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Bérar A, Balusson F, Allain JS. Factitious disorder imposed on self: A retrospective study of 2232 cases from health insurance databases. Gen Hosp Psychiatry 2023; 85:114-119. [PMID: 37862960 DOI: 10.1016/j.genhosppsych.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE Patients with factitious disorder imposed on self (FDIS) seek medical care for deliberately falsified problems. Although a large amount of work has been published, the scientific literature lacks robust data on FDIS. The present study aimed to estimate the annual mean of in-hospital FDIS codings in France, describe the sociodemographic characteristics of subjects with FDIS, assess healthcare utilisation and medical nomadism, and describe the pathologies most frequently associated with FDIS. METHOD Subjects with at least one coding of FDIS in French health insurance databases between January 1, 2009, and December 31, 2017 were included. Subjects younger than 18 years of age at the time of first coding were excluded from the study. Sociodemographic data of subjects and diagnoses associated with the first coding of FDIS were collected. Healthcare utilisation and medical nomadism were analysed descriptively from one year before to one year after the first FDIS coding. RESULTS 2232 subjects were included, representing an average of 248 new in-hospital FDIS codings per year. The subjects included were 58.2% female. The mean age at diagnosis was 48.5 years. In the year following the first coding of FDIS, 1268 subjects (56.8%) were re-hospitalised at least once, including 159 (7.1%) with at least one new coding for FDIS. From one year before to one year after the first coding of FDIS, 66% of the subjects included had received at least one prescription for benzodiazepines, 58.3% for antidepressants, and 42.6% for antipsychotics. CONCLUSIONS Our findings bring new data working towards a better understanding of FDIS. The consumption of psychotropic drugs is particularly frequent in patients with FDIS.
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Affiliation(s)
- Antoine Bérar
- Department of Internal Medicine, Rennes University Hospital, F-35000 Rennes, France; University of Rennes, F-35000 Rennes, France.
| | - Frédéric Balusson
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - Jean-Sébastien Allain
- Department of Polyvalent Medicine, Groupe Hospitalier Bretagne Sud, F-56100 Lorient, France
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Launay O, Cachanado M, Luong LB, Ninove L, Lachâtre M, Ghezala IB, Bardou M, Schmidt-Mutter C, Lacombe K, Laine F, Allain JS, Botelho-Nevers E, Tavolacci MP, Chidiac C, Pavese P, Dussol B, Priet S, Deplanque D, Touati A, Curci L, Konate E, Hamouda NB, Besbes A, Nubret E, Capelle F, Berard L, Rousseau A, Tartour E, Simon T, Lamballerie XD, Felten R, SURGERS L. 1954. Immunogenicity against SARS CoV-2 ancestral strain and variants of two new COVID-19 recombinant adjuvanted vaccines compared to BNT162b2 as a third dose following two doses of BNT162b2: a single-blinded multicenter randomized controlled trial. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
New adjuvanted recombinant protein vaccines against coronavirus disease 2019 (COVID-19) as heterologous boosters could maximize the benefits of vaccination against SARS CoV-2.
Methods
In this randomized, single-blinded, multicenter trial, adults who had received two doses of Pfizer-BioNTech mRNA vaccine (BNT162b2) 3–7 months before were randomly assigned to receive a boost of BNT162b2, Sanofi/GSK SARS-CoV-2 adjuvanted recombinant protein MV D614 (monovalent parental formulation) or SARS-CoV-2 adjuvanted recombinant protein MV B.1.351 vaccine (monovalent Beta formulation). The primary endpoint was the percentage of subjects with a ≥ 10-fold increase in neutralizing antibody titers for the Wuhan (D614) and B.1.351 (Beta) SARS-CoV-2 viral strains between D0 and D15.
Results
The percentages of participants whose neutralizing antibody titers against the Wuhan (D614) SARS-CoV-2 strain increased by a factor ≥ 10 between Day 0 and Day 15 was 55.3% (95% CI 43.4-66.7) in MV(D614) group (n=76), 76.1% (64.5-85.4) in MV(Beta) group (n=71) and 63.2% (51.3-73.9) in BNT162b2 group (n=76). These percentages were 44.7% (33.3-56.6), 84.5% (74.0-92.0) and 51.3% (39.6-63.0) for the B.1.351 (Beta) viral strain, respectively. Higher neutralizing antibodies rates against Delta and Omicron BA.1 variants were also elicited after Sanofi/GSK MV(Beta) vaccine compared to the other vaccines. Comparable reactogenicity profile was observed the three vaccines. Table 1.Characteristics of patients at inclusion (per-protocol population).Figure 2.Neutralizing antibodies against D614 (wild-type; Wuhan) SARS-CoV-2 and variants Beta, Delta and Omicron BA.1 at D0, D15 and D28 after the boost dose (“post D3”)with Sanofi/GSK-D614, Sanofi/GSK-B.1.351 or BNT162b2 (per-protocol population); dotted line represents the positivity threshold.Figure 4.Rates and grades of severity of solicited adverse events reported from D0 to D7 by participants from the three randomized groups of the safety population (G1, Sanofi/GSK-D614; G2, Sanofi/GSK-B.1.351; G3, BNT162b2) according to the Toxicity Grading Scale for Healthy Adult and Adolescent Volunteers Enrolled in Preventive Vaccine Clinical Trials (Modified FDA scale/September 2007)
Conclusion
All three vaccines boosted antibodies and neutralizing response after BNT162b2 initial course. Heterologous boosting with the Sanofi/GSK SARS-CoV-2 adjuvanted recombinant protein vaccine B.1.351 (Beta formulation) provided higher neutralizing antibodies response rates against variants, including Omicron BA.1, compared with the mRNA BNT162b2 vaccine.
Disclosures
Odile Launay, MD, PhD, AstraZeneca: Financial|GlaxoSmithKline: Advisor/Consultant|GlaxoSmithKline: Grant/Research Support|Johnson & Johnson: Advisor/Consultant|Johnson & Johnson: Grant/Research Support|MD: Advisor/Consultant|Moderna: Advisor/Consultant|MSD: Data safety monitoring board|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant|Sanofi Pasteur: Grant/Research Support|Sanofi Pasteur: Data safety monitoring board Liem Binh Luong, MD, Pfizer: Advisor/Consultant|Pfizer: Honoraria Karine Lacombe, MD, PhD, Gilead: Advisor/Consultant|Janssen: Grant/Research Support|MSD: Grant/Research Support|ViiV Healthcare: Grant/Research Support Elisabeth Botelho-Nevers, MD, PHD, Janssen: Board Member|Pfizer: Board Member|Sanofi Pasteur: Board Member.
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Affiliation(s)
- Odile Launay
- Université Paris Cité; Inserm F-CRIN , I-REIVAC; Assistance Publique Hôpitaux de Paris, Paris, Ile-de-France , France
| | - Marine Cachanado
- Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB) , APHP, Hôpital St Antoine, Paris, France, Paris, Ile-de-France , France
| | - Liem Binh Luong
- AP-HP, Hôpital Cochin; Inserm CIC 1417 , Paris , France ; , France, Paris, Ile-de-France , France
- Inserm, F-CRIN, I REIVAC/COVIREIVAC , Paris , France ; , France, Paris, Ile-de-France , France
| | - Laetitia Ninove
- Unité des Virus Emergents, UVE : Aix Marseille Univ, IRD 190, INSERM 1207, IHU Méditerranée Infection , 13005, Marseille, France, Marseille, Provence-Alpes-Cote d'Azur , France
| | - Marie Lachâtre
- AP-HP, Hôpital Cochin; Inserm CIC 1417 , Paris , France ; , France, Paris, Ile-de-France , France
- Inserm, F-CRIN, I REIVAC/COVIREIVAC , Paris , France ; , France, Paris, Ile-de-France , France
| | - Inès Ben Ghezala
- Inserm, CIC 1432, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, University Hospital , Dijon , France ; , France, Dijon, Bourgogne , France
- F-CRIN, I REIVAC/COVIREIVAC , Dijon , France ; , France, Dijon, Bourgogne , France
| | - Marc Bardou
- Inserm, CIC 1432, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, University Hospital , Dijon , France ; , France, Dijon, Bourgogne , France
- F-CRIN, I REIVAC/COVIREIVAC , Dijon , France ; , France, Dijon, Bourgogne , France
| | - Catherine Schmidt-Mutter
- CIC Inserm 1434, Hôpitaux Universitaires de Strasbourg , France ; , France, Strasbourg, Alsace , France
- F-CRIN, I REIVAC/COVIREIVAC , France ; , France, Strasbourg, Alsace , France
| | - Karine Lacombe
- Sorbonne Inserm UMR-S1136, Hôpital St Antoine , AP-HP, Paris , France ; , France, Paris, Ile-de-France , France
- F-CRIN, I REIVAC/COVIREIVAC , AP-HP, Paris , France ; , France, Paris, Ile-de-France , France
| | - Fabrice Laine
- INSERM, CIC1414 , CHU Rennes, Rennes , France ; , France, Rennes, Bretagne , France
- F-CRIN, I REIVAC/COVIREIVAC , CHU Rennes, Rennes , France ; , France, Rennes, Bretagne , France
| | - Jean-Sébastien Allain
- INSERM, CIC1414 , CHU Rennes, Rennes , France ; , France, Rennes, Bretagne , France
- F-CRIN, I REIVAC/COVIREIVAC , CHU Rennes, Rennes , France ; , France, Rennes, Bretagne , France
| | - Elisabeth Botelho-Nevers
- Service d’infectiologie , CIC1408, Inserm, CHU de Saint-Etienne, 42055 Saint-Etienne , France ; , France, Saint Etienne, Auvergne , France
- F-CRIN, I REIVAC/COVIREIVAC , CIC1408, Inserm, CHU de Saint-Etienne, 42055 Saint-Etienne , France ; , France, Saint Etienne, Auvergne , France
| | - Marie-Pierre Tavolacci
- Normandie Univ , UNIROUEN, U1073, CHU Rouen, and CIC-CRB 1404, F-76000 Rouen , France ; , France, Rouen, Haute-Normandie , France
- F-CRIN, I REIVAC/COVIREIVAC , UNIROUEN, U1073, CHU Rouen, and CIC-CRB 1404, F-76000 Rouen , France ; , France, Rouen, Haute-Normandie , France
| | - Christian Chidiac
- 13. Maladies Infectieuses, GHN Croix Rousse, Hospices Civils de Lyon, UFR de Médecine et Maïeutique Lyon Sud Université Claude Bernard Lyon1, Université de Lyon , CIRI PHE3ID, Inserm U1111 UMR5308 - ENS Lyon; F-CRIN, I REIVAC/COVIREIVAC, France, Lyon, Rhone-Alpes , France
| | - Patricia Pavese
- Maladies infectieuses et tropicales , CHU de Grenoble Alpes , France ; , France, Grenoble, Rhone-Alpes , France
- Inserm, F-CRIN, I REIVAC/COVIREIVAC , CHU de Grenoble Alpes , France ; , France, Grenoble, Rhone-Alpes , France
| | - Bertrand Dussol
- CIC 14-09, INSERM - Aix Marseille Université – Hôpitaux Universitaires de Marseille; Inserm, F-CRIN, I REIVAC/COVIREIVAC , France, Marseille, Provence-Alpes-Cote d'Azur , France
| | - Stéphane Priet
- Unité des Virus Émergents, UVE: Aix Marseille Univ , IRD 190, INSERM 1207, Marseille, France, Marseille, Provence-Alpes-Cote d'Azur , France
| | - Dominique Deplanque
- Univ. Lille, Inserm, CHU Lille, CIC 1403 - Centre d’investigation clinique , F-59000 Lille , France ; , France, Lille, Nord-Pas-de-Calais , France
- F-CRIN, I REIVAC/COVIREIVAC , F-59000 Lille , France ; , France, Lille, Nord-Pas-de-Calais , France
| | - Amel Touati
- Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB) , APHP, Hôpital St Antoine, Paris, France, Paris, Ile-de-France , France
| | - Laureen Curci
- AP-HP, Hôpital Cochin; Inserm CIC 1417 , Paris , France ; , France, Paris, Ile-de-France , France
- Inserm, F-CRIN, I REIVAC/COVIREIVAC , Paris , France ; , France, Paris, Ile-de-France , France
| | - Eleine Konate
- AP-HP, Hôpital Cochin; Inserm CIC 1417 , Paris , France ; , France, Paris, Ile-de-France , France
- Inserm, F-CRIN, I REIVAC/COVIREIVAC , Paris , France ; , France, Paris, Ile-de-France , France
| | - Nadine Ben Hamouda
- Service d’Immunologie Biologique, APHP, Hôpital Européen Georges Pompidou , 75015 Paris , France ; , 75006 Paris, France, Paris, Ile-de-France , France
- PARCC, INSERM U970, Université de Paris , 75015 Paris , France ; , 75006 Paris, France, Paris, Ile-de-France , France
| | - Anissa Besbes
- Service d’Immunologie Biologique, APHP, Hôpital Européen Georges Pompidou , 75015 Paris , France ; , 75006 Paris, France, Paris, Ile-de-France , France
- PARCC, INSERM U970, Université de Paris , 75015 Paris , France ; , 75006 Paris, France, Paris, Ile-de-France , France
| | - Eunice Nubret
- APHP, Direction de la Recherche Clinique et de l’Innovation (DRCI) , Paris, France, Paris, Ile-de-France , France
| | - Florence Capelle
- Département des Essais Cliniques de l’AGEPS, DRCI-APHP , Paris, France, Paris, Ile-de-France , France
| | - Laurence Berard
- Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB) , APHP, Hôpital St Antoine, Paris, France, Paris, Ile-de-France , France
| | - Alexandra Rousseau
- Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB) , APHP, Hôpital St Antoine, Paris, France, Paris, Ile-de-France , France
| | - Eric Tartour
- Service d’Immunologie Biologique, APHP, Hôpital Européen Georges Pompidou , 75015 Paris , France ; , 75006 Paris, France, Paris, Ile-de-France , France
- PARCC, INSERM U970, Université de Paris , 75015 Paris , France ; , 75006 Paris, France, Paris, Ile-de-France , France
| | - Tabassome Simon
- Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB) , APHP, Hôpital St Antoine, Paris, France, Paris, Ile-de-France , France
| | - Xavier De Lamballerie
- Unité des Virus Émergents, UVE: Aix Marseille Univ , IRD 190, INSERM 1207, Marseille, France, Marseille, Provence-Alpes-Cote d'Azur , France
| | - Renaud Felten
- Inserm CIC 1434, CHU Strasbourg, Strasbourg, F-CRIN, I REIVAC/COVIREIVAC , Strasbourg, Alsace , France
| | - Laure SURGERS
- Sorbonne Université, IPLESP Inserm UMR-S1136, Hôpital St Antoine , AP-HP, Paris, France - F-CRIN, I REIVAC/COVIREIVAC, Paris, Ile-de-France , France
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Launay O, Cachanado M, Luong Nguyen LB, Ninove L, Lachâtre M, Ben Ghezala I, Bardou M, Schmidt-Mutter C, Lacombe K, Laine F, Allain JS, Botelho-Nevers E, Tavolacci MP, Chidiac C, Pavese P, Dussol B, Priet S, Deplanque D, Touati A, Curci L, Konate E, Ben Hamouda N, Besbes A, Nubret E, Capelle F, Berard L, Rousseau A, Tartour E, Simon T, de Lamballerie X. Immunogenicity and Safety of Beta-Adjuvanted Recombinant Booster Vaccine. N Engl J Med 2022; 387:374-376. [PMID: 35767474 PMCID: PMC9258749 DOI: 10.1056/nejmc2206711] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Fabrice Laine
- Centre Hospitalier Universitaire (CHU) Rennes, Rennes, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Eunice Nubret
- Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | - Eric Tartour
- Hôpital Européen Georges Pompidou, Paris, France
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Bérar A, Bouzillé G, Jego P, Allain JS. A descriptive, retrospective case series of patients with factitious disorder imposed on self. BMC Psychiatry 2021; 21:588. [PMID: 34814866 PMCID: PMC8609835 DOI: 10.1186/s12888-021-03582-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 11/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite cases of factitious disorder imposed on self being documented in the literature for decades, it appears to remain an under-identified and under-diagnosed problem. The present study aimed to explore factitious disorder imposed on self in a series of French patients. METHODS Patients 18 years old and over with factitious disorder imposed on self were retrospectively included by two independent reviewers according to DSM-5 criteria in Rennes University Hospital for the period 1995 to 2019. Patients were identified from a clinical data warehouse. RESULTS 49 patients with factitious disorder imposed on self were included. Among them, 36 (73.5%) were female. The average age at diagnosis was 38.4 years. The 16 patients with a health-related profession were all female. Direct evidence of falsification was found in 20.4% of cases. Falsification was mainly diagnosed on the basis of indirect arguments: history of factitious disorder diagnosed in another hospital (12.2%), extensive use of healthcare services (22.4%), investigations that were normal or inconclusive (69.4%), inconsistent or incomplete anamnesis and/or patient refusal to allow access to outside information sources (20.4%), atypical presentation (59.2%), evocative patient behaviour or comments (32.7%), and/or treatment failure (28.6%). Dermatology and neurology were the most frequently involved specialities (24.5%). Nine patients were hospitalized in intensive care. Some of them received invasive treatments, such as intubations, because of problems that were only reported or feigned. The diagnosis of factitious disorder imposed on self was discussed with the patient in 28 cases (57.1%). None of them admitted to making up the disorder intentionally. Two suicide attempts occurred within 3 months after the discussion of the diagnosis. No deaths were recorded. 44.9% of the patients returned to the same hospital at least once in relation to factitious disorder imposed on self. CONCLUSIONS The present study reinforces data in favour of a predominance of females among patients with factitious disorder imposed on self. This diagnosis is difficult and is based on a range of arguments. While induced cases can be of low severity, cases that are only feigned can lead to extreme medical interventions, such as intubation.
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Affiliation(s)
- Antoine Bérar
- Univ Rennes 1, CHU Rennes, Service de Médecine Interne et Immunologie Clinique, 2 rue Henri Le Guilloux, 35 033, Rennes, France.
| | - Guillaume Bouzillé
- grid.410368.80000 0001 2191 9284Univ Rennes, CHU Rennes, INSERM, LTSI – UMR 1099, Rennes, France
| | - Patrick Jego
- grid.411154.40000 0001 2175 0984Univ Rennes 1, CHU Rennes, Service de Médecine Interne et Immunologie Clinique, Inserm, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - Jean-Sébastien Allain
- grid.411154.40000 0001 2175 0984CHU Rennes, Service de Médecine Interne et Immunologie Clinique, Inserm, CIC 1414, F-35000 Rennes, France ,grid.477854.d0000 0004 0639 4071CH Saint Malo, F-35400 Saint Malo, France
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Le Boedec A, Anthony N, Vigneau C, Hue B, Laine F, Laviolle B, Bonnaure-Mallet M, Bacle A, Allain JS. Gender inequality among medical, pharmaceutical and dental practitioners in French hospitals: Where have we been and where are we now? PLoS One 2021; 16:e0254311. [PMID: 34242351 PMCID: PMC8270123 DOI: 10.1371/journal.pone.0254311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/23/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Women are under-represented in senior academic and hospital positions in many countries. The authors aim to assess the place and the evolution of all appointed female and male health practitioners' working in French public Hospitals. MATERIALS AND METHODS Data of this observational study were collected from the National Management Centre (Centre National de Gestion) from 2015 up to January 1, 2020. First, the authors described demographic characteristics and specialties of all appointed medicine, pharmacy, and dentistry doctors' working as Hospital Practitioners, Associate Professors, and Full Professors in French General and University-affiliated Hospitals in 2020. Then, they retrospectively reported the annual incidence of new entrance according to gender and professional status from 1999 to 2019 thanks to the appointment date of all practitioners in activity between 2015 and 2020. RESULTS In 2020, 51 401 appointed practitioners (49.7% of female) were in activity in French public hospitals with a large majority being medical doctors (92.4%) compared to pharmacists (6%) and dentists (1.6%). Women represented 52.5% of the Hospital Practitioners, 48.6% of the Associate Professors, and 22.0% of the Full Professors (p < 0.001). There were disparities between the rates of female Full Professors in medicine (20.6%), pharmacy (36.1%), and dentistry (44.3%, p < 0.001). Women were appointed Hospital Practitioners and Associate Professors earlier than men (respectively 37.1 versus 38.8 years, p < 0.001 and 36.1 versus 36.5 years, p = 0.04), and at a later age among Full Professors (43.7 versus 41.9 years, p < 0.001). Compared to men, the annual proportion of appointed women varied significantly between 1999 and 2019 from 47.6% to 60.4% for Hospital Practitioners, from 50.0% to 44.6% for Associate Professors, and from 11.2% to 33.3% for Full Professors (p < 0.001 for trend). CONCLUSIONS Although more and more women occupy positions in French hospitals, there is still a gender gap regarding access to Full Professor status in medicine and pharmacy, but not in dentistry. The disparity in numbers makes comparison difficult. Despite a trend towards gender equality during the last twenty years, it has not yet been achieved regarding access to the highest positions.
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Affiliation(s)
- Antoine Le Boedec
- Department of Ophthalmology, Rennes University Hospital, Rennes, France
- Rennes 1 University, France
| | - Norah Anthony
- Methodological Support and Biostatistics Unit, University Hospital, Saint Denis, Reunion Island, France
- National Institute of Health and Medical Research (INSERM), Clinical Investigation Center 1410 Saint Pierre, Reunion Island, France
| | - Cécile Vigneau
- Rennes 1 University, France
- Department of Nephrology, Rennes University Hospital, Rennes, France
- National Institute of Health and Medical Research (INSERM), IRSET-UMR_S 1085, France
| | - Benoit Hue
- Department of Pharmacy, Rennes University Hospital, Rennes, France
| | - Fabrice Laine
- Clinical Investigation Unit, Rennes University Hospital, Rennes, France
- Department of Hepatology, Rennes University Hospital, Rennes, France
- National Institute of Health and Medical Research (INSERM), Clinical Investigation Center1414, France
| | - Bruno Laviolle
- Rennes 1 University, France
- Clinical Investigation Unit, Rennes University Hospital, Rennes, France
- National Institute of Health and Medical Research (INSERM), Clinical Investigation Center1414, France
| | - Martine Bonnaure-Mallet
- Rennes 1 University, France
- Department of Dental Surgery, Rennes University Hospital, Rennes, France
- National Institute of Health and Medical Research (INSERM), U1241 NuMeCAn, France
| | - Astrid Bacle
- Rennes 1 University, France
- National Institute of Health and Medical Research (INSERM), IRSET-UMR_S 1085, France
- Department of Pharmacy, Rennes University Hospital, Rennes, France
| | - Jean-Sébastien Allain
- Clinical Investigation Unit, Rennes University Hospital, Rennes, France
- National Institute of Health and Medical Research (INSERM), Clinical Investigation Center1414, France
- Internal Medicine, Cardiovascular and Metabolism Division, Saint Malo Hospital, Saint Malo, France
- * E-mail:
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Péan de Ponfilly-Sotier M, Jachiet V, Benhamou Y, Lahuna C, De Renzis B, Kottler D, Voillat L, Dimicoli-Salazar S, Banos A, Chauveheid MP, Alexandra JF, Grignano E, Liferman F, Laborde M, Broner J, Michel M, Lambotte O, Laribi K, Venon MD, Dussol B, Martis N, Thepot S, Park S, Couret D, Roux-Sauvat M, Terriou L, Hachulla E, Bally C, Galland J, Allain JS, Parcelier A, Peterlin P, Cohen-Bittan J, Regent A, Ackermann F, Le Guen J, Algrin C, Charles P, Daguindau E, Puechal X, Dunogue B, Blanchard-Delaunay C, Beyne-Rauzy O, Grobost V, Schmidt J, Le Gallou T, Dubos-Lascu G, Sonet A, Denis G, Roy-Peaud F, Fenaux P, Adès L, Fain O, Mekinian A. Venous thromboembolism during systemic inflammatory and autoimmune diseases associated with myelodysplastic syndromes, chronic myelomonocytic leukaemia and myelodysplastic/myeloproliferative neoplasms: a French multicentre retrospective case-control study. Clin Exp Rheumatol 2021; 40:1336-1342. [DOI: 10.55563/clinexprheumatol/nbn38d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Marie Péan de Ponfilly-Sotier
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Paris, France
| | - Vincent Jachiet
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Paris, France
| | - Ygal Benhamou
- Normandie Université, UNIROUEN, Service de Médecine Interne, INSERM U1096, Rouen, France
| | - Constance Lahuna
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Paris, France
| | - Benoit De Renzis
- CHU de Clermont-Ferrand, Service d’Hématologie, Clermont-Ferrand, France
| | - Diane Kottler
- CHU Bichat APHP, Service de Dermatologie, Paris, France
| | - Laurent Voillat
- CH Chalon sur Saône, service d’Hématologie-Oncologie, Chalon sur Saône, France
| | | | - Anne Banos
- CH de la Côte Basque, Service d’Hématologie, Bayonne, France
| | | | | | | | | | | | | | - Marc Michel
- CHU Henri Mondor APHP, Service de Médecine Interne, Créteil, France
| | - Olivier Lambotte
- Paris Saclay Université, CHU Kremlin-Bicêtre, Service de Médecine Interne, Le Kremlin Bicêtre, France
| | - Kamel Laribi
- CH Le Mans, Service d’Hématologie, Le Mans, France
| | | | - Bertrand Dussol
- CHU Hôpital de la Conception APHM, Service de Néphrologie, Marseille, France
| | - Nihal Martis
- CHU de Nice Côte d’Azur, Service de Médecine Interne, Nice, France
| | | | - Sophie Park
- CHU Grenoble, Service d’Hématologie, Grenoble, France
| | - David Couret
- CH de Cornouailles Quimper Concarneau, Service de Médecine Interne-Maladies Infectieuses, Maladies du Sang, Quimper, France
| | - Marielle Roux-Sauvat
- CH Pierre-Oudot Groupe Hospitalier Nord Dauphiné, Service de Médecine Interne, Bourgoin-Jallieu, France
| | - Louis Terriou
- Université de Lille, Hôpital Claude Huriez, Service de Médecine Interne et Immunologie Clinique, Lille, France
| | - Eric Hachulla
- Université de Lille, Hôpital Claude Huriez, Service de Médecine Interne et Immunologie Clinique, Lille, France
| | - Cécile Bally
- CHU Necker-Enfants Malades APHP, Service d’Hématologie Adultes, Paris, France
| | - Joris Galland
- CH Bourg-En-Bresse, Service Médecine Interne, Bourg-En-Bresse, France
| | - Jean-Sébastien Allain
- CHU Rennes, Service de Médecine Interne et Immunologie Clinique, Inserm, CIC 1414, Rennes, France
| | - Anne Parcelier
- CHU de Nantes, Service d’Hématologie Clinique, Nantes, France
| | - Pierre Peterlin
- CHU de Nantes, Service d’Hématologie Clinique, Nantes, France
| | | | | | | | - Julien Le Guen
- CHU Hôpital Européen Georges Pompidou APHP, Service de Gériatrie, Paris, France
| | - Caroline Algrin
- Institut de Cancérologie Daniel Hollard Groupe Hospitalier Mutualiste de Grenoble, Service d’Oncologie, Grenoble, France
| | - Pierre Charles
- Institut Mutualiste Montsouris, Service de Médecine Interne, Paris, France
| | | | | | | | | | - Odile Beyne-Rauzy
- Institut Universitaire du Cancer de Toulouse, Service de Médecine Interne et Immunopathologie Clinique, Toulouse, France
| | - Vincent Grobost
- CHU Estaing de Clermont-Ferrand, Service de Médecine Interne, Clermond-Ferrand, France
| | - Jean Schmidt
- CHU Amiens Nord, Service de Médecine Interne, Amiens, France
| | - Thomas Le Gallou
- CHU Rennes, Service de Médecine Interne et Immunologie Clinique, Inserm, CIC 1414, Rennes, France
| | | | - Anne Sonet
- CHU UCL Namur-Site Godinne, Service d’Hématologie, Yvoir, Belgium
| | - Guillaume Denis
- CH de la Rochelle, Service de Médecine Interne et Hématologie, La Rochelle, France
| | - Frédérique Roy-Peaud
- CHU de Poitiers, Service de Médecine Interne-Maladies infectieuses et Tropicales, Poitiers, France
| | - Pierre Fenaux
- CHU Saint-Louis APHP, Service d’Hématologie Clinique, Université Paris VII, Paris, France
| | - Lionel Adès
- CHU Saint-Louis APHP, Service d’Hématologie Clinique, Université Paris VII, Paris, France
| | - Olivier Fain
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Paris, France
| | - Arsène Mekinian
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Paris, France.
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Le Marec J, Henique H, Rubenstein E, Bigot A, Puyade M, Urbanski G, Lozac’h P, Allain JS, Bayer G, Fain O, Lioger B. Absence of impact of hypovitaminosis C on the bleeding phenotype of primary immune thrombocytopenia: a French prospective multicenter study. Platelets 2020; 31:1101-1103. [DOI: 10.1080/09537104.2020.1732326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Julien Le Marec
- Department of Internal Medicine, CHRU de Tours, Tours, France
| | - Hélène Henique
- Department of Internal Medicine, CHRU de Tours, Tours, France
| | - Emma Rubenstein
- Department of Internal Medicine and Systemic Diseases, Saint-Louis Hospital, Paris VII University, Paris, France
| | - Adrien Bigot
- Department of Internal Medicine, CHRU de Tours, Tours, France
| | - Mathieu Puyade
- Department of Internal Medicine, CHU de Poitiers, Poitiers, France
| | | | - Pierre Lozac’h
- Department of Internal Medicine, CHU d’Angers, Angers, France
| | - Jean-Sébastien Allain
- Department of Internal Medicine and Clinical Immunology, CHU de Rennes, Rennes, France
- Pôle CVM, Centre hospitalier de Saint Malo, France
| | - Guillaume Bayer
- Department of Internal Medicine, Claude Galien Private Hospital, Quincy-sous-Sénart, France
| | - Olivier Fain
- Department of Internal Medicine, Saint-Antoine Hospital, AP-HP, DHUi2B, Sorbonne University, Paris, France
| | - Bertrand Lioger
- Department of Internal Medicine and Systemic Diseases, Saint-Louis Hospital, Paris VII University, Paris, France
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Roupie AL, Guedon A, Terrier B, Lahuna C, Jachiet V, Regent A, de Boysson H, Carrat F, Seguier J, Terriou L, Versini M, Queyrel V, Groh M, Benhamou Y, Maurier F, Ledoult E, Clech LL, D'Aveni M, Rossignol J, Galland J, Willems L, Chiche NJ, Peterlin P, Roux-Sauvat M, Parcelier A, Wemeau M, Lambert M, Belizna C, Puechal X, Swiader L, Cohen-Valensi R, Noc V, Dao E, Thepot S, de Frémont GM, Tanguy-Schmidt A, Koka AM, Bussone G, Philipponnet C, Konate A, Cavaille G, Guilpain P, Allain JS, Broner J, Solary E, Ruivard M, de Renzis B, Corm S, Baati N, Schleinitz N, Ponsoye M, Stamatoullas-Bastard A, Ades L, Dellal A, Tchirkov A, Aouba A, Fenaux P, Fain O, Mekinian A. Vasculitis associated with myelodysplastic syndrome and chronic myelomonocytic leukemia: French multicenter case-control study. Semin Arthritis Rheum 2020; 50:879-884. [PMID: 32896704 DOI: 10.1016/j.semarthrit.2020.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/13/2020] [Accepted: 07/06/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Our objective was to evaluate characteristics, treatment and outcome of vasculitis associated with myelodysplastic syndrome (MDS) and chronic myelomonicytic leukemia (CMML) PATIENTS AND METHODS: Retrospective descriptive analysis of MDS/CMML-related vasculitis and comparison with MDS/CMML patients without dysimmune features. RESULTS Seventy patients with vasculitis and MDS/CMML were included, with median age of 71.5 [21-90] years and male/female ratio of 2.3. Vasculitis was diagnosed prior to MDS/CMML in 31 patients (44%), and after in 20 patients. In comparison with MDS/CMML without autoimmune/inflammatory features, vasculitis with MDS/MPN showed no difference in MDS/CMML subtypes distribution nor International Prognostic Scoring System and CMML-specific prognostic (IPSS/CPSS) scores. Vasculitis subtypes included Giant cell arteritis in 24 patients (34%), Behçet's-like syndrome in 11 patients (20%) and polyarteritis nodosa in 6 patients (9%). Glucocorticoids (GCs) were used as first-line therapy for MDS/CMML vasculitis in 64/70 patients (91%) and 41 (59%) received combined immunosuppressive therapies during the follow-up. After a median follow-up of 33.2 months [1-162], 31 patients (44%) achieved sustained remission. At least one relapse occurred in 43 patients (61%). Relapse rates were higher in patients treated with conventional Disease Modifying Anti-Rheumatic Drug (DMARDs) (odds ratio 4.86 [95% CI 1.38 - 17.10]), but did not differ for biologics (odds ratio 0.59 [95% CI 0.11-3.20]) and azacytidine (odds ratio 1.44 [95% CI 0.21-9.76]) than under glucocorticoids. Overall survival in MDS/CMML vasculitis was not significantly different from MDS/CMML patients without autoimmune/inflammatory features (p = 0.5), but acute leukemia progression rates were decreased (log rank <0.05). CONCLUSION This study shows no correlation of vasculitis diagnoses with subtypes and severity of MDS/CMML, and no significant impact of vasculitis on overall survival. Whereas conventional DMARDs seem to be less effective, biologics or azacytidine therapy could be considered for even low-risk MDS/CMML vasculitis.
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Affiliation(s)
- Anne Laure Roupie
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Sorbonne Université, Paris, France; Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Alexis Guedon
- Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine - National Reference Center for Rare and Systemic Autoimmune Diseases, Assistance Publique - Hôpitaux deAP-HP, Hôpital Cochin, Université de Paris, Paris, France
| | - Constance Lahuna
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Sorbonne Université, Paris, France; Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Vincent Jachiet
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Sorbonne Université, Paris, France; Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Alexis Regent
- Department of Internal Medicine - National Reference Center for Rare and Systemic Autoimmune Diseases, Assistance Publique - Hôpitaux deAP-HP, Hôpital Cochin, Université de Paris, Paris, France
| | - Hubert de Boysson
- Department of Internal Medicine, CHU Caen, Avenue de la côte de nacre, 14033 Caen, France
| | - Fabrice Carrat
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP Sorbonne Université, Hôpital Saint Antoine, 75012 Paris, France
| | - Julie Seguier
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Marseille, Hôpital La Timone, Marseille, France
| | - Louis Terriou
- Department of Internal Medicine, CHU Lille, Lille, France
| | | | | | - Matthieu Groh
- Department of Internal Medicine, National Referral Center for Hypereosinophilic Syndromes (CEREO), Foch Hospital, Suresnes, France
| | - Ygal Benhamou
- Department of Internal Medicine, CHU Rouen, Rouen, France
| | - Francois Maurier
- Department of Internal Medicine, Hôpitaux Privés de Metz, Metz, France
| | - Emmanuel Ledoult
- Department of Internal Medicine and Clinical Immunology, CHU Lille, Lille, France
| | | | - Maud D'Aveni
- Department of Hematology, CHU Nancy, Nancy, France
| | - Julien Rossignol
- Department of Hematology, Gustave Roussy Cancer Center, 94805, Villejuif, France
| | - Joris Galland
- Department of Internal Medicine, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Lise Willems
- Department of Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, 75014 Paris, France
| | - Noemie Jourde Chiche
- Department of Nephrology, Centre de Néphrologie et de Transplantation Rénale, Assistance Publique-Hôpitaux de Marseille, Hôpital La Conception, Marseille, France
| | | | | | - Anne Parcelier
- Department of Hematology, Centre Hospitalier Bretagne Atlantique, Vannes, France
| | | | - Marc Lambert
- Department of Internal Medicine, CHU Lille, Lille, France
| | - Cristina Belizna
- Department of Vascular Medicine, CHU d'Angers, UMR-CNRS 6015 INSERM 1083, Angers, France
| | - Xavier Puechal
- Department of Internal Medicine - National Reference Center for Rare and Systemic Autoimmune Diseases, Assistance Publique - Hôpitaux deAP-HP, Hôpital Cochin, Université de Paris, Paris, France
| | - Laure Swiader
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Marseille, Hôpital La Timone, Marseille, France
| | - Rolande Cohen-Valensi
- Department of Internal Medicine, CH de Martigues Hôpital des Rayettes, Martigues, France
| | - Valérie Noc
- Department of Nephrology, CH Hyères, Hyères, France
| | - Emmanuel Dao
- Department of Nephrology, CH Hyères, Hyères, France
| | | | | | | | | | - Guillaume Bussone
- Department of Internal Medicine, Hôpital Antoine Béclère, Clamart, France
| | | | - Amadou Konate
- Department of Internal Medicine, CHU Montpellier, Montpellier, France
| | - Guilhem Cavaille
- Department of Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, 75014 Paris, France
| | - Philippe Guilpain
- Department of Internal Medicine, CHU Montpellier, Montpellier, France
| | - Jean-Sébastien Allain
- Department of Internal Medicine and Clinical Immunology, CHU Lille, Lille, France; Pôle cardio vasculaire et métabolisme, CH Saint-Malo, Saint-Malo, France
| | - Jonathan Broner
- Department of Internal Medicine, CHU de Nîmes, Nîmes, France
| | - Eric Solary
- Department of Hematology, Gustave Roussy Cancer Center, 94805, Villejuif, France
| | - Marc Ruivard
- Department of Internal Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Benoit de Renzis
- Department of Hematology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Sélim Corm
- Department of Hematology, Médipôle de Savoie, Charles Les Eaux, France
| | - Nadia Baati
- Department of Hematology, CH Strasbourg, Strasbourg, France
| | - Nicolas Schleinitz
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Marseille, Hôpital La Timone, Marseille, France
| | - Matthieu Ponsoye
- Department of Internal Medicine, CHU Ambroise Paré, Boulogne- Billancourt, France
| | | | - Lionel Ades
- Department of Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Azeddine Dellal
- Department of Rheumatology, Montfermeil Hospital, 93370 Montfermeil, France
| | - Andrei Tchirkov
- Department of Medical Cytogenetics, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Achille Aouba
- Department of Internal Medicine, CHU Montpellier, Montpellier, France
| | - Pierre Fenaux
- Department of Medical Cytogenetics, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Olivier Fain
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Sorbonne Université, Paris, France; Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Arsène Mekinian
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Sorbonne Université, Paris, France; Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France.
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Abstract
RATIONALE 3-Methoxyphencyclidine (3-MeO-PCP) is a new psychoactive substance derived from phencyclidine. Although it can lead to severe intoxications, the main manifestations and optimal management have not been well characterized. Here, we report 2 cases of 3-MeO-PCP intoxication in the same patient, and summarize the manifestations of this intoxication reported in literature. PATIENT CONCERNS A 17-year-old male purchased a bag of 3-MeO-PCP on the Internet but took an oral dose (200 mg) that corresponds to the less active isomer 4-MeO-PCP. He developed high blood pressure (158/131 mm Hg), tachycardia (100 bpm), and neurological manifestations (confusion, hypertonia, nystagmus, and then agitation). A maculopapular rash appeared, although this may have been related to the administration of midazolam. Hyperlactatemia (2.6 mmol/L) was the main laboratory finding. Seven days later, he returned to the emergency department after sniffing 50 mg of 3-MeO-PCP. High blood pressure, tachycardia, and neurological manifestations (psychomotor impairment and dysarthria) were present but less severe than after the first intoxication. DIAGNOSIS In the first intoxication, the blood and urine 3-MeO-PCP concentrations were, respectively, 71.1 ng/mL and 706.9 ng/mL. Conventional toxicity tests were all negative. In the second intoxication, biological samples were not available. INTERVENTIONS In the first intoxication, treatment consisted of intravenous hydration and midazolam. The patient was transferred to an intensive care unit for monitoring. After the second intoxication, he was monitored for 12 hours. OUTCOMES The patient's condition improved quickly in both cases. LESSONS These cases provide additional information on the manifestations of 3-MeO-PCP intoxication. These manifestations are mainly cardiovascular (high blood pressure, tachycardia) and neurological. The fact that second (50 mg) intoxication was less severe than the first (200 mg) is suggestive of a dose-effect relationship for 3-MeO-PCP. The first case also emphasizes the risk of dosing errors caused by the similarity between the names "3-MeO-PCP" and "4-MeO-PCP."
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Affiliation(s)
- Antoine Berar
- CHU Rennes, Department of Forensic Medicine
- CHU Rennes, Department of Internal Medicine and Clinical Immunology
| | - Jean-Sébastien Allain
- CHU Rennes, Department of Internal Medicine and Clinical Immunology
- CIC-P 1414 Clinical Investigation Center, Inserm
| | | | | | | | - Isabelle Morel
- CHU Rennes, Department of Forensic Toxicology
- Université de Rennes, INRA, Inserm, Institut NuMeCan – UMR_A 1341, UMR_S 1241
| | - Renaud Bouvet
- CHU Rennes, Department of Forensic Medicine
- Université de Rennes, IDPSP – EA 4640, Rennes, France
| | - Thomas Gicquel
- CHU Rennes, Department of Forensic Toxicology
- Université de Rennes, INRA, Inserm, Institut NuMeCan – UMR_A 1341, UMR_S 1241
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