La vie privée du médecin généraliste pendant la consultation, côté patient. Étude qualitative par entretien semi-dirigés

Introduction : La relation médecin-patient est une relation complexe. De nombreuses études s’y intéressent mais peu abordent la place et l’influence de la vie privée du médecin dans cette relation, particulièrement du côté patient.Objectif : Étudier selon le point de vue des patients la survenue d’éléments de la vie privée du médecin, analyser leurs influences, l’importance qu’ils leurs accordent, et étudier leurs impacts sur la prise en charge.Matériel et Méthode : Étude qualitative menée par entretiens semi-dirigées auprès de patients, enregistrés, retranscris de façon exhaustive, analysés par la méthode de théorisation ancrée avec codage en double aveugle ouvert et axial, suivi d’une analyse thématique du codage.Résultats : 20 patients ont été inclus du 01/10/2014 au 31/01/2015. La vie privée du médecin intervient dans la consultation par sa personnalité, ses expériences, ses convictions. Elle survient lors d’échanges relationnels, indispensables à la construction d’une relation de confiance. Selon eux, le médecin doit savoir mêler compétences professionnelles et compétences relationnelles pour une optimisation de la relation thérapeutique. Sa connaissance améliore la relation en rapprochant médecin et patient, en humanisant le médecin, optimisant leur prise en charge. Cependant des limites à cette connaissance et à ces échanges, pouvant être source d’une ambigüité dans la relation, ont été posées par les patients désirant maintenir une consultation centrée sur eux.Conclusion : La vie privée du médecin généraliste façonne sa manière de consulter et d’échanger avec ses patients. La perception de cette vie privée par les patients peut améliorer la relation thérapeutique

Relevance of cortisol and copeptin blood concentration changes in an experimental pain model

International audienceAbstract The effect of pain and analgesics on stress biomarkers is not well studied. We evaluated the effect of acute pain and analgesics on serum cortisol and copeptin in an experimental pain model in healthy volunteers. Healthy volunteers presented at 8 a.m. for an experimental pain stimulation. Cortisol and copeptin levels were measured before, during and after electrophysiological stimulation, first before and then during opioid delivery. Difference in biomarker levels compared to baseline levels was calculated, and potential influencing factors were evaluated by linear regression analysis. Cortisol decreased by 13% during the 10 min of rest at baseline, but copeptin did not change significantly. Cortisol had a median decrease of −24% or −83 nmol/l (−44 to −124 nmol/l, p = 0.0002) during the electrophysiological stimulation training session, while the median difference for copeptin was −22% or −1.01 pmol/l (−2.35 to 0.08 pmol/l, p = 0.0003). After administration of opioids, cortisol did not decrease but increased by 3% (p = 0.043), indicating an increasing opioids effect on cortisol. This effect was not visible for copeptin (median change −0.003 pmol/l (−0.50 to 0.24), p = 0.45). In this experimental pain model performed in the morning, moderate pain did not have a relevant effect on cortisol or copeptin levels, whereas opioids led to a discrete peak of cortisol. Clinicaltrials.gov identifier: NCT01975753 (registered on November 5, 2013, before start of recruitment)

Rare predicted loss-of-function variants of type I IFN immunity genes are associated with life-threatening COVID-19

BackgroundWe previously reported that impaired type I IFN activity, due to inborn errors of TLR3- and TLR7-dependent type I interferon (IFN) immunity or to autoantibodies against type I IFN, account for 15-20% of cases of life-threatening COVID-19 in unvaccinated patients. Therefore, the determinants of life-threatening COVID-19 remain to be identified in similar to 80% of cases.MethodsWe report here a genome-wide rare variant burden association analysis in 3269 unvaccinated patients with life-threatening COVID-19, and 1373 unvaccinated SARS-CoV-2-infected individuals without pneumonia. Among the 928 patients tested for autoantibodies against type I IFN, a quarter (234) were positive and were excluded.ResultsNo gene reached genome-wide significance. Under a recessive model, the most significant gene with at-risk variants was TLR7, with an OR of 27.68 (95%CI 1.5-528.7, P=1.1x10(-4)) for biochemically loss-of-function (bLOF) variants. We replicated the enrichment in rare predicted LOF (pLOF) variants at 13 influenza susceptibility loci involved in TLR3-dependent type I IFN immunity (OR=3.70[95%CI 1.3-8.2], P=2.1x10(-4)). This enrichment was further strengthened by (1) adding the recently reported TYK2 and TLR7 COVID-19 loci, particularly under a recessive model (OR=19.65[95%CI 2.1-2635.4], P=3.4x10(-3)), and (2) considering as pLOF branchpoint variants with potentially strong impacts on splicing among the 15 loci (OR=4.40[9%CI 2.3-8.4], P=7.7x10(-8)). Finally, the patients with pLOF/bLOF variants at these 15 loci were significantly younger (mean age [SD]=43.3 [20.3] years) than the other patients (56.0 [17.3] years; P=1.68x10(-5)).ConclusionsRare variants of TLR3- and TLR7-dependent type I IFN immunity genes can underlie life-threatening COVID-19, particularly with recessive inheritance, in patients under 60 years old