Les 100 médicaments essentiels. Une approche de médecine interne = 100 essential drugs. An internal medicine approach

Déclaration d'intérêts : B. Grosbois : expert pour Actélion, Celgene, Octapharma, Shire. Recherche subventionnée par LFB, Janssen, Genzyme. L. Guillevin : conseiller scientifique Actélion, expert pour (et conférences rémunérées par) GSK, CSL, Roche. L. Guillevin estime cependant n'avoir pas de conflit d'intérêt concernant le présent travail. C. Le Jeunne : expert pour Roche, Sanofi, Novartis, BSM, UCB. Essais thérapeutiques en cours pour Bayer, Pfizer, BMS. P. Morlat : expert pour Gilead, ViiV Health Care, BMS, Abbott, MSD. Ph. Morlat estime cependant n'avoir pas de conflit d'intérêt concernant le présent travail. P. Arlet, O. Aumaitre, J. Cosserat, A. Kettaneh, C. Massot et M. Thomas : aucun conflit d'intérêt.International audiencePURPOSE: Up to 4600 drugs in about 15,000 pharmaceutical forms are available in France which may be a source of misuse with increased occurrence of side effects and costs. While the World Health Organization is encouraging each developed country to work out its own list of essential drugs. The list provided in 2008 by the French Office for the safety of health products has had so far limited impact on practice, so it became obvious to a group of internists to work out a "wise list" of 100 essential medicines covering 95% of the disorders observed in France. METHODS: In June 2011, 10 internists agreed to each provide a list of 100 essential medicines, according to individual experience. In December 2011, a meeting of the participants provided a list as initial consensus and mandated five among them to make proposals for those areas neglected by too many participants or in which needless dispersion of medicines was stated. After internet-facilitated exchanges, an additional list was validated in mild-January 2012. RESULTS: Fifty-four drugs were included in the list of initial consensus (including nine selected by all 10 participants), and 46 in the additional list. So the final "wise list" included 100 drugs. In June 2012, 56 of these drugs were available as generics. This list was compared to those lists set out by five countries in the European Union. CONCLUSION: Generating such a list is feasible. Undoubtedly still non-comprehensive, this list will benefit from the expertise of 14 general practitioners who are currently working out a similar list across France. The final list will be submitted for validation by the French associations of generalist teachers and Internists

Le complexe majeur d'histocompatibilité joue-t-il un rôle dans la prédisposition à la tuberculose pulmonaire ? (Résultats d'une méta-analyse)

PARIS7-Xavier Bichat (751182101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Activité physique et adipocytokines (relations transversales et longitudinales à l'adiposité, ainsi qu'à d'autres facteurs de risque cardiovasculaire chez l'enfant et l'adulte en population générale)

LE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF

Reliability of bioimpedance analysis compared with other adiposity measurements in children: the FLVS II Study.: Bioimpedance fat measurement in children

OBJECTIVE: To evaluate the reproducibility of the measurement of% body fat by bipedal biometrical impedance analysis (BIA) compared with anthropometric measurements of adiposity in children and the correlations between these methods in children and adults.METHODS: A cross-sectional study in a total of 1080 adults and children enrolled in 1999 in the Fleurbaix-Laventie Ville Sant?I (FLVS II) population-based study in northern France. The reproducibility of anthropometrical and BIA methods was determined by a nested analysis of variance of repeated measurements by 2 investigators and a bipedal BIA device (Tanita TBF 310) in 64 pupils of two 5th grade classes. The correlation of BIA and anthropometric adiposity measurements with the unknown relative fat mass or volume of the body estimated by a latent adiposity variable (LAV) was established by the triads' method in 1080 subjects of the FLVS II cohort.RESULTS: The reproducibility was similar for the sum of skinfolds, waist circumference and BIA% fat measurements (intraclass correlation coefficients: 0.979-0.992). Correlation coefficient between BIA body fat% and the LAV was higher than 0.86 in all sex and Tanner stage related groups, and similar in children and adults, except in pubertal boys (0.76).CONCLUSION: With a high level of reproducibility, foot-to-foot BIA analysis provides a valuable measurement of total% fat for epidemiologic studies in children. However further studies are needed before extrapolating these results to overweight children

Septic Shock Caused by Ochrobactrum anthropi in an Otherwise Healthy Host

Reported is a case of life-threatening septic shock that occurred in an otherwise healthy host after administration of a peripheral venous infusion of a solution contaminated with Ochrobactrum anthropi, an unusual human pathogen. The rapid onset of shock may have been due to a large inoculum caused by nonsterile practices at the time of reconstitution

Growth curves of anthropometric indices in a general population of French children and comparison with reference data.

Background:The description of growth patterns of the different anthropometric measurements mainly used in epidemiological studies is useful to better understand the development of obesity in children and its consequences.Objective:Our aim was to establish growth curves of anthropometric indices in a general population of French children born during the 1980s and to compare them with the French reference curves based on children born in the 1950s.Design:As part of the Fleurbaix Laventie Ville Sant?tudies I and II (FLVS), 441 girls and 467 boys were examined at least twice between 1993 and 2001. Height, weight and four skinfold thicknesses were measured. Body mass index (BMI), sum of peripheral and truncal skinfolds and truncal-to-peripheral ratio were calculated. Mean growth curves from ages 5 to 17 years were assessed for these indices, calculating means and 95% confidence interval per 1 year age group and by gender.Results:Trajectories with age differed importantly according to the index considered; BMI was the one with the smallest difference between genders and the most linear shape with age. From the age of 5 years and after, the FLVS children were on average taller and had a higher subcutaneous adiposity than children born 30 years earlier. Truncal-to-peripheral ratio was higher in our population; this difference became more marked with puberty in girls.Discussion:This study suggests the existence of a secular trend towards a precocious accelerated growth, and a more truncal adiposity distribution, especially in girls. It is a disquieting trend considering its expected consequences on adult health.European Journal of Clinical Nutrition advance online publication, 5 July 2006; doi:10.1038/sj.ejcn.1602474