Adaptation de posologie des quinolones en réanimation par approche de population

La première partie de la thèse a été consacrée à l'analyse pharmacocinétique de population de la ciprofloxacine chez les patients en réanimation et une optimisation, via des simulations pharmacocinétiques/pharmacodynamiques, de sa posologie par rapport aux probabilités de guérison clinique et de développement de résistance. En se basant sur le concept de la fenêtre de sélection des mutants, l'usage de la ciprofloxacine en réanimation contre P. aeruginosa et A. baumannii est remis en question par rapport à l'émergence de résistance. La deuxième partie, plus méthodologique, était centrée sur les outils d'évaluation de modèles en pharmacocinétique de population. Après avoir mis en évidence les limites des Visual Predictive Checks (VPC) et des outils connexes, ce travail visait à développer un nouvel outil graphique exact pour l'évaluation de ces modèles : les Visual Predictive Extended Residuals (VIPER). Les VIPER ont montré de bonnes performances comme outil d'évaluation sans présenter la plupart des lacunes liées aux outils type VPC.The first part of the thesis was devoted to the population pharmacokinetic analysis of ciprofloxacin in intensive care unit (ICU) patients and further optimisation, through pharmacokinetic/pharmacodynamic simulation studies, of ciprofloxacin dosing with respect to clinical outcome and the development of bacterial resistance. Based on the mutant selection window concept, our simulations truly question the use of ciprofloxacin for the treatment of P. aeruginosa and A. baumannii infections in ICU patients due to the potential for developing resistance. The second part of the thesis was more methodological and focused on model evaluation tools for population pharmacokinetic/pharmacodynamic models. After highlighting the shortcomings of the Visual Predictive Checks (VPC) and related methods, we developed a new exact graphical tool (VIsual Predictive Extended Residuals or VIPER) which showed good performances and allowed to overcome many of VPC-related issues

Evaluation of discharge instructions among hospitalized Lebanese patients

Background: Hospital readmissions are considered as the primary indicator of insufficient quality of care and are responsible of increasing annual medical costs by billions of dollars. Different factors tend to reduce readmissions, particularly instructions at discharge. Objectives: Our study objective was to evaluate discharge instructions given to hospitalized Lebanese patients and associated factors. Methods: Two hundred patients, aged between 21 and 79 years and admitted to the emergency department, were recruited from a Lebanese university hospital. Discharge instructions were evaluated by a face-to-face interview to fill a questionnaire with the patients immediately after their final contact with the physician or nurse in charge. We mainly focused on medications instructions and created two scores related to “instructions given” and “instructions appropriate” to later conduct bivariate analysis. Results: We found that discharge instructions were not completely given to all our study population. The degree of appropriateness fluctuated between 25% and 100%. The instructor in charge of giving discharge instructions had its significant influence on medication instructions given (p=0.014). In addition, the instructor and his experience influenced the degree of “appropriate instructions”. In fact, our study showed that despite being capable of giving good medication advice, nurses’ instructions were significantly less effective in comparison with physicians, fellows and residents. However, nurses gave 52% of the instructions, which questions the quality of those instructions. Conclusions: In conclusion, our observational study showed that in a Lebanese university hospital, patients’ understanding of discharge instructions is poor. Careful attention should be drawn to other hospitals as well and interventions should be considered to improve instructions quality and limit later complications and readmissions. The intervention of clinical pharmacists and their medication-related advice might be crucial in order to improve instructions’ quality

Mise au point sur les réactions d'hypersensibilité immédiate et tardive aux produits de contraste iodés

Le recours à des actes radiologiques utilisant des produits de contraste iodés (PCI) est devenu fréquent lors de la prise en charge de patients. En dehors des accidents liés à leur toxicité, on décrit des réactions d'hypersensibilité immédiate et des réactions d'hypersensibilité de type retardé apparaissant de 1 heure à quelques jours après. L'injection de produits iodés, principaux pourvoyeurs des réactions allergiques, justifie l'identification des sujets à risque. Les facteurs de risque de réactions anaphylactiques ou anaphylactoïdes sont les accidents antérieurs aux PCI, l'asthme, l'atopie et les cardiomyopathies. Le sexe féminin, l'âge et les bêta-bloquants sont des facteurs de gravité. Cet article a pour but de résumer les risques "allergiques" liés à l'utilisation des PCI et proposer une attitude diagnostique, thérapeutique et préventive en fonction des situations cliniques rencontrées

Drug-related Problems Among Type 2 Diabetic Patients With Hypertension in a Tertiary Care Hospital in Lebanon: A Cross-sectional Study

Background: Patients with type 2 diabetes (T2D) often have other associated comorbidities, making them susceptible to drug-related problems (DRPs) which can adversely affect their quality of life. Understanding these problems can provide baseline data to allow informed health decisions and effective management of patients.  Objectives: This study aims to investigate DRPs in T2D patients with hypertension and find the predictors of these problems.  Methods: This cross-sectional study was conducted for six months in the internal medicine department of a tertiary care hospital in Lebanon. Participants were 135 adult T2D patients with hypertension who were receiving one or more anti-diabetes drugs, and at least one medication for hypertension. Pharmaceutical care network europe classification system was used to classify the DRPs. Data were collected by two clinical pharmacists using a self-report tool. Results: Most of patients were female. Most of them (94.1%) had at least one DRP (1.43±0.72 per patient). “Non-optimal drug treatment effect” was the most frequent problem (48.2%). Achieving the HbA1C target reduced the odds of this problem by 66.6%, while the increased serum creatinine level caused a two-fold increase in this problem. The use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers reduced the odds of DRPs by 86.2% and 83.3%, respectively, while lipid-lowering and anti-anginal drug use caused a four-fold increase in DRPs.  Conclusion: Early identification of DRPs in diabetic patients with hypertension and their associated factors can help improve their management and reduce the associated mortality and morbidity rates

Passage des benzodiazépines dans le lait maternel : aspects cliniques et analytiques

Objectif: Valider la méthode de dosage par HPLC des benzodiazépines dans le lait afin d'évaluer l'exposition du nourrisson allaité et mettre en place un suivi thérapeutique. Méthodes: La linéarité, le rendement d'extraction, la répétabilité et la reproductibilité sur trois jours du diazépam, desméthyldiazépam, bromazépam, oxazépam et lorazépam ont été étudiés avec trois matrices différentes, du lait de vache Candia$^{\circledR }$, du lait lyophilisé pour nourrissons O-Lac Enfamil$^{\circledR }$ et du lait maternel. Le midazolam a été utilisé comme étalon interne. Le système chromatographique a consisté en une colonne Nucléosil avec un détecteur UV (254 nm). Le débit de la pompe était réglé à 1,2 mL/min avec une durée d'acquisition de 20 min. Résultats: La linéarité allait de 50 à 5000 ng/mL pour diazépam, bromazépam et lorazépam, et de 100 à 10 000 ng/mL pour desméthyldiazépam et oxazépam ($r^{2} > 0{,}99$). Le rendement d'extraction était de l'ordre de 100 % (± 15 %) pour chaque benzodiazépine testée. Coefficients de variation (CV) et biais intra-jour et inter-jour des cinq benzodiazépines allaient de –15,3 % à 17,4 %. Conclusion : La méthode validée est simple, rapide et applicable à des échantillons réels de lait maternel contenant des benzodiazépines

Public Awareness of Environmental Risk Factors of Cancer Among the Lebanese General Population: Public awareness of cancer risk factors

Introduction: Since the majority of cancers occur as a result of modifiable risk factors, cancer is being seen more as a preventable disease. The primary objective of our study was to assess the level of awareness of environmental risk factors for cancer among the Lebanese general population. The secondary objective focused on identifying the predictors of the preventability of the disease. Methods: We conducted a cross-sectional study between June and July 2020. An online questionnaire was used to collect data pertaining to the knowledge of environmental risk factors of cancer, source of information and personal practice of the participants. Bivariate and multivariate analyzes were performed. Results: About 387 respondents agreed to participate in the study. study showed low awareness regarding infectious agents, lifestyle, diet and many work exposures. The predictors of the attitude of respondents regarding the preventability of cancer were: believing that cancer has an environmental cause (p=.014), not having a healthy lifestyle (p=.004), not smoking waterpipe (p=.023), being single (p=.013), and having a university degree (p=.049). Conclusions: Efforts should be made to improve awareness of the cancer risk factors regarding infectious agents, lifestyle, diet and many work exposures. This can also be followed by further studies assessing the impact of these community and governmental cancer prevention initiatives on cancer risk factors level of awareness

Optimizing ciprofloxacin dosing in intensive care unit patients through the use of population pharmacokinetic-pharmacodynamic analysis and Monte Carlo simulations

Objectives: To explore different ciprofloxacin dosage regimens for the treatment of intensive care unit (ICU)patients with respect to clinical outcome and the development of bacterial resistance for the major Gramnegativepathogens.Methods: A population pharmacokinetic model was first developed on ciprofloxacin serum concentrationsobtained in 102 ICU patients. Then, based on this model, pharmacokinetic–pharmacodynamic Monte Carlosimulations (MCSs) were carried out to explore the appropriateness of different ciprofloxacin dosage regimensin ICU patients. The defined targets were free AUC24/MIC ≥90 h (as a predictor of clinical outcome) and TMSW≤20% (as a predictor of selecting resistance), where TMSW is the time spent within the mutant selection windowover 24 h. Two simulation trials were conducted: Trial 1 took into account the whole MIC distribution for eachcausative pathogen in line with empirical antibiotherapy; Trial 2 used MIC breakpoints given by the AntibiogramCommittee of the French Microbiology Society in order to treat the ‘worst-case’ scenario.Results: Trial 1 showed that for Pseudomonas aeruginosa and Acinetobacter baumannii, the common dosageregimens of 400 mg twice or three times a day did not achieve the desired target attainment rates (TARs) withrespect to TMSW, while suboptimal TARs were found for AUC24/MIC. Trial 2 showed that ≤18% of patientsreached the target of TMSW ≤20% for MIC breakpoints of 0.5 and 1 mg/L, regardless of the administered dose.Conclusions: Based on the mutant selection window concept, our simulations truly question the use of ciprofloxacinfor the treatment of P. aeruginosa and A. baumannii infections in ICU patients due to the potential fordeveloping resistance

Factors related to autonomy among Lebanese women: a web-based cross-sectional study

International audienceBackground: Autonomy involves making independent decisions and creating lasting and equitable power relationships within families. Many factors, dependent on both the woman and her partner, can influence self-dependence, and subsequent decision-making, exerting a protective or triggering effect on its development. Therefore, the primary objective of the study was to assess autonomy in a sample of Lebanese women. The secondary objective was to evaluate the association between socioeconomic status, psychological factors, and autonomy. Methods: A web based cross-sectional online study was conducted between June 8 and August 1, 2020. The questionnaire developed on Google Forms was distributed through social media and WhatsApp groups, using the snowball technique. The Women's Autonomy Index (WAI) was created using three items adapted from a previous study. In addition, the Composite Abuse Scale Revised-Short Form (CASR-SF) was used to assess three domains of abuse: physical, sexual, and psychological. The Perceived stress scale short version to measure stress perception, the Lebanese Anxiety Scale to measure anxiety and the Patient Health Questionnaire (PHQ-9) to assess depression. The Statistical Package for the Social Sciences (SPSS) software version 25 was used for data analysis. Linear regressions were performed, taking the Women's Autonomy Index as the dependent variable. Results: The sample consisted of 369 Lebanese women. University education level (beta = 1.263), alcohol consumption (beta = 0.586), intermediate income level (beta = 0.702), high income (beta = 0.911), employment (beta = 0.559), and older age (beta = 0.033) were significantly associated with higher WAI. Living in South Lebanon (beta = − 0.668) and being Druze (beta = − 323) were associated with lower WAI. Significantly higher mean scores of anxiety and perceived stress were found among women with low autonomy. Conclusion: In Lebanon, the autonomy of women depends on several personal and partner-related characteristics (education, socioeconomic status, age), in addition to the cultural (geographic and religious) environment. Furthermore, low autonomy is associated with higher perceived stress and anxiety and probable depression and domestic abuse

sj-docx-1-map-10.1177_27550834231161145 – Supplemental material for Impact of the COVID-19 pandemic on pharmacy practice and on the provision of pharmaceutical care: A cross-sectional study among community pharmacists

Supplemental material, sj-docx-1-map-10.1177_27550834231161145 for Impact of the COVID-19 pandemic on pharmacy practice and on the provision of pharmaceutical care: A cross-sectional study among community pharmacists by Georges Hatem, Sara Ghamloush, Aya Al Chami, Mohammad Chaheen, Dalia Khachman and Sanaa Awada in The Journal of Medicine Access</p

sj-pdf-2-map-10.1177_27550834231161145 – Supplemental material for Impact of the COVID-19 pandemic on pharmacy practice and on the provision of pharmaceutical care: A cross-sectional study among community pharmacists

Supplemental material, sj-pdf-2-map-10.1177_27550834231161145 for Impact of the COVID-19 pandemic on pharmacy practice and on the provision of pharmaceutical care: A cross-sectional study among community pharmacists by Georges Hatem, Sara Ghamloush, Aya Al Chami, Mohammad Chaheen, Dalia Khachman and Sanaa Awada in The Journal of Medicine Access</p