Poisoning exposure from non-pharmaceutical products in residents of structured living facilities

International audienceObjective The objectives of this study were to describe poisonings occurring in older or disabled patients residing in structured living facilities, identify risk factors, and propose preventive measures. Method This was a prospective and observational study, covering all cases of poisoning occurring in structured living facilities in the Brittany region of France. All calls were received at the Grand Ouest Poison Control Centre (PCC) of Angers and were recorded from 1 February 2019 to 31 January 2020. The clinical severity of the poisonings was assessed using the Poisoning Severity Score (PSS). Clinical severity was compared by univariate and multivariate analyses using the following dependent variables: PSS score < 2 and PSS >= 2. Results This study included 158 residents with a median age of 83 years (5-116 years old). The average number of residents supervised by a member of the supervisory staff was 11 (+/-10.7). The substance ingested was a personal hygiene product or a cleaning product in 48% and 25% of cases, respectively. The most frequently ingested product was a bar of soap (n = 20). All moderate to severe cases (4.6%, n = 8 including one death) occurred in residents with dementia living in nursing homes for elderly patients, and 9% of residents required hospital treatment. In more than 50% of cases (n = 83), the product was provided by the facility and in 23% (n = 40), it was brought in by the family. Ingestion of a bar of soap or a product brought in by the family was significantly associated with higher poisoning severity (PSS >= 2). After adjustment for age, sex and the number of residents per supervisor, the severity of poisoning was significantly greater after ingestion of a bar of soap (OR = 12.33, CI95 [2.12, 71.63], p = 0.005). Conclusion Older adults residing in medical facilities who have a history of dementia and/or cognitive impairment are more at risk of non-medicinal product poisoning. Clinical severity and the hospitalisation rate were greater when bar soap was ingested

Les erreurs médicamenteuses en établissement médico-social : étude prospective sur un an

National audienc

Accompagner les réseaux DEPHY-FERME et DEPHY EXPE dans la caractérisation de l’effet des systèmes de culture sur la flore adventice

National audienceTo characterize weed pressure in agricultural fields of the DEPHY Ecophyto networks, the "weeds" working group of the CASIMIR project, helped by crop and weed experts working for the french crop institutes, developed two methods (CASIMIR DEPHY­FARM and CASIMIR DEPHY­EXPE) to survey weeds in main crops. The objectives of these methods are: (i) with short­term concern, assess the efficacy of farming practices to manage weeds within the crop season, (ii) with long­term concern, assess the effect of cropping system (farming practices and crop sequence) on the dynamic of the weed communities. The CASIMIR DEPHY­FARM method is based on walk away surveys made within a 2000­m² reference plot where the trained person walks across the survey area (“W” path). The weeds are identified and their density is visually assessed using a "Barralis" modified scale. Their dominant phenological stages are also recorded. This simple and quick method intends to be used in the DEPHY FARM network. The CASIMIR DEPHY­EXPE method is based on surveys performed on eight 16­m² plots with one quadrat in each. Weed species are identified. The density of each species is visually estimated with a "Barralis" modified scale within the 16­m² plots and precisely counted in the quadrats. On both, the dominant phenological stage of each species is recorded. At the end of the second surveys, the above ground biomass of each weed and crop species is yield to assess the crop­weed competition. This method which is more complex and time­consuming intends to be used in the DEPHY EXPE network. Surveys are performed twice a year: firstly before winter weedings (in winter crops) or before post­emergence weeding (in spring crops) to observe emerging flora; then before the closed­canopy occurred to assess the flora competed crop. To design these methods, the CASIMIR project benefited from the expertise of the RMT Florad. To assess their feasibility, methods were performed in the RotAB and Rés0Pest networks. They are also discussed and criticized by engineers of the DEPHY networks and other professionals from agriculture through a web survey.Afin de caractériser la pression des communautés adventices dans les parcelles agricoles des réseaux DEPHY, le groupe de travail « adventices » du projet CASIMIR, avec la collaboration d’experts de la profession et des utilisateurs potentiels, propose deux protocoles à destination de la filière Grande Culture. Les objectifs de ces protocoles sont de : (i) évaluer à court terme l’effet des pratiques agricoles (à l’échelle de l’itinéraire technique) et leurs performances en matière de gestion des communautés adventices, (ii) évaluer à long terme l’effet du système de culture sur l’évolution des communautés adventices. Le protocole CASIMIR DEPHY­FERME : l’observation est réalisée sur une station de référence de 2000m², dans laquelle l’observateur circule en effectuant un W. Il identifie les adventices, leur attribue une note visuelle de densité via l’utilisation de l’échelle « Barralis » modifiée et renseigne le stade phénologique dominant de chaque espèce adventice. Ce protocole simple et peu chronophage est à destination du réseau DEPHY FERME. Le protocole CASIMIR DEPHY­EXPE : l’observation est réalisée sur huit stations de 16m², ainsi que sur un quadrat positionné à l’intérieur de chacune des stations. Après avoir identifié les espèces adventices, dans la station, l’observateur note la densité avec l’échelle « Barralis » modifiée. Puis dans le quadrat, il complète son observation en réalisant un comptage du nombre d’individus par espèce. Lors de chaque notation le stade phénologique dominant est renseigné. Enfin, un relevé de biomasse est effectué pour évaluer l’importance de la compétition des adventices sur la culture. Ce protocole plus précis et plus long à mettre en œuvre est à destination du réseau DEPHY EXPE. Les observations sont réalisées deux fois par an : avant les désherbages de sortie d’hiver pour les cultures d’hiver ou avant les désherbages de post­levée pour les cultures de printemps afin de faire un état des lieux de la flore présente; puis avant la fermeture du rang ou la floraison afin de voir l’intensité de la compétition avec la culture. Ce travail a bénéficié de l’expertise du RMT Florad. Pour vérifier leur faisabilité, les protocoles ont été testés dans les réseaux RotAB et Rés0Pest. Ils ont également été discutés et critiqués avec les ingénieurs des réseaux DEPHY et d’autres professionnels de l’agriculture via une enquête web

Risks of addictive clay or kaolin consumption in pregnant women: Three cases reports

National audienceIn the literature, a chronic consumption of kaolin potentially exposes pregnant women to two risks: iron deficiency anemia/micronutrient deficiency and heavy metal poiso-ning. The consequences for the fetus and the newborn are still very little documented in the literature. We therefore report the cases of 3 pregnant women who consumed aluminum sili-cate, in the form of kaolin or coomba, as a cultural practice and Pica syndrome. The first case was documented by qualitative and quantitative analysis of a sample of the consumed kaolin. Quantitative analysis of the kaolin consumed by patient 1 showed a very high content of alumi-nium and a high content of copper, vadanium and lead. Only one patient out of the 3 presented an iron deficiency anemia with a normal blood lead level. The others had no repercussions. The Poison Control Center retrospectively followed up on these pregnant women to determine the progress of the delivery and the absence of complications in the newborn. These follow-ups indicated uncomplicated deliveries and normal birth weight. Despite the very high aluminum content of patient 1's sample, the risk of occurrence of chronic effects related to aluminum remains minimal given the low exceedance of the health reference values according to the European Food Safety Authority (EFSA). (C) 2023 Societe Francaise de Toxicologie Analytique. Published by Elsevier Masson SAS. All rights reserved

Comment on: amanitin intoxication

International audienc

Renal Safety Profile of BCR-ABL Tyrosine Kinase Inhibitors in a Real-Life Setting: A Study Based on Vigibase^®, the WHO Pharmacovigilance Database

Background: Alongside their BCR-ABL specificity, TKIs used in chronic myeloid leukemia also target other tyrosine kinases expressed in the kidney such as PDGFR, c-KIT, SRC, and VEGFR, which may result in specific renal adverse drug reaction (ADR). To evaluate the renal safety profile in real-life conditions, a case/non-case study was performed on VigiBase®, the WHO global safety database. Methods: From 7 November 2001 to 2 June 2021, all cases in which the involvement of imatinib, dasatinib, nilotinib, bosutinib, and ponatinib was suspected in the occurrence of renal ADR were extracted from VigiBase®. Disproportionality analyses were assessed using the reporting odds ratio. Results: A total of 1409 cases were included. Imatinib accounts for half of the reported cases. A signal of disproportionate reporting (SDR) of renal failure and fluid retention was found for the five TKIs. Only dasatinib and nilotinib were related to an SDR for nephrotic syndrome. Nilotinib and ponatinib were related to an SDR for renal artery stenosis, while dasatinib was related to an SDR for thrombotic microangiopathy. No SDR for tubulointerstitial nephritis was observed. Conclusion: This study identified a new safety signal, nephrotic syndrome, for nilotinib and highlights the importance of post-marketing safety surveillance

Cyclopeptide mushroom poisoning: A retrospective series of 204 patients

International audienceCyclopeptide mushroom poisoning is responsible for 90%-95% of deaths from macrofungi ingestion. The main objectives of this study are to describe cases of cyclopeptide mushroom poisoning and to determine risk factors that may influence the severity/mortality of poisoned patients. We included all cases of amatoxin toxicity reported to two French Poison Centers from 2013 through 2019. We compared the severity with the Poison Severity Score (PSS) and the outcomes of patients using simple logistic regression and multinomial logistic regression. We included 204 cases of amatoxin toxicity. More than three-quarters developed an increase in AST and/or ALT (78.1%), and over half developed a decrease in prothrombin ratio (<70%: 53%) and/or Factor V (<70%: 54%). One-third developed an acute renal injury (AKI). Twelve patients (5.9%) developed post-poisoning sequelae (persistent kidney injury more than 1 month after ingestion and liver transplant). Five patients (2.5%) received a liver transplant, and nine died (4.4%). The mean time to onset of digestive disorders was shorter in PSS2 and PSS3-4 patients (10.9 +/- 3.9/11.3 +/- 6.3 h) than in PSS1 patients (14 +/- 6.5 h; p < 0.05). Patients who died or developed post-poisoning sequelae had more frequent cardiovascular comorbidities compared with recovered patients (60.0% versus 29.5%; p < 0.01)

Développements méthodologiques pour une CAractérisation SIMplifiée des pressIons biotiques et des Régulations biologiques - CASIMIR

Ce numéro comprend les articles issus du colloque de restitution Ecophyto Recherche « Des outils et des dispositifs pour éclairer les décisions, explorer les possibles et accompagner la transition vers des systèmes économes et multi-performants », qui s’est tenu à Saint-Malo, du 22 au 24 mars 2017.The objective of the CASIMIR project is to propose protocols to characterise the evolution of pests, their damage and the intensity of biological regulation in agricultural plots in order to evaluate the effect of cropping systems. In collaboration with the DEPHY network, the CASIMIR project proposes simplified protocols for monitoring weeds, diseases and pests in several agricultural sectors, as well as a tool to help design sampling strategies and a prototype guideline to realise an agronomic diagnosis of biotic pressures by simple and rapid procedures to be implemented. The project also aimed to study the establishment and intensity of biological regulations in field crop systems with little or no pesticides. New methods of trapping and sampling have been tested on Rés0Pest sites in order to link functional biodiversity to the intensity of biological regulation.L’objectif du projet CASIMIR est de proposer des protocoles de caractérisation de l’évolution desbioagresseurs, de leurs dégâts et de l’intensité de la régulation biologique dans les parcelles agricolesafin d’évaluer l’effet des systèmes de culture. En collaboration avec le réseau DEPHY, le projetCASIMIR propose des protocoles simplifiés de suivi des adventices, maladies et ravageurs dansplusieurs filières agricoles ainsi qu’un outil d’aide à la conception de stratégies d’échantillonnage et unprototype de guide permettant de réaliser un diagnostic agronomique des pressions biotiques grâce àdes modes opératoires simples et rapides à mettre en oeuvre. Le projet avait aussi pour objectif,d’étudier la mise en place et l’intensité des régulations biologiques dans des systèmes de grandescultures avec peu ou pas de pesticides. De nouvelles méthodes de piégeage et d’échantillonnage ontété testées sur les sites Rés0Pest afin de faire le lien entre biodiversité fonctionnelle et intensité desrégulations biologiques

Temporal trends in calls for suicide attempts to poison control centers in France during the COVID-19 pandemic: a nationwide study

International audienceConcerns have been raised about early vs. later impacts of the COVID-19 pandemic on suicidal behavior. However, data remain sparse to date. We investigated all calls for intentional drug or other toxic ingestions to the eight Poison Control Centers in France between 1st January 2018 and 31st May 2022. Data were extracted from the French National Database of Poisonings. Calls during the study period were analyzed using time trends and time series analyses with SARIMA models (based on the first two years). Breakpoints were determined using Chow test. These analyses were performed together with examination of age groups (<= 11, 12-24, 25-64, >= 65 years) and gender effects when possible. Over the studied period, 66,589 calls for suicide attempts were received. Overall, there was a downward trend from 2018, which slowed down in October 2019 and was followed by an increase from November 2020. Number of calls observed during the COVID period were above what was expected. However, important differences were found according to age and gender. The increase in calls from mid-2020 was particularly observed in young females, while middle-aged adults showed a persisting decrease. An increase in older-aged people was observed from mid-2019 and persisted during the pandemic. The pandemic may therefore have exacerbated a pre-existing fragile situation in adolescents and old-aged people. This study emphasizes the rapidly evolving situation regarding suicidal behaviour during the pandemic, the possibility of age and gender differences in impact, and the value of having access to real-time information to monitor suicidal acts

Adverse Drug Reaction-Related to Drug Shortage: A Retrospective Study on the French National Pharmacovigilance Database

International audienceAIM: Drug shortage is a growing global health issue. The aim of the study was to evaluate the consequences of drug shortages on patient safety based on data recorded in the French Pharmacovigilance Database. METHODS: All cases involving drug shortages reported from 1985 to the end of 2019 were extracted from the database. RESULTS: Following the selection process, 462 cases were included. The number of cases increased significantly from 2004 to 2019. Cases mainly involved drugs from the nervous system (22.1%, CI95[17.5;27.0]), the cardiovascular system (16.4%, CI95[11.9;21.4]), and anti-infectives for systemic use (14.3%, CI95[9.7;19.2]) ATC classes. Most of the cases reported an adverse drug reaction (ADR) belonging to the SOC nervous system (21%, CI95[18;24]), skin and subcutaneous (14%, CI95[11;17]), general (13%, CI95[10;17]), and gastrointestinal (8%, CI95[5;11]) disorders. Disease worsening was observed in 15.9% of the cases, mostly related to a lack of efficacy of the replacement drug. Half of the cases were considered as serious. Evolution was favourable in 79.4% of the cases. Death and/or life-threatening situations were reported in 5.8% of the cases. Medication errors (ME) were identified in 51 cases (11%), mostly occurring at the administration step and involving a human factor. CONCLUSION: This study emphasises the clinical impact of drug shortage in terms of ADRs, ME and inefficiency. These observations underline the importance of a global health policy programme to limit the occurrence of drug shortages and to reinforce the information provided to patients and health care professionals in this context to limit risk