Françoise Ballereau

Minerals, trace elements and related biological variables in athletes and during physical activity

This review concerns various minerals (sodium, potassium, calcium, magnesium, phosphorus), trace elements (zinc, manganese, selenium, copper, iron, cobalt, iodine, chromium, fluorine, lead, cadmium) and other biological variables (nitric oxide, L-carnitine, glutamine, serum transferrin receptor, biopyrrins) in relation to hemorheologic effects, stress, immune response and infections during physical and sports activities. In athletes, macroelements in the ionized form contribute to heart and muscle contractions, oxidative phosphorylation and the synthesis and activation of enzymatic systems. Zinc (Zn) protects against the effects of increased free reactive oxygen species such as copper (Cu) and manganese (Mn) (Cu-Zn superoxide dismutases; Mn superoxide dismutase). Selenium in glutathione peroxidase protects the cardiovascular system and the muscles, and helps combat allergic and inflammatory diseases. Copper and iron are involved in many aspects of energy metabolism and are important components in the synthesis of hemoglobin, myoglobin and cytochromes. Fluorine and Cu protect the ligaments and tendons. Physical activity appears to be beneficial to urban residents who are exposed to metal pollution (lead, cadmium). The data cited in this review are often contradictory and incomplete. It is still unclear in many cases how minerals are involved in physiological changes, and much work remains.

A multicentre serosurvey on diphtheria immunity in a French population of 1004 subjects

Diphtheria immunity was determined in serum specimens obtained in 1994 from 1004 subjects seen in emergency departments of three distant French cities. An enzyme immunoassay was used to measure serum diphtheria antitoxin concentrations according to the following criteria: (a) antitoxin < 0.01 IU/ml: susceptibility, (b) 0.01–0.09 IU/ml: basic protection, (c) ≥ 0.10 IU/ml: full protection. Among these patients, 20.3% were fully susceptible to diphtheria, 30.3% had basic but doubtful protection and only 49.4% were fully protected. Protection was different by age-groups: 73.5% of the subjects under 40 years of age, 46% between 40 and 65 and 33% over 65 were fully protected. Protection decreased with increasing age (p < 0.001)and was greater for men than women after 40 years of age (p < 0.001). The results of this exploratory study indicate that the enhancement of diphtheria immunity by boosters in adult population should be reconsidered in France as well as in many industrialized countries.

Relationship between hospital antibiotic use and quinolone resistance in Escherichia coli

BACKGROUND The relationship between the hospital use of various classes of antibiotics and resistance of Escherichia coli to quinolones remains debated. Our aim was to study the relationship between the hospital use of 16 classes of antibacterial agents and the incidence of quinolone-resistant E. coli isolates. METHODS Antibiotic use and resistance data were collected from 36 hospitals. Incident rate ratios (IRR) were assessed using negative binomial regression. RESULTS The incidence of quinolone-resistant isolates was independently associated with the consumption of tetracyclines (IRR 1.139, 95% CI 1.030-1.259), first- and second-generation cephalosporins (IRR 1.007, 95% CI 1.002-1.013), third-generation cephalosporins (IRR 1.029, 95% CI 1.010-1.048), and quinolones (IRR 1.007, 95% CI 1.000-1.014). These associations were independent from the type of patient served. CONCLUSIONS The level of hospital use of quinolones influences the incidence of quinolone resistance in E. coli hospital isolates. The consumption of two other classes of antibiotics, cephalosporins and tetracyclines, is also associated with quinolone resistance.

A questionnaire to document self‐medication history in adult patients visiting emergency departments

To develop the first questionnaire to obtain a complete medication history by documenting self‐medication history in adult patients admitted to a medical emergency department (ED).

Assessment of adverse drug event recognition by emergency physicians in a French teaching hospital

Objectives The frequency and the severity of drug-related visits in emergency department (ED) make the improvement of adverse drug event (ADE) recognition a crucial issue. As part of a research project aiming to improve the diagnosis and the management of ADEs in ED, the authors conducted a pilot study whose primary objective was to assess ADE recognition by emergency physicians. Methods The patients presenting to the ED were included at randomised time periods between 1 October 2007 and 31 March 2008 in this prospective cross-sectional study. The primary outcome was the frequency of ADEs that were attributed to a medication-related problem by the emergency physician. Results A total of 423 patients met the inclusion criteria, of which 95 experienced an ADE (22.5%; 95% CI 18.6% to 26.7%). Emergency physicians correctly attributed 33 of these cases (34.7%; 95% CI 25.3% to 45.2%) to a medication-related problem. Of the 28 cases in which the ADE was considered as a ‘direct drug effect’ (29.5%; 95% CI 20.6% to 39.7%), 16 were correctly identified by emergency physicians (57.1%; 95% CI 37.2% to 75.5%). Of the 67 cases in which the ADE was considered as a ‘drug involvement in a multifactorial pathological condition’ (70.5%; 95% CI 60.3% to 79.4%), 17 were correctly attributed (25.4%; 95% CI 15.5% to 37.5%). Conclusions ADEs are frequent in EDs and are not well recognised by emergency physicians, especially when the drug is involved in a multifactorial pathological condition.

Epidemiology of third-generation cephalosporin-resistant community-acquired Enterobacteria isolated from elderly patients.

AIMS This survey was made to study the epidemiology of multiresistant bacteria (MRB) in the French community, among elderly patients 65 years of age or more, carrying third-generation cephalosporin-resistant (3GC-resistant) Enterobacteriaceae, and the co-resistance of prescribed antibiotics. METHODS The data was collected in 2009 in the West of France by MedQual, a network of 174 private laboratories. RESULTS Two thousand one hundred and sixty strains of the 88,255 identified Enterobacteria strains were 3GC-resistant (2.4%) and 945 of these strains (41.8%) were isolated from elderly patients 65 years of age or more. Escherichia coli was the predominant 3GC-resistant strain (72.7%). 51.4% of the 945 patients in whom a 3GC-resistant strain was isolated produced an extended-spectrum β-lactamase (ESBL). The main risk factors for infection with the 3GC-resistant strain were hospitalization and antibiotic treatment in the previous year (58.2 and 86.9%, respectively). Hospitalization during the previous year was more frequent among elderly patients who lived at home compared with those who lived in nursing homes (P<0.05). The production of ESBL, among the 945 patients who carried the 3GC-resistant strains, was similar among patients who lived at home compared with those who lived in nursing homes (51.4% versus 49.7%). CONCLUSION Microbiologists should warn family physicians about MRB isolates with a specific antimicrobial resistance pattern (3GC-resistant, fluoroquinolone-resistant, etc.) to prescribe more effective medications.

Establishing a pharmacy presence in the emergency department: opportunities and challenges in the French setting

Overview of clinical pharmacy practice around the world shows that pharmaceutical services in emergency departments (EDs) are far less common in Europe than in North America. Reported experiences have shown the impact of a clinical pharmacy service on drug utilisation and safety issues. This commentary presents the implementation of a pharmacy presence in the ED of a French tertiary care hospital. Our experience helps to define the role of the clinical pharmacist in the ED, including patient interviewing, providing medication reconciliation, promoting drug safety, and supporting specific interventions to improve quality of care and patient safety. The role of ED pharmacists in the improvement of quality of care is not necessarily limited to drug therapy, e.g. by helping outpatients to access care and treatment facilities as best suits their needs. Challenges of implementing ED pharmacy services have been identified well, but still require developing strategies to be overcome.

Risk factor for neonatal tetanus in West Burkina Faso : A case control study

A case-control study was carried out to identify risk factors for neonatal tetanus in rural Burkina Faso. Each of the 31 cases identified prospectively were matched with two controls. Risk factors such as the instrument used to cut the umbilical cord and the qualification of the midwives were only identified in the univariate analysis. The multifactorial analysis identified factors commonly believed to be associated with neonatal tetanus: lack of mothers immunization and place of birth other than maternity clinics. However, applying karite nut butter on the umbilical cord was found to be a strong independent factor associated with neonatal tetanus. Immunization of mothers against tetanus should be enforced. Health education must take into consideration sociocultural realities of these populations.

Étude des comportements d’automédication chez les patients admis dans un service d’urgences médicales

OBJECTIVE To describe the self-medicating behaviours (SMBs) in patients admitted to a tertiary care medical emergency department (ED); to study the factors associated with SMBs. METHODS Observational cross-sectional study conducted in 2009. Included patients were interviewed about their SMBs using a standardized questionnaire. The search for factors associated with SMBs used multivariate logistic regression analysis. RESULTS Among the 315 patients who were interviewed, 239 (75.9%) reported one SMBs or more in their lives and 105 (43.9%) within 7 days of admission to the ED. Some of the medications reported during interviews are known to be associated with adverse drug events. After adjustment, SMBs were conversely associated with an age ≥80 years, a number of prescribed medications ≥4 and a social vulnerability condition. CONCLUSION The description of SMBs and the analysis of their determinants are necessary to improve the recognition of adverse events related to self-medication in ED patients.

Who are the carriers of MRSA in the community? A prospective study in the Pays de la Loire region of France

The aim of this study was to determine the demographic characteristics of methicillin-resistant Staphylococcus aureus (MRSA) carriers in the community, to assess their risk factors and possible past hospitalization history and to describe the different resistance phenotypes of community isolates of S. aureus. Data were collected over the course of 16 months (from June 2005 to September 2006) in the Pays de la Loire region of France by MedQual, a network of private biological analysis laboratories. This work was based solely on the analysis of strains isolated in the community as opposed to isolates from private facilities such as nursing homes or hospitals. The antimicrobial susceptibility results for a total of 313 MRSA isolates were included in this study. The isolates were most frequently recovered from skin and soft tissue infections (41.2%), urine (38.3%) and genital samples (8.3%). We distinguished 36 patients without classical risk factors (WRF), such as demographic individual medical, healthcare exposure, carried MRSA, from the other 277 patients with at least one risk factor (RF). WRF MRSA patients were younger than RF patients and an infection was more often found among WRF patients. MRSA strains isolated from RF patients were resistant to ofloxacin in 81.1% of cases, whereas only 50% of the MRSA strains isolated from WRF patients were resistant (p <0.001). Nine resistance phenotypes were observed among the 313 MRSA strains. MRSA resistance profiles in the community have evolved in recent years. Therefore, it is necessary to study the resistance phenotypes of the circulating strains in order to adapt therapeutic care in the community.