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Objectives Intensive care unit patients undergo several nursing care procedures (NCP) every day. These procedures involve a risk for adverse events (AE). Yet, their prevalence, intensity, and predisposing risk factors remain poorly established. The main objective of the study was to measure the incidence and severity of NCP related AE. Design This prospective observational multicentre study was conducted in 9 ICUs. All NCP were recorded for four consecutive weeks. For each NCP, the following were collected: patients’ baseline characteristics, type of NCP, characteristics of the NCP, AE and therapeutic responses. Results 5849 NCP occurred in 340 patients. Among the 340 patients included, 292 (85.9%) were affected by at least one AE, and 141 (41.5%) by an SAE during a NCP. Thirty % of NCP were associated with at least one AE: hemodynamic AE in 17.1%, respiratory AE in 13.6%, agitation and pain (3.7% and 3.3%). Eight invasive devices were accidentally removed. Severe Adverse Events (SAE) occurred in 5.5% of NCP. The main risk factor associated with SAE was pain/agitation at the beginning of the NCP. Conclusion AE are frequent during NCP in ICU. We identified several risk factors, some of them preventable, that could be considered for the development of recommendations for the nursing care of critically ill patients. Trial Registration: ClinicalTrials.gov NCT02881645.

Objective To perform a descriptive analysis of intracranial hemorrhages of patients treated with an antivitamin K (fluindione, acenocoumarol or warfarin) or a direct oral anticoagulant (dabigatran, rivaroxaban or apixaban) at the Nancy Regional University Hospital. Material and method The study period was from January 2011 to December 2013 and the computerized data (Programme de Medicalisation des Systemes d’Information) of our hospital was accessed to identify the patients. Clinical data were obtained from the patients’ files. Regional healthcare system was queried for reimbursement data. Results Among the 157 identified cases of intracranial hemorrhage, 153 were related to antivitamin K, primarily fluindione (n = 127), and only 4 to a direct oral anticoagulant (3 dabigatran and 1 rivaroxaban). During the same period, regional data indicated that 65,345 patients had had at least one reimbursement of antivitamin K and 20,983 patients one reimbursement of an oral direct anticoagulant. In our series, the most frequent intracranial hemorrhages were subdural hematoma (chronic in 65 cases, acute in 50 cases) and intraparenchymal hemorrhage (20 cases). The global mortality rate was 20.2% but varied with the site of hemorrhage. In multivariate analysis, the two risk factors of fatal outcome were coma on admission (OR 6.2; 95%CI: 2.6–15.0) and a history of previous intracranial hemorrhage (OR 13,4; 95% CI: 1,6–114,9). Conclusion During the 2011–2013 period, antivitamin K, especially fluindione, was the most frequently involved anticoagulants in intracranial hemorrhages with hospitalization at our Regional University Hospital. Coma on admission and a history of previous intracranial hemorrhage were the two main risk factors for fatal outcome.

Acetaminophen (paracetamol), the highest over-the-counter (OTC) selling drug in France, is also the first cause of acute hepatic failure. We aimed to assess the good use and the knowledge of acetaminophen in a setting of urban self-medicated patients. We conducted a prospective observational study in randomly selected community pharmacies of Metz (France) agglomeration. Patients coming to buy OTC acetaminophen for themselves or their family had to answer to an anonymous autoquestionnaire. Responses were individually and concomitantly analyzed through 3 scores: good use, knowledge and overdosage. Twenty-four community pharmacies participated and 302 patients were interviewed by mean of a dedicated questionnaire. Most of patients (84.4%) could be considered as "good users" and independent factors of good use were (i) a good knowledge of acetaminophen (OR=5.3; P

Introduction L’anaphylaxie peroperatoire est souvent associee au curare injecte et releve frequemment d’un mecanisme IgE dependant. En France, les anesthesistes et les allergologues declarent volontiers les cas d’anaphylaxie au reseau des centres regionaux de pharmacovigilance, generant ainsi 2 alertes concernant le suxamethonium en 2011 et en 2012. Ce travail porte sur les resultats d’une analyse descriptive retrospective des cas d’anaphylaxie peroperatoire declares entre 2000 et 2012. Methodes Une requete a ete effectuee dans la base nationale de pharmacovigilance pour identifier tous les cas d’anaphylaxie survenus entre le 01/01/2000 et le 31/12/2012, impliquant un des 7 curares alors disponibles (atracurium, cisatracurium, mivacurium, pancuronium, rocuronium, suxamethonium, vecuronium). Un cas etait retenu des lors qu’aucune autre substance n’avait une imputabilite superieure au curare, et il etait considere comme « (IgE) confirme » si a la fois le taux de tryptase etait augmente et les tests cutanes etaient positifs pour le curare implique ; un cas n’ayant pas ces 2 criteres etait considere comme « non (IgE) confirme ». Resultats Sur cette periode de 13 ans, 680 cas « confirmes » et 944 cas « non confirmes » etaient identifies. L’incidence globale de l’anaphylaxie, tous curares confondus, etait de 29,5 cas/million d’ampoules vendues (IC 95 % 28,0–30,9) et le suxamethonium etait le curare le plus implique en nombre absolu de cas (64 %). Mais en tenant compte des donnees de ventes, les incidences observees avec le suxamethonium et le rocuronium etait voisines (respectivement 147,6 et 117,6/million d’ampoules vendues) et se demarquaient nettement de celles des autres curares (11,2/million pour l’atracurium et 6,3/million pour le cisatracurium). Cette difference etait constatee independamment du statut « confirme » ou « non confirme » selon nos criteres. Conclusion Suxamethonium et rocuronium sont clairement les deux curares les plus impliques actuellement dans l’anaphylaxie, que celle-ci soit confirmee par les tests cutanes ou non. La reemergence de l’anaphylaxie au rocuronium, suite a la mise a disposition du sugammadex, est preoccupante et merite d’etre prise en compte dans les recommandations actuelles et a venir.

Background Perioperative anaphylaxis mainly involves neuromuscular blocking agents (NMBAs) with an IgE-mediated mechanism. In France, this life-threatening condition is reported by anesthetists and allergologists, and two safety alerts concerning suxamethonium were raised in 2011 and 2012. This led to start a national survey over the 2000-2012 period which objectives were to provide a descriptive analysis, to estimate incidence rates, and to analyze the trends over this period. Methods The French pharmacovigilance database was retrospectively queried for all the available NMBAs. Anaphylaxis cases with elevated tryptase and positive skin tests were qualified as "confirmed cases." Subgroup analysis compared atracurium and cisatracurium vs suxamethonium and rocuronium. Results A total of 680 confirmed cases and 944 nonconfirmed cases were identified. Suxamethonium was the most implied NMBA (64%). Incidence rates (according to sales data) of suxamethonium and rocuronium were, respectively, 10- and 13-folds higher than those of the others NMBAs, regardless the confirmed/nonconfirmed status. Cisatracurium incidence rates remained stable over the period, while suxamethonium and atracurium increased and rocuronium first decreased but re-increased after 2006. Male patients were more frequent in the subgroup "atracurium-cisatracurium" (P = .019), whereas obesity and emergency setting were more frequent in the subgroup "rocuronium-suxamethonium." Shared characteristics were the poorly documented previous exposure to NMBA(s) and an insufficient adherence of patients to perform skin tests, showing the need to improve this procedure. Conclusion Suxamethonium and rocuronium are markedly more involved in perioperative anaphylaxis than the other available NMBAs. Patients should be more informed about their perioperative anaphylaxis and its consequences.

International audience; BACKGROUND:Silver-containing dressings are considered to be safe even though there have been some reports of complications, including argyria and various organ system dysfunctions. Despite the widespread use of silver dressings, little research has been done regarding the absorption and toxicity of silver.OBJECTIVE:We aimed to study the systemic absorption of silver in patients with chronic inflammatory wounds and to determine associated factors of systemic silver absorption and evaluated its association with silver toxicity.PATIENTS AND METHOD:Prospective, longitudinal, observational, multicentre, open-label pilot study. Patients from the Dermatology Departments of Lorraine (France) with the following inclusion criteria: (i) a chronic wound of more than 6 weeks and (ii) an ulcer needing silver-containing dressing were included. Before and after 28 days of treatment, clinical characteristics of the wound were recorded; hemogram, hepatic and renal functions, albumin sera and serum silver level were measured.RESULTS:Half of the cases displayed raised levels of silver after 1 month of treatment. Predictive factors for systemic silver absorption were wound area, anaemia and malnutrition with anaemia and malnutrition confirmed on multivariate analysis. Wound vascularization may also play a role, as a higher absorption was observed in cases of wound granulation without arterial components. No toxicity was detected. This work has also emphasized the slow elimination of silver from the body.CONCLUSION:Both long-term application and iterative treatments with silver dressings should be discouraged, especially in the elderly, who often suffer from malnutrition and anaemia to avoid potential cumulative toxicity.

Resume Introduction Le paracetamol est la substance active la plus impliquee dans les intoxications medicamenteuses volontaires et involontaires. Neanmoins, sa mise a disposition hors officine, via la grande distribution, est actuellement debattue en France. Methode Nous avons realise une evaluation prospective de la connaissance, de l’usage et du risque de surdosage en paracetamol a l’aide d’un questionnaire autoadministre dans la patientele de cabinets de medecine generale de la zone urbaine de Metz Metropole, entre mai 2015 et fevrier 2016. La prevalence des patients en risque potentiel de surdosage involontaire a ete estimee par methode de capture-recapture. Resultats Parmi les 819 patients ayant repondu, 17,9 % avaient une connaissance satisfaisante et 20,3 % etaient a risque de surdosage potentiel, majoritairement des patients âges de plus de 55 ans ou appartenant aux categories socioprofessionnelles des ouvriers et des inactifs. Un bon score de connaissance etait un facteur protecteur du risque de surdosage ( p Conclusion La dispensation du paracetamol hors des pharmacies d’officine ne saurait etre recommandee en l’etat. Des campagnes d’information sont necessaires pour limiter le risque de surdosage involontaire et de ses consequences hepatotoxiques.

Background Anaphylactic reactions to neuromuscular blocking agents (NMBAs) can be severe and even fatal. Our aim was to evaluate mortality rate in France from anaphylactic reactions to NMBAs, to identify risk factors for a fatal outcome, and to describe management of the cases that proved fatal. Methods The French National Pharmacovigilance Database was queried for reports of NMBA anaphylaxis that occurred between January 2000 and December 2011. A questionnaire was sent to regional pharmacovigilance centers to obtain further information on the management of cases with a fatal outcome. Results Two thousand and twenty-two cases of NMBA hypersensitivity were retrieved, of which 84 were fatal (4.1%). Among the 1247 cases of severe NMBA anaphylaxis (grades 3 and 4), independent risk factors associated with a fatal outcome in a multivariate analysis were male gender (female gender: OR = 0.4; 95% CI 0.2–0.7; P = 0.0004), an emergency setting (OR = 2.6; 95% CI 1.5–4.6; P = 0.0007), a history of hypertension (OR = 2.5; 95% CI 1.5–4.4; P = 0.0010) or of other cardiovascular disease (OR = 4.4; 95% CI 2.4–8.1; P

Resume Introduction La batterie standard europeenne (BSE) des patch-tests, outil indispensable de l'exploration de l'allergie de contact adopte en France en 1980, est periodiquement reactualisee. L'objectif de notre etude etait d'analyser l'evolution de la prevalence des sensibilisations de contact dans un centre francais entre 1981 et 2011 pour determiner si certains allergenes pourraient etre supprimes de la BSE actuelle. Patients, materiels et methodes Une etude retrospective etait realisee dans un secteur de dermato-allergologie, portant sur l'ensemble des BSE realisees en 1981, 1991, 2001, puis tous les ans de 2007 a 2011. Etaient egalement etudies certains ajouts, introduits en 2010. L'evolution de la positivite des allergenes au cours du temps etait evaluee par un test de tendance de Cochran-Armitage. Resultats Sur huit annees etudiees, la prevalence de positivite etait de 42,91 % sur 4551 patients inclus. Les allergenes les plus frequents etaient le sulfate de nickel (17,25 %), avec une prevalence en constante augmentation, Myroxylon pereirae (baume du Perou, 10,68 %), fragrance mix I (8,11 %), le chlorure de cobalt (6,99 %) et le bichromate de potassium (6,33 %). Les allergenes les plus rares, avec une prevalence en diminution, etaient le clioquinol (0,25 %), la primine (0,54 %) et la benzocaine (0,55 %). Conclusion L'evolution de la prevalence des tests epicutanes reflete les changements d'exposition aux allergenes, la sensibilisation croissante au sulfate de sulfate de nickel n'etant pas influencee par les directives europeennes. Le chlorure de benzalkonium, la methylisothiazolinone, le lavender absolute pourraient etre ajoutes et les allergenes avec moins de 1 % de positivites retires. ________________________________________ Summary Background Periodically updated, the European baseline series (EBS), first introduced in France in 1980, is an indispensable tool for the exploration of contact allergy. The aim of our study was to describe the prevalence of contact sensitization in a French centre between 1981 and 2011 to determine whether certain allergens may be deleted from the current BSE. Patients, materials and methods A retrospective study was conducted in a department of dermatology-allergology to analyse the results of all EBS tests performed every 10 years, from 1981 to 2001, and annually from 2007 to 2011. Some added allergens, introduced in 2010, were also studied. Changes in allergen positivity were analysed using a Cochran-Armitage test. Results Among the 4551 patients included for the 8-year period studied, the prevalence of positivity was 42.91%. The most common allergens in the general population were nickel sulphate (17.25%), with a constantly increasing prevalence, Myroxylon pereirae (10.68%), fragrance mix I (8.11%), cobalt chloride (6.99%) and chromium (6.33%). The least frequent sensitizations, with a decreasing prevalence, were found with clioquinol (0.25%), primin (0.54%) and benzocaine (0.55%). Conclusion Due to modifications in exposure to allergens, the incidence of contact sensitization can change, but nickel sulphate sensitization is increasing despite recent European directives. Allergens with less than 1% of positive results could be withdrawn from the EBS, with benzalkonium chloride, methylisothiazolinone and lavender absolute being added.

Resume Objectif Evaluer le role du Brilliant Blue G (BBG) dans la chirurgie des trous maculaires (TM). Patients et methodes Etude retrospective comparative des resultats fonctionnels et anatomiques entre deux groupes de 20 patients consecutivement operes de TM. Dans le groupe G1, la membrane limitante interne (MLI) etait systematiquement pelee sans colorant alors que dans le groupe G2 du BBG etait toujours utilise. Les acuites visuelles (AV) pre- et postoperatoires converties en logMAR ont ete analysees, ainsi que les tomographies a coherence optique de l’aire maculaire, afin de preciser la taille du TM, de confirmer sa fermeture et d’analyser l’integrite de la ligne de l’article externe des photorecepteurs. La duree du pelage ainsi que sa difficulte ont ete evaluees dans les deux groupes. Le suivi minimum etait de six mois. Resultats Au terme du suivi, le gain moyen d’acuite etait de 0,56 ± 0,48 logMAR pour le groupe G1, versus 0,60 ± 0,44 logMAR pour le groupe G2 (p = 0,80). Le taux de fermeture apres la premiere chirurgie etait de 17/20 (85 %) pour le groupe G1, versus 19/20 (95 %) pour le groupe G2 (p = 0,29). L’aspect en tomographie a coherence optique (OCT) de la ligne de l’article externe des photorecepteurs etait identique dans les deux groupes : continue chez 80 % des patients, disjointe chez 15 % des patients, et non analysable chez 5 % des patients. La duree moyenne du pelage dans le groupe G1 etait de 270,9 ± 27,4 secondes, il etait declare difficile pour dix yeux et incomplet chez deux patients. Dans le groupe G2, la duree moyenne du pelage etait de 140,8 ± 37,6 secondes (p Conclusion L’utilisation du BBG a accelere et ameliore la qualite du pelage de la MLI dans la chirurgie des trous maculaires. Les resultats anatomiques et fonctionnels ont progresse de maniere non significative dans le groupe ayant beneficie du colorant.

Background The script concordance test (SCT) measures clinical data interpretation in the context of uncertainty. To our knowledge, its feasibility has not yet been demonstrated in dermatology. Objectives This study describes the feasibility, reliability and validity of the SCT for use in dermatology teaching to family medicine residents. Methods We designed an SCT for dermatology teaching, adapted to the level of family medicine students. The family medicine residents attending a dermatology lecture course and a reference panel of dermatologists underwent the test. Software available on the SCT-dedicated website was used to determine the scores. The Cronbach’s α was calculated. The scores were described by means, standard deviation, and minimum and maximum scores. Mann–Whitney tests were used to compare resident and reference panel scores. Results The test contained 33 vignettes of four questions each. Cronbach’s α was 0.80. Mean scores were 75.6 for the reference panel and 65.0 for the residents (P = 0.0009). Conclusions This study confirmed the SCT’s capacity to distinguish groups on the basis of experience. This study demonstrated the feasibility and reliability of the SCT in the field of dermatology.

Background Post-excisional brachytherapy with Iridium 192 is a treatment of keloids scars (KS). Its indications and its parameters are not subject to any consensus. Objective We wanted to assess the effectiveness and satisfaction of patients treated in our centre. Patients and Methods This was a retrospective study conducted from November 2006 to November 2007. Patients with clinically and histologically proven KS treated between 1990 and 2005, were convened in consultation between September and October 2007. Clinical data and parameters of the brachytherapy have been collected. Results Eighty-seven patients (138 KS) were treated. Eighty-two KS (46 patients) met the criteria for inclusion. Thirty-two patients (55 KS) have been seen in consultation. The average time between the onset of KS and treatment was 63.5 months. The brachytherapy has begun after a maximum of 7 hours posterior to surgery for all KS. The average dose was 17.9 Gy calculated at 5 mm. We observed 23.6% of recurrence after treatment. Seventy-nine per cent of itching and 87.5% of pain have totally disappeared. The phototypes 5 and 6 had an increased risk of reccurence. Discussion This is the most important series of KS treated with Post-excisional brachytherapy presented so far. The technique is efficient in preventing keloid reccurence and in treating the functional signs, but at the expense of an unaesthetic result, of wich patient must be warned about. A follow-up of at least two years after treatment is recommended. Conflicts of interest None declared

Objectifs L’evolution clinique des patients atteints de sclerose en plaques (SEP) a evolue depuis le debut du XXIe siecle. L’introduction de traitements de fond, et les changements de l’offre globale de soin ont pu avoir un certain impact sur l’evolution a long terme de la maladie. L’objectif de cette analyse etait d’evaluer l’efficacite des traitements en vie reelle et leur impact sur l’evolution du handicap chez les patients atteints de SEP dans le registre lorrain. Methode Le Registre lorrain de la SEP a ete qualifie par le Comite national des registres le 24 novembre 2009. Il s’agit du seul registre national pour cette maladie, avec donnees medicales de suivi, a l’exception des registres scandinaves. Le Logiciel EDMUS (« European Database of Multiple Sclerosis ») est l’outil de recueil des informations cliniques et demographiques. Les patients inclus dans le registre ont ete identifies a partir des donnees des hopitaux, des neurologues liberaux et de la securite sociale. Le diagnostic de sclerose en plaques etait pose par un neurologue selon les criteres de Poser ou de McDonald. Les patients etaient generalement evalues tous les six mois en utilisant un protocole standardise et l’evaluation du handicap de faisait a l’aide de l’echelle EDSS (« Expanded Disability Status Scale »). Les donnees sur la progression de la maladie etaient analysees retrospectivement pour tous les patients inclus dans le registre avant le 12 avril 2012. Resultats Le registre de sclerose en plaques Lorrain a inclus 4129 patients avec un diagnostic confirme de SEP, dont 3704 ont commence par une SEP recurrente-remittente (RR) et 425 par une SEP primaire progressive (10,3 %). La duree moyenne de suivi etait de 13,8 ± 10 ans ; 69,9 % des patients ayant une SEP RR ont recu un traitement de fond. Parmi ceux-ci l’interferon beta representait le premier traitement pour 73 % des patients, l’acetate de glatiramer pour 8,7 % des patients, le natalizumab pour 0,6 % des patients, et les autres immunosuppresseurs pour 17,1 % des patients. L’âge moyen au debut du traitement etait de 35,2 ± 13 ans et la duree totale moyenne de traitement de 5,8 ± 4,9 ans Dans les quatre ans suivant le debut de la maladie, le taux annualise de poussee etait de 2,5 ± 1,7. Le score EDSS etait augmente de plus de deux points chez seulement 31,2 % des patients apres 10 ans Le temps median pour atteindre les EDSS de 3, 4 et 6 etaient de 13,6,18,4 et 28,2 ans respectivement. Conclusion Ces resultats, issus d’une collaboration public/prive, decrivent les donnees de suivi longitudinales de tous les patients atteints de SEP dans cette region. L’evolution de la maladie chez ces patients semble plus lente que ce qui a ete reporte anterieurement dans des etudes de cohortes et des registres de patients.

Introduction Paracetamol, the highest over-the-counter (OTC) selling drug in France, has become the first cause of acute hepatic failure [1] . Patient's knowledge of paracetamol has to date only been assessed in hospitalized patients. We aimed to assess good use and knowledge of paracetamol in patients in a realistic setting of self-medication in our region. Methods We conducted a prospective observational study in randomly selected community pharmacies of Metz (France) agglomeration. Patients coming to buy OTC paracetamol for themselves or their family had to answer to an anonymous auto-questionnaire. After being asked about gender, age, weight, parenthood and chronic disease, the patient had to answer to 14 items about paracetamol indications, recommended maximal dose per intake and maximal daily dose, delay between 2 doses, consequences of overdosage and alcohol intake, and the need to adapt dosage to the body weight. The patient also had to identify drugs containing paracetamol among 6 usual drugs; and finally to tell how he gets information and circumstances that can lead him to stop self-medication and visit his general practitioner. Responses were individually and concomitantly analyzed through 3 scores: good use (5 points; good user if > 3), overdosage (4 points; positive if ≤ 3) and knowledge (9 points; good knowledge if > 6). Univariate and multivariate analysis were performed with SAS, version 9.3 (SAS Institute, Cary, NC). Results Twenty-four community pharmacies participated and 302 individual questionnaires were collected. Most of patients (84.4%) could be considered as “good users”. Independent factors of good use were a good knowledge of paracetamol (OR = 5.3; p Conclusion Patients should be better informed about hepatotoxicity of paracetamol to warrant a better safety of its consumption by self-medication. Pharmacists and physicians have to remind patients the risk factors of unintentional overdose and liver toxicity and not hesitate to check if the patient may be at risk for overdosage. Package leaflets should also to be more informative.

Introduction La reaction anaphylactique aux curares est une complication qui peut concerner et preoccuper l’ensemble des anesthesistes car elle peut etre severe voire fatale. Le but de cette etude etait d’evaluer son taux de mortalite en France, d’identifier les facteurs de risque de mortalite et de decrire la prise en charge therapeutique des cas mortels. Materiel et methodes La base de donnees du systeme national de pharmacovigilance etait analysee afin de selectionner les cas de reactions d’hypersensibilites aux curares survenus entre janvier 2000 et decembre 2011. Un questionnaire supplementaire etait envoye aux centres regionaux afin d’ameliorer l’information sur la gestion therapeutique des cas a issue fatale. Les cas mortels etaient separes en deux groupes : – « deces precoces » : issue fatale immediate (arret cardiovasculaire non recupere) ou apres mise en place d’une assistance cardiocirculatoire ; – « deces tardifs » liees a une defaillance multiviscerale secondaire a l’arret cardiovasculaire recupere. Une analyse multivariee etait realisee afin de determiner les facteurs de risque independants de mortalite. Resultats Deux mille vingt-deux cas de reaction d’hypersensibilite a un curare etaient analyses dont 84 cas mortels (taux de mortalite moyen 4,1%). A partir des 1247 cas de reactions severes (grade 3 et 4) ont pu etre mis en evidence les facteurs de risques independants de mortalite reportes dans le Tableau 1 . Le curare le plus souvent incrimine etait le suxamethonium ( n = 815, 65,4 %) suivi de l’atracrium ( n = 181, 14,5 %), rocuronium ( n = 105, 8,4 %), cisatracrium ( n = 94, 7,5 %) et vecuronium ( n = 23, 1,8 %). Aucun d’entre eux n’etait identifier comme facteur de risque de surmortalite. Les details de la prise en charge des reactions mortelles etaient obtenus pour 31 patients. Le delai moyen de survenu du premier symptome etait de 2,1 minutes, le delai moyen d’injection du premier bolus d’adrenaline etait de 3,4 minutes et la dose totale d’adrenaline injectee en bolus etait de 15 mg. Il n’y avait aucune difference significative dans la prise en charge entre les groupes deces tardif et precoce. Aucun des patients places sous assistance cardiocirculatoire ne survivait. Discussion Le sexe masculin, l’obesite, un antecedent de maladie cardiovasculaire, un traitement chronique par betabloquant et le contexte d’urgence sont des facteurs de risques independants de mortalite a une reaction d’hypersensibilite aux curares. Le taux de mortalite est de 4,1 %. La prise en charge des cas mortels etait conforme aux recommandations internationales, avec un delai court de mise en œuvre des therapeutiques specifiques. On peut donc supposer qu’il existe des cas de resistance a l’adrenaline. Il est donc necessaire de developper de nouvelles approches therapeutiques.

International audience; ObjectivesTo assess medical students’ knowledge and training requirements in relation to doping in sport and to investigate their attitudes on doping prevention.MethodsProspective study based upon the comparison of two randomised groups: experimental group (A) benefiting of a specific educational intervention (role-playing games) on doping in sport and control group (B). Training requirements, knowledge and attitudes were assessed by questionnaires at the beginning (T0) and the end (T1) of the training and 1 year later (T2).ResultsA total of 58 students participated to the study at T0 and T1 (A = 31; B = 27) and 52 at T2 (A = 28; B = 24). Even 88% felt that they have a role to play in the prevention of doping in sport, 91% felt that the vocational training scheme did not deliver accurate formation for such a role. After the training, knowledge is improved (T1 and T2) for both groups especially regarding to the French law against doping and the ability to access to the list of prohibited substances. Role playing games are effective in improving medical students’ attitude in doping issues and its prevention with a higher level of confidence of group A at T1 (P < 0.001) and T2 (P < 0.05) for some communication skills.ConclusionsBasic medical training of medical students’ is perceived as insufficient to effectively participate in the prevention in doping issues. A specific training is able to provide them accurate communication skills to meet future prevention needs.

Periodically updated, the European baseline series (EBS), first introduced in France in 1980, is an indispensable tool for the exploration of contact allergy. The aim of our study was to describe the prevalence of contact sensitization in a French centre between 1981 and 2011 to determine whether certain allergens may be deleted from the current BSE.A retrospective study was conducted in a department of dermatology-allergology to analyse the results of all EBS tests performed every 10 years, from 1981 to 2001, and annually from 2007 to 2011. Some added allergens, introduced in 2010, were also studied. Changes in allergen positivity were analysed using a Cochran-Armitage test.Among the 4551 patients included for the 8-year period studied, the prevalence of positivity was 42.91%. The most common allergens in the general population were nickel sulphate (17.25%), with a constantly increasing prevalence, Myroxylon pereirae (10.68%), fragrance mix I (8.11%), cobalt chloride (6.99%) and chromium (6.33%). The least frequent sensitizations, with a decreasing prevalence, were found with clioquinol (0.25%), primin (0.54%) and benzocaine (0.55%).Due to modifications in exposure to allergens, the incidence of contact sensitization can change, but nickel sulphate sensitization is increasing despite recent European directives. Allergens with less than 1% of positive results could be withdrawn from the EBS, with benzalkonium chloride, methylisothiazolinone and lavender absolute being added.

The script concordance test (SCT) measures clinical data interpretation in the context of uncertainty. To our knowledge, its feasibility has not yet been demonstrated in dermatology.This study describes the feasibility, reliability and validity of the SCT for use in dermatology teaching to family medicine residents.We designed an SCT for dermatology teaching, adapted to the level of family medicine students. The family medicine residents attending a dermatology lecture course and a reference panel of dermatologists underwent the test. Software available on the SCT-dedicated website was used to determine the scores. The Cronbach's α was calculated. The scores were described by means, standard deviation, and minimum and maximum scores. Mann-Whitney tests were used to compare resident and reference panel scores.The test contained 33 vignettes of four questions each. Cronbach's α was 0.80. Mean scores were 75.6 for the reference panel and 65.0 for the residents (P = 0.0009).This study confirmed the SCT's capacity to distinguish groups on the basis of experience. This study demonstrated the feasibility and reliability of the SCT in the field of dermatology.

Purpose To determinate if retinal nerve fiber layer (RNFL) thickness was correlated with Expanded Disability Status Scale (EDSS) score in patients with definite multiple sclerosis (MS) Methods 74 consecutive patients (extracted from the prospective Lorraine Multiple Sclerosis Registry) were included. A neurological examination with determination of the EDSS score and an ophthalmological examination with visual acuity, visual field testing, and RNFL measurements with optical coherence tomography (OCT3-Carl Zeiss Meditec, Dublin California USA) were performed. Results Mean age was 44,5 years and 66% were women. EDSS average score was 3. Prior optic neuritis was present in 83% OD and 41% OS. EDSS score was negatively correlated with RNFL thickness (-0,28 p=0.04 OD and -0.2 p

To evaluate the role of Brilliant Blue G (BBG) in macular hole (MH) surgery.Comparative retrospective study between two groups of 20 consecutive patients who underwent macular hole surgery. In the first group (G1), the inner limiting membrane (ILM) was systematically peeled without staining, while in the second group (G2), BBG was consistently utilized. Pre- and postoperative logMAR visual acuities (VA) were studied, as well as macular optical coherence tomography (OCT) scans to measure MH size, to confirm postoperative closure and to evaluate the integrity of the IS/OS junction. Time required and difficulty of peeling were compared between the two groups. Minimum follow-up was six months.After six months follow-up, the average improvement in acuity was 0.56±0.48 logMAR for G1, versus 0.60±0.44 logMAR for G2 (P=0.80). The rate of closure after one surgery was 85% (17/20 patients) for G1, versus 95% (19/20 patients) for G2 (P=0.29). Postoperative OCT appearance of the IS/OS junction was similar in both groups: intact in 16/20 patients (80%), disrupted in 3/20 patients (15%), and indeterminate in 1/20 patients (5%) (P=1). The mean duration of peeling in G1 was 270.9±27.4 seconds. It was deemed difficult in ten eyes and incomplete in two patients, while in the G2 group, the mean duration of ILM peeling was 140.8±37.6 seconds (P0.01); it was deemed complete and technically easy in all cases.The use of BBG was effective in facilitating and accelerating ILM peeling during MH surgery. The anatomical and functional results were not statistically better in the group that received BBG.