Proton pump inhibitors are still overprescribed for hospitalized children.

OBJECTIVE: The use of proton pump inhibitors has increased exponentially over the past 20 years. Several side effects have been reported and concerns exist about the consequences of long-term proton pump inhibitors on health, leading to limitation of their use. The present study analyzed prescriptions of proton pump inhibitors at inpatient units and assessed their compliance with current recommendations. METHODS: This single-center, observational, retrospective study reviewed medical file of patients hospitalized at the pediatric medical departments of the Bordeaux University Hospital between April 1 and September 30, 2019. Patients younger than 18 years, hospitalized in the pediatric hospital units and treated with proton pump inhibitors were included. Prescriptions of proton pump inhibitors were compared with French and international guidelines. RESULTS: Proton pump inhibitors were prescribed for 251 of 2237 children (11%), mainly for gastroesophageal reflux disease (47%) and prevention of peptic ulcer disease (32.7%). Proton pump inhibitor prescription complied to recommendations in 34.5% of cases, less often in children aged younger than 1 year (13.5%) than in older children. Compliance to recommendations was lower when proton pump inhibitors were indicated for the prevention of peptic disease (5%) than for gastroesophageal reflux disease (48%). CONCLUSIONS: Proton pump inhibitors are frequently prescribed for hospitalized children, and indications comply with recommendations in only 35% of the cases. Efforts in spreading awareness of the recommendations on the use of proton pump inhibitors in children are mandatory among hospital pediatricians.

[Electrophysiological effects of intravenous sotalol. Relation with plasma levels]. / Etude des effets électrophysiologiques du sotalol intraveineux. Relation avec les concentrations plasmatiques.

The object of this study was to confirm the electrophysiological effects of sotalol, a betablocker which increases the duration of the action potentials of myocardial cells, and to investigate the relationship of these effects with the doses used and plasma concentrations (PC) of the drug. 13 patients (23 to 72 years) were divided into 3 groups: Group 1 (n = 5): 0.6 mg/kg; Group 2 (n = 4): 1.2 mg/kg; and Group 3 (n = 5): 1.8 mg/kg. Measurements were performed before and 35 minutes after starting a 15 minute intravenous infusion of sotalol. At all doses, sotalol decreased the heart rate (HR), increased the corrected sinus node recovery time (CSNRT), prolonged the effective refractory periods (ERPA) and functional refractory periods (FRPA) of the right atrium. Atrioventricular conduction was depressed; prolongation of AH at an imposed rate of 100/min, prolongation of the nodal refractory periods (ERPN and FRPN), and an earlier Wenckebach point. The corrected QT interval (QTc) and ventricular refractory period (ERPV) increased. The QRS complexes and HV intervals were unchanged. Increases of CSNRT, AH, ERPN, FRPN, QTc, and ERPV were observed after the first dose (Group 1). At the dose of 1.8 mg/kg (Group 3) all parameters were modified (except the QRS and HV). All patients increased their ERPV by more than 20 p. 100. The parameters which illustrated the dose-effect relationship were the HR, ERPA, FRPN, and CSNRT. The PC of sotalol measured 60 minutes after starting the infusion were 0.58 +/- 0.23 microgram/ml (Group 1), 0.78 +/- 0.32 microgram/ml (Group 2) and 1.73 +/- 0.43 microgram/ml (Group 3).(ABSTRACT TRUNCATED AT 250 WORDS)

[Respiratory physiotherapy and respiratory mechanics of chronic respiratory insufficiency]. / Kinésithérapie respiratoire et mécanique respiratoire des insuffisants respiratoires chroniques.

The effect of short, medium and long term physiotherapy remain controversial. The theoretical objectives of the method are to reduce dyspnoea and respiratory disability while improving exercise performance and expectation of life. As regards respiratory mechanics, the goals are to reduce bronchial obstruction and the mechanical properties of the chest wall. A rise in expiratory flow might result in an increased drainage of secretions, a reduction in transmural bronchial pressure and a raised level of ventilation at end-tidal volume. The correction of parietal distortions by physiotherapy has as an objective a diminution of thoracic elastance. Muscular training, a new aspect of respiratory physiotherapy, consists of increased both the endurance and the force of contraction of the respiratory muscles. The beneficial effects of these recent methods require confirmation with long term clinical studies. The correct indications for the diverse techniques proposed require a better understanding of the mechanism of action of respiratory physiotherapy, an essential complement to effective treatment of chronic airflow obstruction.

[Hyponatremia after very heavy beer drinking (author's transl)]. / Hyponatémie après absorption massive de bière.

Severe water and electrolyte disturbances were observed in a patient after a bout of very heavy beer drinking (30 liters in 6 days). On admission she was found to have hypokalemia (2.2 mEq/I), metabolic alkalosis (pHa: 7.55-total CO2: 40 mEq/I), and more particularly hyponatremia (109 mEq/I), responsible for the typical neurological signs of water intoxication (hyponatremic encephalopathy). There was a positive cumulative return of sodium (570 mEq) and chloride (900 mEq) levels, and normal conditions were restored without significant modifications in water balance or weight. No other etiology, apart from the beer, was discovered. Heavy drinking of beer alone can therefore provoke chloride and sodium depletion, probably because beer, which is poor in NaCl, must produce urinary loss of these electrolytes. The high osmolarity of beer may explain this latter phenomenon. This particular cause of hyponatremia should be recognized, if only to avoid confusing the clinical signs of alcoholic intoxication with those due to water intoxication.