Misuse of Trihexyphenidyl (Artane) on Réunion Island

International audienceTrihexyphenidyl (THP) is an anticholinergic drug misused to procure hallucination, sedation, and anxiolysis. The aim of this cohort was to show and describe, within a public health risk management policy, the risks of a long-standing but relatively unknown addiction: THP addiction.METHODS:On Réunion island, a cohort with systematic data collection has been set up by addictologists working in the Centres for Addiction Prevention and Treatment, in the university hospital, and in general practices who have active lists of patients misusing THP. Data collection included socioeconomic data and clinical data concerning addiction.RESULTS:This cohort included 69 patients during November 2016. The average age of the patients was 36 years; 97% were men; 93% had living accommodation but only 32 % were employed. In this cohort drug administration was exclusively oral. The most common reasons for use were anxiolytic (46%), stimulation (26%), and sedation (10%), the main effects described were dyskinesia and behavioral disorders. Over half (61%) of the patients reported a coaddiction, mainly to benzodiazepines, cannabis, tobacco, alcohol, and buprenorphine.CONCLUSIONS:This cohort describing the clinical characteristics of 69 patients is the largest cohort studied for THP addiction. Patients from the Centres for Addiction Prevention and Treatment were the youngest and most recently addicted, whereas general practice patients had been addicted for longer and were more socially integrated. This clinical description of THP addiction therefore enables us to identify the patients who are the most at risk, to set up an adapted care protocol

Is the species flock concept operational? The Antarctic shelf case.

10 pagesInternational audienceThere has been a significant body of literature on species flock definition but not so much about practical means to appraise them. We here apply the five criteria of Eastman and McCune for detecting species flocks in four taxonomic components of the benthic fauna of the Antarctic shelf: teleost fishes, crinoids (feather stars), echinoids (sea urchins) and crustacean arthropods. Practical limitations led us to prioritize the three historical criteria (endemicity, monophyly, species richness) over the two ecological ones (ecological diversity and habitat dominance). We propose a new protocol which includes an iterative fine-tuning of the monophyly and endemicity criteria in order to discover unsuspected flocks. As a result nine " full " species flocks (fulfilling the five criteria) are briefly described. Eight other flocks fit the three historical criteria but need to be further investigated from the ecological point of view (here called " core flocks "). The approach also shows that some candidate taxonomic components are no species flocks at all. The present study contradicts the paradigm that marine species flocks are rare. The hypothesis according to which the Antarctic shelf acts as a species flocks generator is supported, and the approach indicates paths for further ecological studies and may serve as a starting point to investigate the processes leading to flock-like patterning of biodiversity

Case 3 of Table 1.

<p>This situation is a mix of case 1 and case 2. A taxonomic decision would simply lead to case 2, where supplementary data about the tempo of diversification would then be required (see text).</p

Case 2 of Table 1.

<p>The set of species under focus is monophyletic but contains an internal subpart that is secondarily « exported » outside the area of reference (red circle). See text for discussion.</p

Three situations for the taxon of reference (columns) are to be considered: it is monophyletic, paraphyletic or polyphyletic.

<p>There are also three situations to consider for the components of this taxon in the given area of reference (lines): monophyletic, paraphyletic or polyphyletic. To explain the table, we consider again the example of the non-notothenioid fish family Liparidae. It is monophyletic as a family (first column), however its components of the Antarctic shelf are polyphyletic because they are each related to Arctic liparids (bottom line). So the Antarctic liparid situation is the bottom left cell. Case 2 (when a taxon originating in the area of reference secondarily “exports” a part of its descent outside this area, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0068787#pone-0068787-g004" target="_blank">Fig. 4</a>) is discussed in the text.</p

Protocol to use the five criteria of Eastman and McCune [17] to detect and evaluate species flocks.

<p>The first three criteria (3 K) are the species diversity (« speciosity ») of the taxonomic component, its level of endemicity, and its monophyly. The two other criteria (2 K) are habitat dominance (in biomass) and ecological diversity. The modulation loop means that the geographical range and the taxonomic rank may have to be redefined in order to discover unsuspected flocks.</p

Case 1 of Table 1.

<p>A set of species is paraphyletic (blue) with a taxonomic entity embedded within (purple) it that is restricted to the area of reference (red circle): A simple taxonomic decision could fulfill the two criteria of monophyly and endemicity. Indeed the taxonomic decision would render the whole set of species monophyletic (purple becomes blue).</p

Low incidence of SARS-CoV-2, risk factors of mortality and the course of illness in the French national cohort of dialysis patients

International audienceThe aim of this study was to estimate the incidence of COVID-19 disease in the French national population of dialysis patients, their course of illness and to identify the risk factors associated with mortality. Our study included all patients on dialysis recorded in the French REIN Registry in April 2020. Clinical characteristics at last follow-up and the evolution of COVID-19 illness severity over time were recorded for diagnosed cases (either suspicious clinical symptoms, characteristic signs on the chest scan or a positive reverse transcription polymerase chain reaction) for SARS-CoV-2. A total of 1,621 infected patients were reported on the REIN registry from March 16th, 2020 to May 4th, 2020. Of these, 344 died. The prevalence of COVID-19 patients varied from less than 1% to 10% between regions. The probability of being a case was higher in males, patients with diabetes, those in need of assistance for transfer or treated at a self-care unit. Dialysis at home was associated with a lower probability of being infected as was being a smoker, a former smoker, having an active malignancy, or peripheral vascular disease. Mortality in diagnosed cases (21%) was associated with the same causes as in the general population. Higher age, hypoalbuminemia and the presence of an ischemic heart disease were statistically independently associated with a higher risk of death. Being treated at a selfcare unit was associated with a lower risk. Thus, our study showed a relatively low frequency of COVID-19 among dialysis patients contrary to what might have been assumed