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The "author-pay" model of open access publication, which appeared in 2002, allocates to the author or his institution the costs of processing articles due to the journal after acceptance, for an amount of a few hundred to several thousand euros. New publishers emerged towards the end of the 2000s, which used this model but with purely commercial objectives, offering naive authors and/or wishing to quickly expand their curriculum vitae by publications in "predatory journals". They are characterized by aggressive e-mail solicitations, lack of ethics, lack of details about the publisher and the editorial board, poor peer review, unspecified and low fees for processing articles, a lack of indexing and the promise of rapid publication., (Copyright © 2021 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)

The deleterious consequences of "predatory" journals are numerous, whether the researcher submitted his work to them naively or knowingly: work little or not read by the international community in the absence of indexing and disappearance of any digital trace in the absence of archiving. The reputation of researchers but also of universities and research organizations and the credit of science for citizens can be sustainably damaged. These open access journals, with the author who pays as model, represent as many resources unavailable for legitimate journals. A joint mobilization of all the actors involved is necessary: researchers, universities and faculties of medicine, sections of the national university council, publishers of legitimate journals, research organizations, learned societies, ethics committees, funders, media and political decision-makers. Publishing in a predatory journal is now a scientific misconduct., (Copyright © 2021 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)

Objectives: To assess the level and factors of compliance of carbapenem prescriptions with guidelines and to determine the impact of an antibiotic stewardship team in a university hospital., Patients and Methods: Five-month prospective study in the intensive care, surgery, and medicine units to measure the compliance of carbapenem prescriptions with guidelines from French scientific societies; compliance was assessed by an infectious disease specialist warned by the pharmacy, and the prescribers' compliance with the infectious disease specialist's advice was then assessed., Results: One hundred and four treatment initiations for 94 patients were included. Prescriptions were mostly empirical (64%), for pulmonary (35%), urinary tract (23%), and intra-abdominal (17%) infections. Prescriptions were mostly made in an intensive care unit (50%), by a junior physician (66%), with the use of imipenem (74%), and were followed by an objective reassessment (80%). Compliance with guidelines (82%) was significantly higher for empirical than documented prescriptions (91% vs 65%, P<0.001). Compliance was higher in intensive care units than medicine units (87% vs 61%, P=0.037). No change in the compliance rate was observed during the study. Compliance with the infectious disease specialist's advice (68%) improved, although not significantly (P=0.066)., Conclusions: Because of a higher than expected compliance of carbapenem prescriptions with guidelines and a lower than expected inclusions in the study, we did not show any impact. The diffusion of guidelines and long-term control of carbapenem prescriptions seem to be possible and necessary in hospitals to limit their ecological impact., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Scientific misconduct (fabrication, falsification, and plagiarism) and detrimental research practices (selective reporting of data, inappropriate citation practice, ghostwriting) are admitted respectively by 2 % and 33 % of researchers. The consequences of scientific misconduct and detrimental research practices are disastrous, both for the doctors, who are the most affected researchers in view of the number of retracted articles, and for the patients, victims of false information that may have health consequences. In order to fight against the causes (promotion of doctors and allocation of resources to clinical wards and laboratories on purely quantitative research criteria, lack of training in scientific integrity in medical studies, heterogenous quality of reviewing, legal impunity), there are legislative, academic, technological and editorial solutions, but radical and urgent cultural change is needed first., (Copyright © 2020 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)

Objective: Although urinary tract infections are the second leading cause of infections among patients aged above 65 years, data on bacterial epidemiology of urinary specimens in these patients is scarce. Our aim was to describe the main bacterial species found at significant levels in urine specimens of the elderly and to determine their antimicrobial resistance profiles., Methods: From October 2012 to October 2015, all urinary specimens (catheter-related or not) received at the laboratory of microbiology of the university hospital of Caen (France) were retrospectively studied. Results were compared to those of urinary specimens of patients aged 18-64 years. Bacterial identification was performed using MALDI-TOF mass spectrometry and antimicrobial susceptibility testing was performed as per CA-SFM guidelines., Results: Out of 33,302 urine cytobacteriological examinations (UCBE) performed in patients aged above 65 years, 13,450 microorganisms were identified. Escherichia coli was the most frequent species (41.8%) followed by Enterococcus faecalis (9.7%), Pseudomonas aeruginosa (5.7%), Proteus mirabilis (4.6%), and Klebsiella pneumoniae (4.2%). Around 9% of E. coli isolates were resistant to third-generation cephalosporins, including 8.2% by production of extended-spectrum β-lactamase (ESBL). This prevalence was significantly higher than that observed in urinary specimens of patients aged 18-74 years (4.9%, P<0.001)., Conclusion: The bacterial epidemiology of urines collected from the elderly is diverse and significantly different from that of urine specimens of younger patients, with a higher proportion of multidrug-resistant bacteria (particularly ESBL-producing E. coli)., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Background: The Hajj is the largest annual mass gathering event in the world, thus favoring the transmission of various infections: 183 different nationalities, high temperatures, coincidence with the start of the flu season in the Northern hemisphere, a long barefoot walk, tent-type accommodation, communal toilet facilities, absence of food control, and sharing of razors. Infections are the first cause of hospital admission, which often occurs in the home country of pilgrims., Methods: Literature review on PubMed from 1952 to November 2015 on the epidemiology and prevention of infections contracted during the Hajj, using the keywords "Hajj" and "infections"., Results: Respiratory tract infections, ENT infections, influenza, pyogenic pneumonia, whooping cough, and tuberculosis are most frequently observed during the Hajj. Outbreaks of meningococcal meningitis have been reported in pilgrims and their contacts. Waterborne infections such as gastroenteritis and hepatitis A are common, despite the improvement of health conditions. Pyoderma and furuncles are also frequently observed. Recently, dengue fever, Alkhumra hemorrhagic fever, and Rift Valley fever have emerged but no case of MERS-coronavirus, appeared in Saudi Arabia in 2012, have yet been observed during the 2012-2014 Hajj., Conclusion: Prevention is based on compulsory meningococcal vaccination, vaccination against seasonal influenza and pneumococcal infections for pilgrims at high risk of contracting the infection, and on vaccination against hepatitis A. Updating immunization for diphtheria/tetanus/poliomyelitis/pertussis and measles/mumps is also crucial and pilgrims must comply with hygiene precautions., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Purpose: We determined the prevalence of ESBL Enterobacteriaceae in urinary tract infections among inpatients, identified risk factors of acquisition, and evaluated the effectiveness of alternatives to carbapenems., Methods: The clinical, microbiological, and therapeutic data as well as the outcomes were recorded for all ESBL-E positive urine samples for three months., Results: Thirty-one (4%) of the 762 Enterobacteriaceae positive cultures were ESBL producers. The predisposing conditions for being infected with those strains were: immunodepression (61%), recent hospitalization (52%), recent antibiotic therapy (52%), and urinary catheterization (61%). 19% of infections were community acquired. The seven cases of acute pyelonephritis and five of prostatitis were treated with piperacillin-tazobactam (5), fluoroquinolones (4), ceftazidime (2), or carbapenems (only 1) after specialized advice. Four (33%) patients relapsed at week 10: three were immunodepressed and three presented with bacteremia., Conclusions: Alternatives to carbapenems (especially piperacillin-tazobactam) seem to be a good option for non-bacteremic UTI in immunocompetent patients., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Campylobacter has been associated with immunoproliferative small intestinal disease (IPSID), on the basis of 16S rDNA sequencing, in situ hybridization, and immunohistochemistry. Here, for the first time, we have cultured Campylobacter from the stools of a patient with IPSID. Phenotypic analysis and whole genome sequencing identified Campylobacter coli. PCR on a IPSID tissue biopsy sample was positive for Campylobacter coli and negative for Campylobacter jejuni. These findings further support a causative role for Campylobacter in the development of IPSID., (© 2014 The Authors Clinical Microbiology and Infection © 2014 European Society of Clinical Microbiology and Infectious Diseases.)

Dirofilariosis is an endemic filarial parasitic disease in the Mediterranean basin, unfamiliar in France. Its incidence and geographic area are increasing due to global warming. Dogs and cats are the usual hosts, but humans may be accidentally infected. We reported the 91st case of French dirofilariosis, contracted in Camargue (South France) which appeared as a subcutaneous abdominal nodule. Ultrasound strongly guided the diagnosis by showing a linear structure moving in a fibrocystic structure. Surgical excision confirmed the diagnosis of species (Dirofilaria repens) and this remains the only curative treatment., (Copyright © 2011 Société nationale Française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.)

Chronic cavitary pulmonary aspergillosis requires a first-line prolonged treatment with itraconazole or voriconazole. We report a 71-year-old immunocompetent man with polyarteritis and history of multiple lung surgery procedures, who developed a peripheral axonal neuropathy 1 month after voriconazole therapy was started for a chronic cavitary pulmonary aspergillosis. After discontinuation of the treatment and a switch to posaconazole, the neuropathy partly improved. Three other cases of peripheral neuropathy with voriconazole have been already published, all reversible after voriconazole discontinuation.

We report a case of severe aortic bicuspid valve endocarditis, revealed by global cardiac failure without fever, in a 38-year-old man who had developed cerebral mycotic aneurysms nine months earlier. PCR analysis of the excised aortic valve and serological tests (even 9 months earlier) were positive for Bartonella henselae. A combination of intravenous then oral doxycyclin at 200mg/day and intravenous gentamycin at 90mg/day was given for 6 and 2 weeks respectively. The evolution was favorable on follow-up, 12 months after completion of the therapy. Only 49 cases of B. henselae endocarditis have been reported to date, none with associated mycotic aneurysm but most often located on the bicuspid aortic valve, and usually with severe valvular damage due to late diagnosis.

Introduction: Five years after introducing the Permanent Access to Healthcare activity (PASS), it became necessary to analyse how it works., Material and Methods: A computerized data collection and assessment system intended to evaluate the PASS health activities has been set up in 11 University Hospitals and ten General Hospitals. From January 1st to June, 30th 2003 data was captured in a computer., Results: The patients requiring medical advice are young (with an average age of 35 years) and present several signs of poverty in terms of accommodation, social relationships and financial means. Besides, almost all of them are uninsured. The PASS public corresponds completely to the created system. Poverty risk factors vary according to the geographic origin. Indeed, French people often suffer from isolation, whereas foreign patients present financial problems. The major part of patients are foreigners and more than a third of them do not speak French, which is an additional obstacle to care. Most of the time, the PASS patients present digestive disorders, nevertheless there are some differences between French and foreign patients. Indeed, foreigners very frequently have digestive and osteoarticluar problems, whereas French patients suffer from psychic disorders and present addictive behaviours. Some patients are sent to physicians downtown (9%) and to external medicosocial assistance centres (39.5%)., Discussion: This study (first one in France) provides us with homogenous data regarding the activities of PASS centres nationwide. The usefulness of computers and its acceptability facilitate data diffusion, with possibilities of adapting to each centre while preserving a common basis.

Purpose: Precariousness and its consequences have not been re-evaluated in France since the introduction of the Law to fight exclusion, which instituted Universal Medical Cover (CMU) and permanently maintained health care facilities (PASS) in 1998., Method: Throughout the year 2002, a descriptive medical, psychological and social prospective study was carried out amongst PASS patients seen in 2002 at Avignon Hospital., Results: Three hundred and fifty out of 359 patients have been analysed. Most of them were adults (93%), young (mean age 38), male (56%), foreigners from non-EU countries (73%), with an illegal status (69%). They were without any declared income (77%), but with accommodation (67%), living as married (or such) or single in equal proportion. They were often without social security cover (48%). Their dominant pathologies were infections (42% of the patients). The most frequently diagnosed conditions were obesity (14%), pregnancy (8%), lower back pain (7%), high blood pressure (7%), chronic hepatitis C virus infection (6%), fungal infections (6%) and traumas (6%). Dental (43%) and psychiatric (27%) disorders were very frequent. The analysis of sub-groups has shown that some disorders are more frequent in French and European patients: chronic hepatitis C virus infection (14% vs. 4%), traumas (14% vs. 4%), psychopathy (11% vs. 0%), alcohol abuse (32% vs. 5%), smoking (80% vs. 25%), cannabis (20% vs. 2%) or opioids (16% vs. 0%) use., Conclusion: Access to health care has been difficult in 2002 in Avignon mostly for illegal immigrants for whom the only valid response should be of a political nature. Both French and European communities who still do not benefit from CMU improvements probably mean local interventions and combined operations because of the homelessness and the addictions of these people.

The objective of this study was to determine the risk factors of the first occurrence of Mycobacterium avium complex disease (MAC) infection among human immunodeficiency virus (HIV)-infected subjects during two different time periods: before and after the introduction of protease inhibitor (respectively, period 1: 1 January 1992 to 31 December 1995, and period 2: 1 January 1996 to 30 June 1998). This study was performed using the French Hospital Database on HIV (FHDH). Subjects were included when their CD4+ cell count was less than 100/mm3. If they did not die or develop MAC within the first 6 months after the inclusion, their follow-up had to be longer than 6 months to be included. Cox's model was used to calculated the relative hazards (RH) of MAC occurrence according to the age and time-dependent variables, such as CD4+ below 50/mm3, previous occurrence of tuberculosis, cytomegalovirus (CMV) infection and other acquired immunodeficiency syndrome (AIDS)-defining disease, nature of antiretroviral treatment and MAC prophylaxis. Among the 14,779 subjects followed during period 1, 1,710 (11.6%) had a diagnosis of MAC infection during their follow-up (incidence: 8.4 +/- 0.2 for 100 persons per year), while only 453 (4.4%) among 10,239 subjects presented this infection during period 2 (2.8 +/- 0.1 for 100 persons per year). Rifabutin regular prescription was a protective factor of MAC occurrence during period 1 (RH = 0.51 95% confidence interval (CI) = [0.37-0.69]), whereas this protective effect was not observed during period 2 (RH = 1.05 CI = [0.63-1.67]). Thus, during the HAART period, the results that we present do not indicate an interest into continuing MAC prophylaxis.

Background: Lesions of adrenal glands are common findings at autopsy of patients with acquired immunodeficiency syndrome (AIDS). In contrast the diagnosis of symptomatic adrenal insufficiency is rarely established during the lifetime of these patients., Patients: We report four new cases and review the literature. All four patients had full blown AIDS with a mean CD4 cell count of 19 mu/L. One or more opportunistic disease was present at the time of diagnostic: cytomegalovirus retinitis in two cases, disseminated Mycobacterium avium infection in two, Kaposi's sarcoma in two and Candida esophagitis in one., Results: The clinical presentation constantly included fatigue, weight loss, severe orthostatic hypotension and gastrointestinal disturbances. Cutaneous hyperpigmentation was present in three cases. In most cases biological abnormalities were typical, such as hyponatremia, urinary Na/K ratio > or = 1, and hyperkalemia. Serum cortisol levels were within the range of normal in three cases but response to the cosyntropin challenge was typically impaired in all cases. Clinical and biological manifestations returned to normal in 1 to 3 weeks after initiation of therapy with cortisol, associated to fludrocortisone in three cases. However, 13 months after diagnosis, three patients were dead., Conclusion: Usually asymptomatic, diagnostic of symptomatic adrenal insufficiency must be suspected even when clinical presentation is atypical because rapid efficiency of hormonal treatment.

We report the case of a 23 year-old Caribbean woman with sarcoidosis who developed specific skin ulcerations. Ulcerative lesions in sarcoidosis are distinctly unusual, generally multiple, painless, with preponderant location on the lower limbs. The diagnosis is difficult. The pathogenesis is discussed. The most successful therapy is hydrochloroquine with corticosteroids.

The concept of Internal Medicine was introduced recently and stems from the Internal Pathology which dates back to Antiquity. This concept spread out during the XIXth century with the concomitant progress of clinical science and heurism within a global and humanistic medicine. In France, Internal Medicine was not recognized until 1966. The criteria of eligibility for certification in this specialty were issued in 1970. The Syndicat National des Médecins Spécialistes de Médecine Interne, the Société Nationale Française de Médecine Interne and the diploma of certification in Internal Medicine were respectively created in 1975, 1979, 1984. The field of interest of Internal Medicine is wide and ambiguous. It includes a specific hard core and less specific allocations that encroach on "organ" specialties. French internist practitioners are not numerous and most of them are practising in hospitals. Internal Medicine is highly regarded in Anglo-Saxon countries and in Germany. In the European Community, the future of this medical specialty depends on the success of the harmonization of training programs and the development of medical students exchange. There is currently a controversy about the recognition of Internal Medicine as a full specialty. To bring out this specialty, French internists should benefit from reforms at several levels: university, hospital and French health service contract.

Bartter's syndrome, sometimes a familial autosomal recessive condition, is characterized by hypokalaemia with normal kaliuresis, hyperreninaemia with secondary hyperaldosteronism, vascular resistance to angiotensin and overproduction of prostaglandins by the kidneys. This syndrome is rare but sometimes envisaged in patients with unexplained hypokalaemia, the main difficulty being to exclude intoxication with diuretics which is very similar in all respects. Its physiopathology is unknown, and the various hypotheses put forward since it was first described (vascular insensitiveness to angiotensin, defect of sodium or chloride reabsorption, excess of atrial natriuretic factor, general abnormality of membrane permeability) were unable to demonstrate their primary character, each disorder described seeming, subsequently, secondary to another. For this reason, treatment is difficult and disappointing, but although the hypokalaemia is sometimes worrying, Bartter's syndrome is usually a benign condition.