Drug-induced hallucination: A case/non case study in the French Pharmacovigilance Database

ABSTRACT -Background and Objectives: Hallucinations are sensory perceptions which occur without external stimuli. There are associated with psychiatric disease but also can be related to organic disease and drug or toxic exposure. The purpose of our study was to investigate the association between exposure to medications and the reporting of hallucinations using data from the spontaneous-reporting French Pharmacovigilance Database (FPVD). Methods: We used the case/noncase method in the FPVD. Cases were all the observations of hallucination with the LLT term "perception disturbances", registered into the FPVD from January 1985 to Jan 2013. Data were expressed as odds ratio (OR) with their 95% confidence intervals. Results: Among the 469,181 reports of adverse effects recorded between 1985 and 2013, 4,086 are hallucinations. For about 50% of these hallucinations were experimented by patient older than 65 years old. A statistically significant OR was found with several medications included rasagiline ]), zolpidem , methylphenidate ) and baclofene ). An increased risk of hallucinations was also observed with non central nervous system drugs, including ertapenem .5]), voriconazole ) and valacyclovir ]). Conclusions: This pharmacoepidemiological study describes an association between drugs and hallucinations. This relationship involves not only some already suspected drugs but also other drugs less known to induce such an adverse reaction. Despite the mandatory limits of this kind of study, these data should lead to special precautions in patient at risk

Childhood asthma outcomes during the COVID-19 pandemic: Findings from the PeARL multinational cohort

Background The interplay between COVID-19 pandemic and asthma in children is still unclear. We evaluated the impact of COVID-19 pandemic on childhood asthma outcomes.Methods The PeARL multinational cohort included 1,054 children with asthma and 505 non-asthmatic children aged between 4 and 18 years from 25 pediatric departments, from 15 countries globally. We compared the frequency of acute respiratory and febrile presentations during the first wave of the COVID-19 pandemic between groups and with data available from the previous year. In children with asthma, we also compared current and historical disease control.Results During the pandemic, children with asthma experienced fewer upper respiratory tract infections, episodes of pyrexia, emergency visits, hospital admissions, asthma attacks, and hospitalizations due to asthma, in comparison with the preceding year. Sixty-six percent of asthmatic children had improved asthma control while in 33% the improvement exceeded the minimal clinically important difference. Pre-bronchodilatation FEV1 and peak expiratory flow rate were improved during the pandemic. When compared to non-asthmatic controls, children with asthma were not at increased risk of LRTIs, episodes of pyrexia, emergency visits, or hospitalizations during the pandemic. However, an increased risk of URTIs emerged.Conclusion Childhood asthma outcomes, including control, were improved during the first wave of the COVID-19 pandemic, probably because of reduced exposure to asthma triggers and increased treatment adherence. The decreased frequency of acute episodes does not support the notion that childhood asthma may be a risk factor for COVID-19. Furthermore, the potential for improving childhood asthma outcomes through environmental control becomes apparent.</p

Évaluation de l'intérêt du test à la métacholine chez l'enfant d'âge pré-scolaire dans l'aide au diagnostic étiologique d'une toux chronique ou récidivante (étude pilote rétrospective)

La toux chronique ou récidivante est un symptôme très prévalent en pédiatrie et notamment chez l'enfant d'âge pré-scolaire (3 à 7 ans). A côté des infections respiratoires banales qui sont une étiologie très fréquente à cet âge, il faut évoquer un certain nombre de diagnostics qui requièrent une prise en charge spécifique et particulièrement l'asthme. Dans la majorité des cas le diagnostic d'asthme est possible par l'anamnèse, la clinique, des examens paracliniques ciblés et une épreuve thérapeutique positive. Quand la présentation n'est pas typique, en particulier quand la toux ne s'accompagne pas de sibilants, quand elle ne cède pas complètement avec un traitement anti-asthmatique, il a été proposé, chez l'adulte et le grand enfant, d'étayer le diagnostic d'asthme en recherchant une hyperréactivité bronchique. L'objectif de ce travail était d'évaluer la valeur diagnostique de la recherche d'une hyperréactivité bronchique chez l'enfant d'âge pré-scolaire. Nous avons étudié 49 enfants âgés en moyenne de 62,8 [écart 42 ; 93] mois (environ 5 ans) qui présentaient une toux chronique ou récidivante et pour qui nous avions demandé un test à la métacholine pour orienter le diagnostic. La recherche d'une hyperréactivité bronchique a été faite par un test à la métacholine et évaluation de la réponse par mesure de la pression transcutanée en oxygène. Nous avons revu les enfants avec un recul de 31,3 [3 ; 60] mois et avons comparé le diagnostic initial, le diagnostic final et l'évolution, chez ceux dont le test était positif et ceux dont le test était négatif. Les probabilités initiales et finales étaient établies en aveugle, sans le résultat du test à la métacholine, par un pneumo-pédiatre à partir des données cliniques initiales et finales recueillies de façon standardisée. Aucune différence n'a été retrouvée dans les probabilités d'asthme des 2 groupes d'enfants ni en ce qui concerne la persistance de la toux et l'efficacité de la corticothérapie inhalée. Cette étude suggère que la présence d'une hyperréactivité bronchique à cet âge n'est pas associée à un diagnostic final ou à une évolution de type asthmatique. Cependant le caractère rétrospectif de l'évaluation et l'effectif réduit ne permettent pas des conclusions formelles.GRENOBLE1-BU Médecine pharm. (385162101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Presence of tracheal bronchus in children undergoing flexible bronchoscopy

Background and objectives: Tracheal bronchus (TB) is a rare congenital malformation of the lung tree with a bronchus originating from the trachea. Only a small number of publications have analyzed the frequency and diagnostic procedure of TB in children, based on a restricted sample of patients. In the present study, we analyze and discuss new aspects of prevalence, clinical presentation and associated malformations of TB based on a large pediatric cohort. Methods: Data from 5970 children having a flexible bronchoscopy for investigation of respiratory symptoms were selected. We analyzed the anesthesic management, the presence of associated malformations, and all tracheobronchial anomalies observed during the endoscopic procedure. Results: Fifty-seven cases of tracheal bronchus were identified (0.9%). In the majority of them, tracheal bronchus was a fortuitous discovery without clear clinical relevance. Statistical analysis revealed that the majority of TB originated from the middle and lower one third of the trachea (56%). 61.5% of patients had associated anomalies such as syndromic association (21%), cardiac malformations (19.2%) or tracheal stenosis (14%). Only 38.5% of children had no associated anomalies. Conclusions: Tracheal bronchus is a rare morphological anomaly of the tracheobronchial tree. Most often TB is associated with other birth defects such as another tracheo-bronchial tree malformation, vascular abnormality, congenital heart malformation or in the context of a syndromic pattern. A relationship between respiratory symptoms and the presence of TB is very rare and selective treatment is infrequent

Biologicals in childhood severe asthma: the European PERMEABLE survey on the status quo

Introduction Severe asthma is a rare disease in children, for which three biologicals, anti-immunoglobulin E, anti-interleukin-5 and anti-IL4RA antibodies, are available in European countries. While global guidelines exist on who should receive biologicals, knowledge is lacking on how those guidelines are implemented in real life and which unmet needs exist in the field. In this survey, we aimed to investigate the status quo and identify open questions in biological therapy of childhood asthma across Europe. Methods Structured interviews regarding experience with biologicals, regulations on access to the different treatment options, drug selection, therapy success and discontinuation of therapy were performed. Content analysis was used to analyse data. Results We interviewed 37 experts from 25 European countries and Turkey and found a considerable range in the number of children treated with biologicals per centre. All participating countries provide public access to at least one biological. Most countries allow different medical disciplines to prescribe biologicals to children with asthma, and only a few restrict therapy to specialised centres. We observed significant variation in the time point at which treatment success is assessed, in therapy duration and in the success rate of discontinuation. Most participating centres intend to apply a personalised medicine approach in the future to match patients a priori to available biologicals. Conclusion Substantial differences exist in the management of childhood severe asthma across Europe, and the need for further studies on biomarkers supporting selection of biologicals, on criteria to assess therapy response and on how/when to end therapy in stable patients is evident

Alveolar proteinosis of genetic origins

International audiencePulmonary alveolar proteinosis (PAP) is a rare form of chronic interstitial lung disease, characterised by the intra-alveolar accumulation of lipoproteinaceous material. Numerous conditions can lead to its development. Whereas the autoimmune type is the main cause in adults, genetic defects account for a large part of cases in infants and children. Even if associated extra-respiratory signs may guide the clinician during diagnostic work-up, next-generation sequencing panels represent an efficient diagnostic tool. Exome sequencing also allowed the discovery of new variants and genes involved in PAP. The aim of this article is to summarise our current knowledge of genetic causes of PAP

Circulating IL-17-producing mucosal-associated invariant T cells (MAIT) are associated with symptoms in children with asthma

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Efficacy of a short pretreatment with omalizumab in children with anaphylaxis to hymenoptera venom immunotherapy A report of three cases

International audienceHymenoptera venom allergy is the second cause of anaphylaxis in European children. Systemic reactions occur in up to 0.8% of schoolchildren. Venom immunotherapy (VIT) is recommended in sensitized children having systemic skin reactions exceeding generalized skin symptoms. VIT carries an 8–20% risk of systemic adverse events. Short protocols achieve the maintenance dose faster than conventional protocols but are more frequently associated with anaphylactic reactions. We report the cases of teenagers who experienced severe anaphylactic reactions (SAR) during the rush phase of VIT (Table 1). After an informed consent, a second rush VIT was performed after a pretreatment with omalizumab and was tolerated. No injection of omalizumab was required during the maintenance phase

The economic burden of allergic comorbidities in pediatric severe asthma

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The economic burden of allergic comorbidities in pediatric severe asthma

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