[ORION®: a simple and effective method for systemic analysis of clinical events and precursors occurring in hospital practice]. / Méthode Orion(®) : analyse systémique simple et efficace des événements cliniques et des précurseurs survenant en pratique médicale hospitalière.

PURPOSE: Morbimortality review is now recommended by the French Health Authority (Haute Autorité de santé [HAS]) in all hospital settings. It could be completed by Comités de retour d'expérience (CREX), making systemic analysis of event precursors which may potentially result in medical damage. As commonly captured by their current practice, medical teams may not favour systemic analysis of events occurring in their setting. They require an easy-to-use method, more or less intuitive and easy-to-learn. It is the reason why ORION(®) has been set up. METHODS: ORION(®) is based on experience acquired in aeronautics which is the main precursor in risk management since aircraft crashes are considered as unacceptable even though the mortality from aircraft crashes is extremely low compared to the mortality from medical errors in hospital settings. The systemic analysis is divided in six steps: (i) collecting data, (ii) rebuilding the chronology of facts, (iii) identifying the gaps, (iv) identifying contributing and influential factors, (v) proposing actions to put in place, (vi) writing the analysis report. When identifying contributing and influential factors, four kinds of factors favouring the event are considered: technical domain, working environment, organisation and procedures, human factors. Although they are essentials, human factors are not always considered correctly. The systemic analysis is done by a pilot, chosen among people trained to use the method, querying information from all categories of people acting in the setting. RESULTS: ORION(®) is now used in more than 400 French hospital settings for systemic analysis of either morbimortality cases or event precursors. It is used, in particular, in 145 radiotherapy centres for supporting CREX. CONCLUSION: As very simple to use and quasi-intuitive, ORION(®) is an asset to reach the objectives defined by HAS: to set up effective morbi-mortality reviews (RMM) and CREX for improving the quality of care in hospital settings. By helping the efforts of medical teams, ORION(®) is an essential tool contributing to the patients' security.

[Rapid resolution of Plasmodium ovale malarial attacks using artesunate (Arsumax)]. / Resolution rapide des acces palustres à Plasmodium ovale par l'artésunate (Arsumax).

This randomized, non-comparative clinical trial without placebo was carried out to assess the efficacy and tolerance of artesunate for treatment of acute Plasmodium ovale malarial attacks. Thirty Cameroonese patients were included. All presented acute Plasmodium ovale malarial attacks with parasitemia in excess of 500 asexual forms per mm3. Four days after treatment with artesunate, all 30 patients were asymptomatic with no parasitemia. Reduction rates were 93.9 p. 100 for asexual forms and 75.4 p. 100 for gametocytes. Parasite clearance was achieved within 38.8 hours and fever disappeared within 36.6 hours. Tolerance was excellent in 29 patients. The remaining patient briefly complained of mild vertigo. A transient decrease in reticulocyte levels was observed in one patient initially presenting anemia. Artesunate appears to achieve rapid and complete resolution of acute Plasmodium ovale malarial attacks. Since artesunate eliminates both asexual forms and gametocytes, it also acts on transmission by limiting the duration of survival of asexual forms.

Efficacy and pharmacokinetics of a new intrarectal quinine formulation in children with Plasmodium falciparum malaria.

1. Three groups of seven children aged 2-14 years with acute uncomplicated Plasmodium falciparum malaria received 12.8 mg kg-1 quinine gluconate by the intrarectal route (new cream formulation) or 8 mg kg-1 Quinimax (a Cinchona alkaloid alkaloid combination) by the intramuscular or intravenous (4 h infusion) route every 8 h for 3 days. Clinical and parasitological status was similar in the three groups at enrolment. 2. At 36 h, body temperature of all children of the three groups was returned to normal and remained so until day 7. 3. The decrease in parasitaemia did not differ between the three groups and the time required for a 50% fall in parasitaemia relative to baseline was 12.3 +/- 5.4, 18.2 +/- 6.1 and 14.5 +/- 4.2 h in the intrarectal, intramuscular and intravenous treatment groups, respectively. Parasitaemia expressed as a percentage of initial values was not significantly different in the three groups after 48 h of treatment (7.4 +/- 16.0, 4.1 +/- 4.2 and 2.2 +/- 3.8% in the intrarectal, intramuscular and intravenous treatment groups, respectively). All the patients were aparasitaemic by day 7. 4. The tolerability of the three treatments was good; in particular, no rectal irritation was reported with the cream formulation. 5. The tmax occurred later after intrarectal (4.1 +/- 2.4 h) and intravenous infusion (3.8 +/- 0.5 h) than after intramuscular injection (1.6 +/- 1.3 h) (P = 0.02). Cmax was lower with the intrarectal (3.0 +/- 1.0 mg 1(-1)) and intramuscular routes (3.2 +/- 0.7 mg 1(-1)) than with the intravenous route (5.1 +/- 1.4 mg 1(-1)) (P = 0.003). Areas under the curve (AUC(0, 8 h)) were smaller with intrarectal (17.0 +/- 7 mg 1(-1) h) and intramuscular routes (19.4 +/- 4.8 mg 1(-1)) than with the intravenous route (27.8 +/- 8.2 mg 1(-1) h) (P = 0.02). The approximate bioavailability of intrarectal quinine from 0 to 8 h was 36% vs intravenous quinine and 51% vs intramuscular quinine. 6. The good tolerability and efficacy of this new intrarectal quinine formulation outweigh its low approximate bioavailability. This new approach might thus be a safe and effective alternative to intramuscular quinine injection for the treatment of children with acute uncomplicated Plasmodium falciparum malaria in the field.

[Echocardiographic, angiographic and hemodynamic development of surgically treated endomyocardial fibrosis]. / Evolution échocardiographique, angiographique et hémodynamique des fibroses endomyocardiques opérées.

The echocardiographic, angiographic and haemodynamic evolution of endomyocardial fibrosis (EMF) was assessed in 19 patients: 8 patients with isolated right sided EMF, 3 with predominantly right-sided EMF, and 8 with isolated left sided EMF with mitral regurgitation. Echocardiographic controls were preformed in 16 patients, on average 11.3 months after surgery; angiographic and haemodynamic controls were preformed in 14 patients, on average 14 months after surgery. In isolated or predominantly right-sided EMF, echocardiographic abnormalities of septal motion (paradoxal) disappeared. Although the volume of the right heart chambers decreased, they remained dilated. The syndrome of adiastole disappeared in patients operated early. In left EMF with mitral regurgitation, the M-shaped motion of the septum regressed in the 4 cases in which this abnormality was observed preoperatively. The size of the left heart chambers decreased on post-operative echo and angiographic studies. Left ventricular function returned to normal after surgery. The author underline the differences between right and left-sided EMF with mitral regurgitation. In right-sided EMF the evolution is that of adiastole and surgery should be preformed early because the right ventricular reserve is small. In left-sided EMF with mitral regurgitation, the evolution is that of a valvular lesion with a good postoperative result.

[Determination of normal pressure in 15756 African school children from 11 to 18 years old in the Ivory Coast. Comparative study of an African group and an European group]. / Détermination des normes tensionnelles chez 15756 écoliers africains de 11 à 18 ans en Côte d'Ivoire. Etude comparative d'un groupe africain et d'un groupe européen.

Blood pressure readings of 15756 coloured African schoolchildren aged between 11 and 18 years old were studied. The measurements were casual readings. The study group was not perfectly representative of the school population. However, from the practical point of view, the data may be used in the whole Ivory Coast school population in the 11 to 18 years age range. The distribution of the average readings with respect to age and sex is indicated on Table II. Abnormally high blood pressure was defined as readings greater than the average BP + 2 standard deviations, to the nearest 0,5 cm Hg (to take the practical problems of BP measurement into account). Under these conditions, all boys and girls between 11 and 18 years of age with BP greater than or equal to 150/90 (except boys of 17-18 years of age for whom the limit was 155/95) were considered to be hypertensive. According to these criteria the prevalence of hypertension in coloured African schoolchildren was: -systolic hypertension: 4,86% boys and 4,03% girls; -diastolic hypertension: 4,20% boys and 5,09% girls; -systolic or diastolic hypertension: 6,77% boys and 7,54% girls; -systolic and diastolic hypertension: 2,29% boys and 1,57% girls. In fact, these would be children "at risk" rather than hypertensive. The true number of hypertensive children would only become apparent on follow-up. A comparison with coloured African and white European schoolchildren in the same schools in Abidjan showed that the average BP readings and prevalence of hypertension was higher in the coloured population but the difference was not always statistically significant. The small number of European children made comparison difficult. The data obtained was compared to previously reported series but it was difficult to draw conclusions because of differences in methodology.

[Epidemiological study of foci of S. intercalatum schistosomiasis in Eseka and Edea (Cameroon). Effects of treatment with praziquantel]. / Etude épidémiologique des foyers de bilharziose à S. intercvalatum d'Eséka et d'Edéa (Cameroun). Effets du traitement par le praziquantel.

In Eseka and Edea bilharziasis caused by S. intercalatum is transmitted by B. forskali, the only intermediate host of human schistosomes found in the area. The prevalence of the disease is obtained by calculating the percentage of inhabitants voiding eggs in their stools in the districts of the towns located in the neighbourhood of Bulinus-containing streams and ponds. The prevalence is low, 5,6% in Eseka and 4,9% in Edea. The size and the number of waterbodies where transmission occurs is small. Rectoscopy showed that rectal and sigmoid lesions are frequently seen. Clinical manifestations are abdominal pain, diarrhoea, dysentery, tenesmus, appearance of blood in the stools. Hepatomegaly and splenomegaly occur sometimes. A single dose of 2-cyclohexylcarbonyl-1,2,3,6,7,11b-hexahydro-4H-pyrazino[2,1-a] isoquinolin-4-one (praziquantel, EMBAY 8440, Biltricide) is effective in the treatment of the disease.