La mucite buccale chimio- ou radio-induite en Hématologie Clinique (les difficultés de sa prise en charge)

Les traitements anti-cancéreux peuvent occasionner l'émergence d'une mucite buccale. La mucite buccale, qui se définit par un ulcère sévère au niveau de la muqueuse, représente la complication non-hématologique majeure des traitements de conditionnement de greffe de moelle osseuse par radio- ou chimiothérapie. En effet, 70% des patients traités par une thérapie de conditionnement développent cette complication. La mucite buccale, très douloureuse, entraîne alors des difficultés à manger, boire et parler pour le patient et entraîne un risque de contracter une infection fortement augmenté. De nombreuses stratégies de prise en charge préventives et/ou curatives de la mucite sont proposées, peu efficaces pour la plupart. Les recommandations préconisent avant tout le maintien de l'hygiène buccale. La palifermine a prouvé son efficacité mais présente des inconvénients. Ainsi les difficultés rencontrées dans la prise en charge de la mucite buccale radio- ou chimio-induite sont nombreuses.Treatment for cancer, including bone marrow transplant, can cause oral mucositis. Oral mucositis, defined by severe ulcers in the mouth, represents a major non-hematologic complication of cytotoxic chemotherapy and radiotherapy associated with significant morbidity. Indeed, up to 70% of patients undergoing conditioning therapy for bone marrow transplantation experience oral complications. This painful condition can cause difficulties in relation to eating, drinking and swallowing, and may also be associated with infectious which may require the patient to stay longer in hospital. Different strategies are used to prevent this condition, but their efficacity is limited. Guidelines recommend oral care. Palifermin is effective n the prevention of mucositis but is associated with side effects. Thus radio- and chemo-induced oral mucositis prevention and treatment present many difficulties.RENNES1-BU Santé (352382103) / SudocLYON1-BU Santé (693882101) / SudocSudocFranceF

Hospital databases for the identification of adverse drug reactions: A 2-year multicentre study in 9 French general hospitals

International audienceAims To estimate the actual number of adverse drug reactions (ADRs), we used the French medical administrative database (PMSI) in addition to ADRs spontaneously reported in the French Pharmacovigilance Database (FPVDB). Methods Capture-recapture method was applied to these 2 sources (PMSI and FPVDB), checking their independence via a third data source. The study ran from 1 July 2014 to 30 June 2016 in 9 French general hospitals. From PMSI, all discharge summaries including a selection of 10th International Classification of Diseases codes related to ADRs were analysed. This selection was based on the results of a previous study. All ADRs corresponding to these codes, spontaneously reported in the FPVDB, were included. Results In PMSI, 56.9% of hospital stays were related to an ADR (628 out of 1104). In the FPVDB, we retained 115 cases. A total of 43 ADRs were common to the 2 databases. In both sources, the most frequently reported ADRs were cutaneous (33.1 and 19.1%) and renal (25.2% and 11.6%). The most frequently suspected drugs were anti-infectives in PMSI (31.1%) and antineoplastic drugs in the FPVDB (30.4%). Using the capture-recapture method, the estimated number of ADRs was 1657 [95% CI 1273 to 2040].Conclusion The use of the PMSI could constitute an additional tool for the estimation of the actual number of ADRs in French hospitals. A model involving a third data source enabled the independence of the 2 sources (PMSI and FPVDB) to be checked before applying the capture-recapture method