[Reducing the environmental impact of inhalers dispensed in France. From diagnosis to sustainable action]

OBJECTIVES

While inhaled drugs are mainly used to treat chronic respiratory diseases, they are also responsible for greenhouse gas (GHG) emission. To highlight this issue, a dispensed analysis and a carbon footprint evaluation of inhalers in France have been conducted.

METHODS

A national qualitative and quantitative analysis of dispensed inhalers in community pharmacies (CP) and hospitals (H) was conducted in France for 2019. A data review from the literature led to the determination of the inhalers carbon footprint, expressed in carbon dioxide equivalent (CO₂e) during the inhaler life cycle.

RESULTS

Close to 40 million inhalers were dispensed by community pharmacies and one million by hospitals in 2019. It concerned three types of inhalers: metered-dose inhalers (MDI) [CP: 49%; H: 45%], dry powder inhalers (DPI) [CP: 47%; H: 51%], and soft mist inhalers (SMI) [CP: 4%; H: 4%]. According to the literature, MDI have the highest carbon footprint, ranging from 11 to 28 kgCO2e versus less than 1 kgCO2e for DPI/SMI. In 2019, the national carbon footprint of salbutamol (MDI), the most dispensed inhaler, was estimated to be over 310 million kgCO2e (CP+H) corresponding to more than 310,000 round-trip Paris-New York.

CONCLUSIONS

This study shows the involvement of MDI in GHG emissions. Taking actions as part of a global and coordinated approach to limit their environmental impact is possible and thus is a priority.

Surveillance de la bronchiolite à Mayotte : dynamique des épidémies en temps de Covid-19

Introduction

La bronchiolite est une affection virale fréquente chez les enfants de moins de deux ans, atteignant les petites voies aériennes avec une inflammation aiguë des bronchioles, pouvant évoluer vers des difficultés respiratoires importantes. Le virus respiratoire syncitial (VRS) est responsable de plus de 70 % des infections. Le virus se transmet par la salive, les éternuements, la toux et les mains

A Mayotte, la recrudescence saisonnière des cas de bronchiolite débute habituellement en janvier avec le plus souvent un pic épidémique en février et une épidémie qui se termine à la fin de l'été austral. Depuis la survenue de l'épidémie de Covid-19 dont les premiers cas ont été détectés à Mayotte en mars 2020, la saisonnalité des pathologies respiratoires a été fortement modifiée.

Matériels et méthodes

La surveillance épidémiologique de la bronchiolite à Mayotte repose sur deux sources de données. Le réseau de médecins sentinelles, instauré en 2009, rapporte la proportion de consultations pour bronchiolite parmi l'ensemble des consultations en ville et dans les centres de soins rattachés à l'hôpital. Le dispositif de surveillance des passages dans le service d'urgence de l'hôpital de Mayotte, mis en place depuis 2010, suit la proportion de passages pour bronchiolite parmi l'ensemble des passages. Toute l'année, les médecins hospitaliers assurent des prélèvements nasopharyngés et le laboratoire réalise un panel respiratoire permettant de détecter la présence des virus influenza, VRS, rhinovirus et entovirus et metapneumovirus

Résultats

En 2020 l'épidémie de bronchiolite est survenue selon la saisonnalité habituelle entre janvier et mars, avant la première vague de Covid de mai à juin 2020. La seconde vague de Covid-19 est survenue entre janvier et mars 2021 suivie de l'épidémie de bronchiolite qui est survenue avec trois mois de retard et une durée plus longue qu'habituellement de mai à septembre. La période inter-épidémique a été marquée par une circulation plus élevée du VRS chez les moins de deux ans par rapport aux niveaux de base habituellement observés. En 2021-2022 l'épidémie de bronchiolite a débuté dès le mois de décembre de manière précoce et s'est déroulée de manière concomitante avec la troisième vague épidémique de Covid-19 (fin décembre-janvier 2022). Fin février 2022, l'épidémie de bronchiolite 2022 est encore en cours.

Conclusion

Les mesures de prévention de la bronchiolite sont similaires à celles du Covid-19. Le retard de survenue de l'épidémie de 2021 laisse supposer une bonne adhésion de la population aux mesures de prévention lors des premières vagues de Covid-19 sur l'île. En revanche l'étendue de l'épidémie de bronchiolite de 2021 et la survenue de l'épidémie 2022 simultanément à la troisième vague de Covid-19 laissent supposer une lassitude de la population et une moindre application des mesures de protection nécessitant une adaptation de la stratégie de communication.

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Introducing clinical nanorachaeaology: Isolation by co-culture of Nanopusillus massiliensis sp. nov

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The first ever detection in human microbiota of nanoarchaea.

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Detection and co-isolation of nanoarchaea new species in human oral microbiota.

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These data suggest the contribution of methanogens to the perinatal development of intestinal microbiota and physiology.

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Extended our knowledge of human microbiota diversity.

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Opening a new field of research in clinical microbiology here referred to as clinical nanoarchaeology.

Background

Nanoarchaeota, obligate symbiont of some environmental archaea with reduced genomes, have been described in marine thermal vent environments, yet never detected in hosts, including humans.

Methods

Here, using laboratory tools geared towards the detection of nanoarchaea including PCR-sequencing, WGS, microscopy and culture.

Results

We discovered a novel nanoarchaea, Nanopusillus massiliensis, detected in dental plate samples by specific PCR-based assays. Combining fluorescent in situ hybridization (FISH) with scanning electron microscopy disclosed close contacts between N. massiliensis and the archaea Methanobrevibacter oralis in these samples. Culturing one sample yielded co-isolation of M. oralis and N. massiliensis with a 606,935-bp genome, with 23.6% GC encoded 16 tRNA, 3 rRNA and 942 coding DNA sequences, of which 400 were assigned to clusters of orthologous groups.

Conclusion

The discovery of N. massiliensis, made publicly available in collection, extended our knowledge of human microbiota diversity, opening a new field of research in clinical microbiology here referred to as clinical nanoarchaeology.

[French national overview of the inclusion of environmental criteria in the public purchasing of health products (drugs and sterile medical devices)]

OBJECTIVES

Healthcare products (HP) have a significant carbon footprint that must be included by regulation in the facility's purchasing policy. A national overview of the inclusion of environmental criteria (EC) in the public procurement (PP) of HP in hospitals has been carried out.

METHODS

Thirty EC were identified in the literature. Two questionnaires were proposed: (i) for buyers that analyze the level of "importance" and "ease of application" for public tenders (PT), and (ii) for suppliers that declare their commitments and evidence.

RESULTS

Six regional buyers and 28 suppliers participated. Buyers recognize the "importance" of sustainable development (SD) but are more reticent about the "applicability" of EC in PT. The environmental rating remains low: on average 4.38 (0.25-10.00) % of the total rating. Only 12 EC are integrated within some PT. Suppliers report a high and diversified commitment to SD: 18 suppliers sent 474 evidence. Buyers and suppliers converge on the optimization of primary packaging and the establishment of a minimum order or delivery group.

CONCLUSIONS

Since the efficiency of PP is inevitable, EC that combines SD and savings should be prioritized. The integration of additional EC, simple and easily documented, allowing cost containment for both suppliers and buyers, is possible to promote sustainable purchasing.

[Sclerosing pneumocytoma: A rare and benign tumor]

INTRODUCTION

Sclerosing pneumocytoma is a benign and rare lung tumor affecting epithelial cells. In most cases, patients are asymptomatic and the diagnosis is made on an X ray or a CT scan performed for other enquiry. Sex ratio favors women. Epidemiological studies report that middle-aged Asian women are more frequently affected. Radiological investigations find a solitary nodule or a mass with peripheric localization. When performed, histological analysis shows a tumor composed of at least two of the four following architectures: papillary, sclerosing, hemangiomatous and solid, with two types of cells that can be round or cubic cells.

CASES REPORT

We report two cases of multiple sclerosing pneumocytoma in two caucasien men. The first patient was asymptomatic, the second complain from moderate dyspnea. A wedge resection was performed in both, allowing diagnosis. Anatomopathology revealed respectively a predominant sclerosing and solid architecture and a sclerosing and papillary architecture. There was no progression of the other concomitant nodules after three years follow-up.

CONCLUSION

Pneumocytoma is a benign, slow-growing tumor with good prognosis.

Enorma burkinafasonensis sp. nov., a new bacterium isolated from a human gut microbiota

Strain Marseille-P9525^T is a Gram-positive, obligatory anaerobic and non-motile bacterium isolated from a human faecal micobiota. Its phenotypic pattern, including mass spectrometry peptide profile and genome sequence, support the proposal of a new species for which the name Enorma burkinafasonensis sp. nov. is proposed. The type strain has been deposited in a public collection.

Urinary S-PMA related to indoor benzene and asthma in children

INTRODUCTION

Benzene is a ubiquitous pollutant of both indoor and outdoor environments which impacts on respiratory health. Our aim was to relate urinary S-phenylmercapturic acid (S-PMA), a biomarker of benzene exposure, to benzene concentrations and related sources at home and asthma in a population-based sample of children.

METHODS

Exposure to benzene was assessed in the dwellings of 63 children (32 asthmatics and 31 controls) through the identification of sources of benzene and in situ assessments with passive samplers. The determination of urinary S-PMA was obtained by liquid chromatography-mass spectrometry.

RESULTS

At home, asthmatics were significantly more polluted by benzene levels from ambient sampling than controls (p ≤ 0.05). Benzene exposure significantly aggravated asthma symptoms overall in non-atopic children (OR = 10.10; 95% confidence interval: 10.10). Urinary S-PMA was significantly associated with benzene concentrations in the entire population (regression coefficient = 0.28, 95% CI: 0.07-0.49; p < 0.05) and asthma (OR = 7.69; 95% CI: 1.37-42.52 for an increase of 1 µg/g creatinine of urinary S-PMA). However, after adjustment for environmental tobacco smoking exposure, familial allergy, age and sex, the latter relationship was no more significant (OR = 4.95; 95% CI: 0.91-27.4, p < 0.10). Both benzene concentrations and urinary S-PMA concentrations were higher in dwelling built after 1948 and in flats.

CONCLUSIONS

Our study suggests a relationship between childhood asthma and benzene concentrations at home, even at low levels of this pollutant. This was confirmed when considering urinary S-PMA, which was related to both benzene concentrations and asthma. Further epidemiological and toxicological studies are needed to confirm our results.