with limited therapeutic options. Adalimumab, an anti-tumor necrosis factor-alpha (TNF-α) monoclonal antibody, was the first biological agent approved for the treatment of moderate to severe HS. Tuberculosis (TB) is a highly prevalent global public health problem, affecting individuals worldwide. Continuous immunosuppression from TNF-α treatment increases the risk of TB development. Isolated neurotuberculosis, in the absence of other symptoms, emerges as a rarely observed infection pattern in such patients. We present a case of a 23-year-old woman with severe HS undergoing treatment with adalimumab. After two years, she developed a pronounced occipital tension headache, constant nausea, and persistent fever. The patient's latent TB status was unknown without annual screening. Subsequent magnetic resonance imaging revealed a lesion in the cerebellar vermis. Immunosuppressive therapy was suspended and an etiological study was conducted; the only positive result was the interferon-gamma release assay. Empirically, antituberculosis treatment and prednisolone were initiated, leading to clinical and neurological improvement. After one year of treatment, symptoms resolved without neurological sequelae. This case highlights the importance of vigilant monitoring before, during, and after immunosuppressive treatment. Early recognition, discontinuation of anti-tumor necrosis factor medications, and appropriate management of TB are crucial to prevent complications.

[Overview of the implementation of pharmaceutical interviews in pharmacies in France: Analysis of responses to a questionnaire]. / État des lieux de la mise en place en France des entretiens pharmaceutiques en officine : analyse des réponses issues d'un questionnaire.

OBJECTIVE: To evaluate the development of pharmaceutical interviews in pharmacies in France, in order to understand the organization implemented, any limitations and the expansion of eligible pathologies. METHOD: A dematerialized questionnaire was designed and distributed between November 2022 and February 2023 to pharmacists and pharmacy students in France (mainland and overseas) via a link to a Google Form. RESULTS: Ninety-four pharmacists from 8 different regions of France responded to the survey. The 94 responses showed that 56% of pharmacists practiced pharmaceutical interviews. Among pharmacists who practiced interviews, pharmacy owners practiced significantly more interviews than other statuses within the pharmacy (67% vs. 38% P=0.014). No other factor, such as dispensary size or geographical area of practice, had a significant impact on whether or not pharmaceutical interviews were carried out. These talks are often carried out at the patient's request, and 89% of them are accompanied by documents for the patient's attention. For pharmacists who do not carry out interviews, time, staffing and remuneration are the 3 main blocking factors found in both quantitative and verbatim variables. Whether or not pharmacists carry out pharmaceutical interviews, this activity received 87% approval from the 94 respondents, and 84% of them would like to include more chronic disease themes. CONCLUSION: The survey shows that pharmacists approve of the pharmaceutical interviewing activity, but it also highlights obvious logistical obstacles linked to a lack of resources. Thus, even among pharmacists who carry out pharmaceutical interviews, this activity is still carried out relatively infrequently on a routine basis, and often by the incumbent pharmacist, who takes on the responsibility of carrying out this activity.

[Rules of good practice for the elderly]. / Les règles de bonne pratique chez le sujet âgé.

The treatment of infectious diseases in geriatric medicine is a complex subject. Diagnosis is often difficult, as is the correct indication for antibiotic therapy. To combat antibiotic resistance, we need to limit unnecessary antibiotic prescriptions and prevent the onset of bacterial infections, notably through vaccination.

[Pregabalin under the prison lens. Reflections on an emerging issue]. / Prégabaline sous la loupe carcérale. Réflexions sur une problématique émergente.

The practice of medicine in prison confronts the prescriber with emerging trends in psychotropic drug misuse. We examine the increasing demand for pregabaliun, as we observe it in patients in detention, and offer a reflection on the health issues. We explain our approach to abstaining from prescribing.

[Validation of a method for detecting hospitalizations for falls related to adverse drug reactions in geriatric departments]. / Validation d'une méthode de détection des hospitalisations pour chute liées à un effet indésirable médicamenteux en service de gériatrie aiguë.

Fall is one of the five main causes of drug-related hospital admissions (DRA) in France. A standardized chart review method, to identify DRA adapted to elderly patients, has recently been developed by Thevelin et al. Our first aim was to assess the reliability of this method for detecting DRA for falls in elderly subjects. Our second aim was to assess the feasibility of this method and to evaluate its reliability for assessing causality, the contribution of DRA to hospitalization, and the avoidability of DRAs in elderly patients hospitalized for a medication-related fall. A retrospective observational study was conducted on 16 patient cases admitted to the hospital for falls in May 2022, in the geriatric department of a French university hospital. Six healthcare professionals (pharmacists, pharmacologists, and geriatricians) assessed a method for detecting DRA individually and then in multidisciplinary pairs of raters. Inter-rater agreement (individually and in pairs) was assessed for DRA detection, causality, avoidability, and contribution of the DRA to hospitalization. A κ > 0,4 was considered a satisfactory threshold for agreement. The mean age was 86 years. When the assessment was done individually, detection of DRA-related hospitalizations (κ = 0,46; p < ,001), and DRA contribution to hospitalization (κ = 0,50; p < ,001) were moderately concordant. The causality assessment (κ = 0,09; p = 0,24) did not agree, and the avoidability assessment (κ = 0,63; p < ,001) agreed substantially. When the evaluation was done in pairs, detection of DRA-related hospitalizations (κ = 0,47; p < ,001) was moderately concordant between pairs. Avoidability assessment (κ = 0,79; p < ,001) concurred substantially. The assessment of causality (κ = 0,29; p = 0,01) and DRA contribution to hospitalization (κ = 0,38; p < .001) agreed fairly well. This study validated, individually and in pairs, the reliability of the method to identify DRA in the context of falls. This method will be of great use in research and epidemiological studies.

[Lipid pneumonitis, a serious iatrogenic event with lubricating laxatives]. / La pneumopathie lipidique, un accident iatrogène grave aux laxatifs lubrifiants.

The prescription of lubricating laxatives (paraffin oil) is widespread in geriatrics because of the frequency of constipation. These molecules can cause serious adverse effects such as lipoid pneumonia, especially in subjects with swallowing disorders.

[A pragmatic approach to iatrogenic risk in the emergency room]. / Approche pragmatique du risque iatrogène aux urgences.

The links between the emergency department (ED) and drug-related harm are close. In practice, it is necessary to ask systematically if an iatrogenic accident is possible and to evaluate a new prescription carefully so as not to create iatrogenia during the visit to the emergency department. Any situation in which a nurse takes charge of an emergency room must be subject to precautions. Simple measures should be put in place during any hospitalisation of an elderly person.

Iatrogenic hand trauma in institutionalized brain-injured patients: About 2 cases.

The objective of this work was to draw the attention of caretakers for institutionalized brain-injured patients to the risk of iatrogenic trauma associated with improper manipulation of the fingers during hand opening for grooming. Two clinical cases of chronic open dislocation of the thumb and the fifth finger in institutionalized brain-injured patients were reviewed. Interrogation of the patients and their relatives did not reveal either the date or the mechanism of the injury. In the light of these two cases, it appears that better training of caretakers should make it possible to avoid iatrogenic trauma during hygiene care of institutionalized brain-injured patients.

[Corneal perforation with tyrosine kinase inhibitor chemotherapy: REGORAFENIB]. / Perforation cornéenne sous chimiothérapie inhibiteur des tyrosines kinases : REGORAFENIB.

INTRODUCTION: Tyrosine kinase inhibitors (TKIs) are active in a variety of metastatic cancers. They have a good general tolerance with mainly hepatic and dermatological side effects. Rarely, ophthalmologic side effects may occur: eyelash abnormalities, eyelids abnormalities, disorders of the ocular surface with ocular dryness or even corneal erosions that can even lead to perforation. Regorafenib is a new oral multi-targeted tyrosine kinase inhibitor that inhibits multiple protein kinases, including those involved in tumor angiogenesis, oncogenesis and tumor microenvironment. CASE DESCRIPTION: We describe, to the best of our knowledge, the first case of complicated bilateral ulcers of corneal perforation in a patient under REGORAFENIB. OBSERVATION: 20-year-old patient with metastatic chondrosarcomas of the pelvis, mandible and thorax received chemotherapy with REGORAFENIB. A few weeks after initiation of treatment, he experienced an increased dry eye syndrome associated with bilateral corneal ulcers complicated by perforation. Despite discontinuation of chemotherapy and maximal medical and surgical treatment (iterative amniotic membrane grafts and corneal transplantation), the progression was unfavorable. DISCUSSION: This is the first known case of corneal perforation under REGORAFENIB. The pathophysiology is multifactorial. On the one hand, this chemotherapy targets angiogenesis (VEGFR), oncogenesis (KIT, RET, RAF1, BRAF) and the tumor microenvironment (PDGFR, FGFR). On the other hand, other triggers are added, namely mixed dry eye syndrome, hypovitaminosis A (anorexia), the neurotrophic component, as well as the toxicity of chemotherapy via tears. CONCLUSION: First described case of corneal perforation under REGORAFENIB, non-regressive at the end of chemotherapy, and despite medical and surgical treatments. Ophthalmologic surveillance is therefore necessary for patients under chemotherapy with tyrosine kinase inhibitors, as serious ocular complications, especially corneal ones, may occur.

[Evaluation of the implantation of a de-prescribing process for proton pump inhibitor (PPI) using an algorithm within an internal medicine department]. / Évaluation de l'implantation d'un processus de dé-prescription des inhibiteurs de la pompe à protons (IPP) à l'aide d'un algorithme au sein d'un service de médecine interne.

INTRODUCTION: The prescription of proton pump inhibitors (PPIs) seems excessive. Taken over the long term, PPIs can cause serious side effects. It therefore turns out to be justified to suspend treatments whose expected benefit seems too low compared to the risks involved : it is deprescription. The objective of this study is to assess a process for the deprescription of PPIs in a hospital internal medicine department. METHOD: After collegial deliberation, an algorithm for assisting in the deprescription of PPIs was validated. If necessary, the PPI was phased out over 1 month. A telephone follow-up at 1, 2 and 3 months was carried out in order to assess the maintenance of deprescription and the occurrence of digestive symptoms. The evaluation criteria were the rate of deprescription and the rate of maintenance of deprescription at 3 months following reports from patients, their caregivers or a family member. RESULTS: 105 patients with a mean age of 72 years were included over a period of 21 weeks, and in 31 cases (29%), deprescription was performed. After 3 months of follow-up, there was 71% maintenance of deprescription. Three patients were lost to follow-up and 6 patients resumed PPI. CONCLUSION: The approach undertaken resulted in the suspension of PPI intake in almost 3 out of 10 cases. This result was maintained at least three months for a large majority of patients. It will be interesting to continue this process and extend the monitoring over longer periods, in order to ensure that PPI de-prescription is maintained in the long term.

[Atrial fibrillation and QT prolongation due to proton pump inhibitor-induced hypomagnesemia]. / Fibrillation atriale et allongement du QT sur hypomagnésémie secondaire à un traitement par inhibiteur de la pompe à protons.

Proton pump inhibitors are widely prescribed but their long-term use can expose patients to adverse effects. Some of these are not very well known, including hypomagnesemia. Hypomagnesemia can be manifested by cardiac complications such as supraventricular arrhythmia or QT prolongation, increasing the risk of torsade de pointe. We present a case of atrial fibrillation triggered by severe hypomagnesemia secondary to proton pump inhibitor use and exacerbated by thiazide diuretic treatment. Conversion to sinus rhythm showed a prolonged corrected QT interval. We approach the pathophysiology and the electrophysiologic effects of hypomagnesemia.

Mitochondrial functions and rare diseases.

Mitochondria are dynamic cellular organelles responsible for a large variety of biochemical processes as energy transduction, REDOX signaling, the biosynthesis of hormones and vitamins, inflammation or cell death execution. Cell biology studies established that 1158 human genes encode proteins localized to mitochondria, as registered in MITOCARTA. Clinical studies showed that a large number of these mitochondrial proteins can be altered in expression and function through genetic, epigenetic or biochemical mechanisms including the interaction with environmental toxics or iatrogenic medicine. As a result, pathogenic mitochondrial genetic and functional defects participate to the onset and the progression of a growing number of rare diseases. In this review we provide an exhaustive survey of the biochemical, genetic and clinical studies that demonstrated the implication of mitochondrial dysfunction in human rare diseases. We discuss the striking diversity of the symptoms caused by mitochondrial dysfunction and the strategies proposed for mitochondrial therapy, including a survey of ongoing clinical trials.

Iatrogenic Bronchopleural Fistula.

A bronchopleural fistula (BPF) is a communication between the pleural space and the bronchial tree or the lung parenchyma. Despite being a rare entity, a BPF may carry a high mortality rate. Symptoms of BPF are often nonspecific and subtle, so a high index of clinical suspicion is essential for its correct diagnosis, with imaging playing an extremely important role both in the diagnosis and in the selection of the most appropriate therapeutic approach for each patient. This paper reports a case of a 60-year-old male admitted to the hospital for an etiological investigation of a unilateral pleural effusion. The patient underwent several procedures, among them a video-assisted thoracic surgery, complicated by a peripheral BPF. Therapeutic approach for BPFs must be adapted to each particular case. In this patient, a conservative approach proved to be effective. Meanwhile, the patient was diagnosed with pleural tuberculosis, being discharged on antibacillary medication and while improving BPF's manifestations.

Amlodipine-induced gingival enlargement: A case report.

Gingival enlargements (GEs) can be caused by local, systemic diseases or drugs. Three molecules can be responsible of GEs: ciclosporin, phenytoin and calcium channel blockers (CCBs). We report the case of a 56-year-old male treated by Amlodipine, a CCB, for hypertension for many years and who recently developed a severe GE affecting both mandibular and maxillary arches inducing dental malposition. The histological examination showed non-specific inflammation with a predominance of lymphocytes. Amlodipine was suspected and suspended in agreement with his physician. One month later, the enlargement significantly reduced but GE was so severe and dental malposition so marked that all the teeth but the canines were extracted. No recurrence was noted one year later. This exceptional case should encourage every practitioner to be vigilant with patient treated with CCBs and their potential side effects and consequences.

Nonsurgical management of endodontic iatrogeny using mta plug: A case report

Endodontic treatment confronting previous iatrogeny in teeth with incomplete root formation and apical periodontitis is presented as a challenge to the Endodontists. The sanitization and peri-radicular repair can be achieved by the assist of auxiliary materials to biomechanical treatment procedures. MTA is cogitated as a choice for these cases due to its composition, physicochemical, mechanical and biological properties. In this case report, the patient presented tooth 11 with incomplete root formation and peri-radicular radiolucent lesion accompanied by the presence of an inverted gutta-percha cone in an attempt to filling the root canal. Endodontic treatment was accomplished by removal of the previous gutta-percha. After determining the working length, biomechanical preparation was achieved up until #80 K-file. Sequentially application of calcium hydroxide, as intracanal medication, was performed. Six monthly exchanges of intracanal dressing were completed. Apex was sealed with MTA bonded with saline through #4 Paiva condenser, creating an apical plug. The tooth was temporarily sealed, and patient returned after a week to perform the root canal filling with gutta-percha associated to Sealapex. The final radiography shows apical tissue repair with no peri-radicular lesions and clinical signs of successful treatment. This case report highlights the tissue repair and lack of local infection, absence of sensitivity pain or edema. These findings indicated that these approaches could be elect to presence of necrotic lesions achieving tissue repair.

[Prescription of furosemide in general medicine in Aquitaine: Prospective practice survey among universities general practitioners]. / Prescription de furosémide en médecine générale en Aquitaine. Enquête de pratique auprès des médecins généralistes maîtres de stages universitaires.

OBJECTIVES: Furosemide is essential in the management of patients with congestive heart failure, and provides important iatrogenic complications. We described the prescription of this treatment in general medicine, and tried to identify areas for optimizing its use. PATIENTS AND METHOD: We carried out a prospective inventory of the prescription of furosemide with the general practitioners of the universities of Bordeaux, between May 1, 2017 and July 30, 2017. RESULTS: We obtained data from 119 prescriptions of furosemide. The indications seemed well known, largely dominated by heart failure (67%) and its associated signs (24%). Clinical and biological follow-up (52%) and therapeutic education (42%) seemed relatively infrequent. CONCLUSIONS: Our study confirms the central role of the general practitioner in the prescription of furosemide, the predominant place of heart failure in its indications and the iatrogeny observed. We identified areas of optimization of the safety and effectiveness of the treatment. The reinforcement of training concerning heart failure and its treatments, a better communication between specialties, the implementation of reference systems dedicated to the prescription of furosemide and prescription support software seem promising.

Adesão de idosos ao tratamento medicamentoso em diferentes níveis de Atenção à Saúde no município de São Paulo, Brasil / Elderly adherence to drug treatment at different levels of health care in the city of São Paulo, Brazil / Adhesión de ancianos al tratamiento farmacológico en diferentes niveles de atención médica en la ciudad de São Paulo, Brasil

A qualidade de vida de idosos e a adesão a um tratamento podem ser influenciadas pela presença da polifarmácia e, até mesmo, de iatrogenias relacionadas aos medicamentos prescritos. O artigo retrata uma verificação das prescrições farmacológicas direcionadas a idosos e a adesão ao tratamento em diferentes níveis da atenção à saúde pública na cidade de São Paulo (SP), durante os anos de 2016 e 2017. É ressaltada a importância do devido conhecimento farmacológico e de técnicas de comunicação por parte dos profissionais de saúde.

The quality of life of the elderly and adherence to treatment may be influenced by the presence of polypharmacy and even iatrogenesis related to prescription drugs. The article portrays a verification of pharmacological prescriptions directed at the elderly and adherence to treatment at different levels of public health care in the city of São Paulo (SP), during 2016 and 2017. The importance of due pharmacological knowledge and communication techniques by health professionals.

La calidad de vida de los ancianos y el cumplimiento del tratamiento pueden verse influenciados por la presencia de polifarmacia e incluso de iatrogénesis relacionada con medicamentos recetados. El artículo retrata una verificación de las prescripciones farmacológicas dirigidas a los ancianos y la adherencia al tratamiento en diferentes niveles de atención de salud pública en la ciudad de Sao Paulo (SP), durante 2016 y 2017. La importancia del debido conocimiento farmacológico y las técnicas de comunicación por parte de los profesionales de la salud.