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A surveillance program for invasive pneumococcal disease was undertaken in Puy-de-Dôme, an administrative district of the region Auvergne in France, from 1 January 1994 to 31 December 1998. A total of 214 cases were identified. The annual incidence of invasive pneumococcal disease increased (P=0.04) from 5.5 in 1994 to 9.3 cases per 105 person-years in 1998. The highest incidences were for children <2 years of age (59.2 cases per 105 person-years) and for adults ≥65 years (18 cases per 105 person-years). Clinical diagnoses, available in 200 patients, included acute pneumonia (62%), meningitis (10%), sepsis without focus (20%), and others (8%). The most frequent chronic medical conditions of the patients included smoking, alcoholism, cardiovascular and pulmonary diseases, and malignancies. Thirty-one percent of the isolates were nonsusceptible to penicillin. Penicillin resistance (MIC≥0.1 mg/l) was more frequent (P=0.02) in cancer patients. The overall case-fatality rate was 21.5%. Risk factors for death were age, sex, and underlying diseases of the patients, along with the severity of illness. These population-based findings should convince clinicians to offer pneumococcal vaccine to patients at high risk for invasive pneumococcal disease, thereby increasing vaccination coverage levels in France. [ABSTRACT FROM AUTHOR]

Abstract: During the years 1994–2001, a progressive decrease of the number of blood units transfused has been reported in France. In contrast, since 2002, there is an increasing number of blood units issuing (+7.6% between 2001 and 2006) and this must be investigated. On behalf of the French Society of Blood Transfusion, the “Recipients” working group promoted a nation wide survey with the support of the regional blood transfusion centres. This survey was aimed at describing the profiles of the transfused patients: socio-demographical patterns, and reasons of the blood transfusion (main and associated diagnoses). A cross-sectional survey was designed. All the patients who received a blood unit during a specific day were considered as the population of the study. They were identified by the regional transfusion centres by means of the “individual issuing form”. Survey forms were fully filled for 90% of the patients. It has been considered as a good answer rate. Seven thousand four hundred and twenty-two blood units, delivered to 3450 patients were analyzed. Three groups of pathologies were found as a reason of transfusion: haematology–oncology (52.70% of the prescriptions) with 892 patients (27.8%) for haematological malignancies; surgical procedures (23.99%); intensive care and medicine procedures (21.92%). More than 50% of the recipients are 70 years old and more. This result is explained by the age distribution of inpatients. In a context of lack of donors and consequently difficulties to provide patients with optimal number of blood units, this study is helpful. Variability of blood unit issuings must be detected, analyzed and monitored in real time by the actors of the transfusion process, using computerized dashboards: the blood units provider (in order to adjust the strategy of blood units provision) and the health care establishment as well as care blood components prescribers (reasons of blood transfusion and evaluation of practices). [Copyright &y& Elsevier]

Abstract: Objective: To describe the organization of medical and transfusion services within the framework of hospital admission for multiple trauma. Study design: National survey in France. Material and methods: All French hospitals caring for multiple trauma patients were sent a questionnaire. Organization of the medical and transfusion services, and their related resources were evaluated. Results: Among 372 questionnaires sent, 116 replies were received from structures which care for 18 (1-500) multiple trauma patients each year. An orthopaedic and an abdominal surgery unit were widely available whereas a neurosurgeon was available in 21% of responding centers. A transfusion site was found in 43%, whereas others have either a deposit for distribution to specific patients (40%) or a small deposit to cover urgent situations (17%). Comparison with legal or expert based rules of adequate transfusion process disclosed a variable incidence of practice dysfunctions (2-49%) depending on the parameter assessed. Conclusion: The French organization of multiple trauma patients'' care and blood transfusion delivered for these patients is not homogenous. Dysfunctions were found in all types of hospitals. Recommendations describing good practice seem necessary to be built at the national level. [Copyright &y& Elsevier]

La pandémie de SARS-CoV-2 a entraîné en France un confinement généralisé à l'impact sanitaire, social et économique important. Sans traitement spécifique ni vaccin, il est primordial de pouvoir identifier et isoler les personnes infectées, ainsi que de retrouver et dépister les personnes contacts. Les outils digitaux de contact tracing sont intéressants mais entraînent des défis technologiques et éthiques. Bayes Impact, une association développant des outils digitaux à impact social a conçu en collaboration avec des médecins infectiologues la plateforme « BriserLaChaine.org » (BLC), de notification d'exposition au COVID-19. Une plateforme web a été développée de mars à mai 2020 pour permettre d'identifier les cas suspects de COVID-19 et de calculer la période de contagiosité pour retrouver des personnes contacts en les prévenant par voie électronique. Un comité scientifique a conçu un outil d'orientation diagnostique en cas de symptômes par une veille bibliographique régulière et des avis d'experts. La plateforme BLC, ouverte à tous, ne nécessite ni téléchargement, ni compte, et ne stocke aucune donnée personnelle ou de géolocalisation. Soit l'infection par le COVID-19 est déjà connue et diagnostiquée par un médecin, soit suspectée par l'utilisateur devant la présence de symptômes. L'outil d'orientation diagnostique se base sur des points attribués selon chaque symptôme déclaré : 3 points pour une fièvre > 38 ° C, une toux ou une dyspnée ; 2 points pour asthénie, myalgies, expectorations, anosmie ou agueusie ; 1 point pour rhinorrhée, odynophagie, céphalée, diarrhée ou vomissements. Les personnes ayant une infection probable (score > 3 points) sont invitées à se faire tester et à consulter un médecin. Des conseils sont données aux autres, avec un lien vers le site maladiecoronavirus.com. La période de contagion considérée est de 2 jours avant et 13 jours après l'apparition des premiers symptômes. La notification des personnes contacts se fait soit par l'utilisateur soit anonymement via la plateforme. Depuis sa mise en ligne, il y a eu plus de 12 000 connexions. La plateforme BLC est le premier outil digital de notification utilisable en France. Il ne collecte aucune donnée personnelle ni de géolocalisation. Sans adoption massive nécessaire, BLC peut être une aide en cas de recirculation du virus à l'échelle nationale de clusters, avec d'autres mesures de prévention. L'évaluation de l'adoption et de l'utilisation permettra de connaître l'adhésion en France de ce type d'outil et une modélisation d'impact est en cours de réalisation. À terme BLC a pour vocation à être étendu à d'autres pays. [ABSTRACT FROM AUTHOR]

Background: The current prevalence of chronic obstructive pulmonary disease (COPD) in France is estimated to be 2.6 million and is predicted to increase to 2.8 million by 2025. Presently, there is a lack of data on COPD management within the private healthcare setting. The aim of this study was to investigate the management of COPD exacerbations by pulmonologists within private practices in France., Methods: A prospective, online, qualitative survey was distributed to private practice pulmonologists in France. The survey covered all aspects of COPD management from diagnosis and therapeutic management, to secondary prevention and organization of care. Survey responses were collected between 27 January 2018 and 18 June 2018 and all data were summarized descriptively., Results: The survey had a response rate of 20.6%, with 116 out of 563 pulmonologists providing responses. Overall, 87.4% of respondents stated that the management of COPD represented over 15% of their total clinical activity. Most respondents indicated that they work closely with general practitioners and a large multidisciplinary team to manage patients with numerous comorbidities. Following a COPD exacerbation, the majority of respondents (78.4%) were in favor of using respiratory-connected devices (class 2a-connected medical device according to the French HAS classification and available on medical prescription) to assist with patient follow-up at home., Conclusions: COPD management forms part of the core clinical activity for pulmonologists within the private practice setting in France. Patients with COPD generally have multiple comorbidities and are managed by a multidisciplinary team in line with French guidelines. The use of respiratory-connected devices was highlighted as an important new strategy for improving patient care following a COPD exacerbation., Competing Interests: The authors have read the journal’s policy and have the following competing interests: AC and ZA are employees of GlaxoSmithKline and hold stocks and shares in the company. LN reports non-financial support from Novartis, Boehringer Ingelheim, GlaxoSmithKline, ALK, AstraZeneca and SOS Oxygène. BS reports financial support from AstraZeneca and non-financial support from Bastide Medical, SOS Oxygène, SANTEO, Bristol-Myers Squibb, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Menarini, Novartis, VIVISOL, WEINMANN, PharmaDom, Elia medical, SEFAM, Philips France Commercial, Roche SAS and France Oxygène. CZ reports financial support from Novartis and AstraZeneca and non-financial support from France Oxygène, Sysmed, SOS Oxygène, Pharamadom, ALK, Roche, Sanofi, GlaxoSmithKline, Bristol-Myers Squibb and Novartis. FLG reports financial support from Novartis, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Menarini, Novartis, Pfizer, Philips Health care and non-financial support from Alize Sante, Bastide Medical and SOS Oxygène. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development or marketed products associated with this research to declare.

Background: Chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality around the world. The aim of our study was to determine the association between specific comorbidities and COPD severity., Methods: Pulmonologists included patients with COPD using a web-site questionnaire. Diagnosis of COPD was made using spirometry post-bronchodilator FEV1/FVC < 70%. The questionnaire included the following domains: demographic criteria, clinical symptoms, functional tests, comorbidities and therapeutic management. COPD severity was classified according to GOLD 2011. First we performed a principal component analysis and a non-hierarchical cluster analysis to describe the cluster of comorbidities., Results: One thousand, five hundred and eighty-four patients were included in the cohort during the first 2 years. The distribution of COPD severity was: 27.4% in group A, 24.7% in group B, 11.2% in group C, and 36.6% in group D. The mean age was 66.5 (sd: 11), with 35% of women. Management of COPD differed according to the comorbidities, with the same level of severity. Only 28.4% of patients had no comorbidities associated with COPD. The proportion of patients with two comorbidities was significantly higher (p < 0.001) in GOLD B (50.4%) and D patients (53.1%) than in GOLD A (35.4%) and GOLD C ones (34.3%). The cluster analysis showed five phenotypes of comorbidities: cluster 1 included cardiac profile; cluster 2 included less comorbidities; cluster 3 included metabolic syndrome, apnea and anxiety-depression; cluster 4 included denutrition and osteoporosis and cluster 5 included bronchiectasis. The clusters were mostly significantly associated with symptomatic patients i.e. GOLD B and GOLD D., Conclusions: This study in a large real-life cohort shows that multimorbidity is common in patients with COPD.

Aims: Vinflunine (VFL) ditartrate, a novel tubulin-targeted inhibitor, is registered for the treatment of patients with advanced or metastatic urothelial transitional cell carcinoma. This phase I study assessed the effect of renal impairment on the pharmacokinetics and tolerability of VFL., Methods: VFL was infused in patients with advanced/metastatic solid tumours once every 3 weeks with anticipated dose reduction on the first cycle stratified according to the creatinine clearance (CLcr ) values. Pharmacokinetic data were collected on the first two cycles in renally impaired patients (CLcr ≤ 60 ml min(-1) ) and were compared with a control cohort of patients (CLcr > 60 ml min(-1) )., Results: Thirty-three patients (46-86 years) were treated, 13 in group 1 (40 ml min(-1) ≤ CLcr ≤ 60 ml min(-1) ) and 20 in group 2 (20 ml min(-1) ≤ CLcr < 40 ml min(-1) ). The renal dysfunction induced a mean decrease in VFL clearance of 12% in group 1 and 28% in group 2, compared with the control group. The anticipated dose reduction given in renally impaired patients (i.e. 280 mg m(-2) and 250 mg m(-2) in groups 1 and 2, respectively) yielded similar drug exposure to control patients. The tolerance profile of VFL in patients with renal dysfunction was similar to that observed in patients with CLcr > 60 ml min(-1) ., Conclusion: In conclusion, the recommended doses of intravenous VFL administered once every 3 weeks in cancer patients with renal impairment are 280 mg m(-2) when CLcr is between 40 and 60 ml min(-1) and 250 mg m(-2) when CLcr is between 20 and <40 ml min(-1) ., (© 2013 The British Pharmacological Society.)

Context: Discordant data have been reported about the prevalence of hepatitis C virus (HCV) infection in patients with lymphoproliferative diseases and the putative role of HCV in lymphomagenesis., Objective: To assess the prevalence of HCV infection in patients admitted to a hematology department in Paris, France., Design: Prospective, controlled study., Setting: University medical center., Patients: 813 patients admitted to the Hematology department (164 B-cell non-Hodgkin's lymphoma, 34 Hodgkin's diseases, 107 chronic lymphocytic leukemia, 54 multiple myeloma, 12 Waldenström's macroglobulinemia, 17 acute lymphoblastic leukemia, 6 hairy cell leukemia, 189 myeloproliferative diseases, 6 solid organ tumors, and 224 nonmalignant diseases) and 694 patients admitted to the Internal Medicine department (control group)., Measurements: All patients were tested for antibodies to HCV by a third-generation enzyme-linked immunosorbent assay., Results: HCV antibodies were detected in 20 of 813 (2.46%) patients in Hematology including 11 of 394 (2.79%) patients with lymphoproliferative diseases, 3 of 164 (1.83%) B-cell non-Hodgkin's lymphoma, 2 of 107 (1.87%) chronic lymphocytic leukemia, 1 of 54 (1.85%) multiple myeloma, 1 of 189 (0.5%) myeloproliferative diseases, and 8 of 224 (3.57%) nonmalignant hematologic diseases. HCV antibodies were detected in 3 of 694 (0.43%) patients in the control group. HCV contamination preceded B-cell non-Hodgkin's lymphoma only in 2 of 3 HCV-positive patients., Conclusion: The prevalence of HCV infection was low (1.83%) in patients with B-cell non-Hodgkin lymphoma. HCV seems not to play a major role in the pathogenesis of B-cell lymphoma in France. Cofactors should be stressed to explain geographical discrepancies., (Copyright 2001 Wiley-Liss, Inc.)

We studied the clonality of clinical isolates of Streptococcus pneumoniae 23F, the serotype most often associated with penicillin resistance in France. Clinical isolates obtained between November 1992 and April 1993 from nasopharyngeal samples from children with acute otitis media from different regions of the country were analyzed. The genetic polymorphism of penicillin-susceptible and -resistant 23F isolates (MIC, 2 mg/liter) was studied by pulsed-field gel electrophoresis. The resistant isolates were closely related, whereas the susceptible isolates were genetically heterogeneous. PCR amplification and restriction of the genes encoding penicillin-binding proteins (PBPs) 1A, 2B, and 2X also showed that the 24 resistant isolates had similar patterns which were very different from those of the susceptible isolates. All resistant isolates gave the same PBP pattern, with low affinities of PBPs for penicillin. Our results indicate that, in contrast to penicillin-susceptible 23F isolates, the penicillin-resistant 23F isolates have a single clonal origin, suggesting the rapid clonal spread of a resistant epidemic strain throughout the country.

Besides classical neuroleptics, several drugs can induce parkinsonian symptoms. The present retrospective study investigates the characteristics of drug-induced parkinsonism notified to the Midi-Pyrénées Pharmacovigilance Centre between 1983 and 1992. Among 3,923 side effects spontaneously reported between 1983 and 1992 to the center, 53 (1.4%) were drug-induced parkinsonism. Mean age was 65 +/- 2 (s.e.m.) years (range 21-88). Drug-induced parkinsonism appeared after a mean treatment duration of 473 +/- 142 days (range 1 day to 15 years) and occurred most frequently in women (63%). The occurrence onset of drug-induced Parkinsonism exhibited a bimodal pattern with a first peak (between 0 and 6 months) mainly due to peripheral or central antidopaminergic drugs and a second one later (between 9 and 12 months) due mostly to calcium channel blockers. Involved drugs were mostly antidopaminergic agents: neuroleptics (antipsychotic drugs: 39%) but also agents used for nausea or vomiting (domperidone, metoclopramide, metopimazine or triethylperazine: 12%) or symptoms associated with menopause (veralipride: 6%). Other cases were related mainly to drugs with "calcium channel blocker" properties (flunarizine and cinnarizine: 30%), H1 antihistamine (1 case), fluoxetine (1 case), alphamethyldopa (1 case) or reserpine (1 case) whereas 3 cases were due to drug interactions. Imputability scores (according to the method of assessment of unexpected drug reactions used in France) were "doubtful" (11%), "plausible" (34%) and "probable" (53%). The complete triad (tremor, akinesia plus rigidity) was seen in 13 (25%) cases. Symmetrical symptoms occurred in 41 (77%) patients. A total disappearance of the clinical feature occurred in 39 (74%) patients whereas in 8 cases (15%), drug-induced parkinsonism led to the diagnosis of underlying idiopathic Parkinson's disease. The present study shows that around 80% of drug-induced parkinsonism are due to two pharmacological classes: central and peripheral antidopaminergic agents and calcium channel blockers.