Th.--Méd.--Reims, 1978. N°: 88.

No description available.

No description available.

<div>My PhD thesis evolves around the potential protective effects of sex hormones progesterone and testosterone against drug-induced QT interval prolongation in premenopasual women and older men.<br></div>

Long QT syndrome (LQTS) can present with syncope and seizure-like activity in the setting of torsades de pointes (TdP) with hemodynamic instability. Electrolyte abnormalities and medications can predispose to TdP in the setting of latent LQTS. An implantable cardioverter defibrillator (ICD) is needed if patients with TdP continue to be symptomatic despite medical treatment. We report a case of a patient who presented with seizures and was found to have prolonged corrected QT interval (QTc). During her admission, she was treated with ondansetron. She went into torsades de pointes and continued to have prolonged QTc. She underwent implantable cardioverter defibrillator (ICD) placement and remains asymptomatic to date.

No description available.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal

Pharmacovigilance in healthcare is essential for safe drug treatment. Spontaneous reporting is the most common source of information in the context of implementing label changes and taking a drug off the market. However, underreporting is found to be very prevalent. One way to decrease underreporting is to include different categories of healthcare professionals in such reporting and to investigate attitudes towards and incentives for reporting adverse drug reaction (ADR)s. As nurses form the largest group of health professionals, a sample of nurses were allowed and encouraged to report ADR during a 12 month period after they had received training in pharmacovigilance. A questionnaire posted to physicians and nurses investigated their knowledge and attitudes towards reporting. Spontaneous reports of torsade de pointes (TdP) and erectile dysfunction (ED) were scrutinized with respect to the reported drugs, risk factors and if the reaction was listed in the summary of product characteristics (SPC). After training, the nurses produced relevant reports and three years after the introduction of nurses in the reporting scheme, more than half of the responding nurses were aware of their role as reporters. Both nurses and physicians stated that the most important factor for reporting a suspected ADR was the severity of the ADR and an ADR arising in response to a newly approved drug. A web-based reporting system was deemed to facilitate the reporting. In spontaneous reports of TdP, citalopram was reported as a suspected drug. However, neither QT prolongations, nor TdP, were labelled in the SPC. ED was reported for all antihypertensive drugs including angiotensin II type I blockers. A positive information component (IC), assessing the disproportionality between the observed and the expected number of reports, was found indicating that ED was reported more often in association with antihypertensive drug classes, except for angiotensinconverting enzyme inhibitors. This thesis demonstrates the importance of pharmacoviglilance in healthcare in terms of capturing new signals. By including nurses as reporters, the overall safety of drugs might improve. Information and education are needed to secure safe treatment when applying drugs.

Les médicaments qui provoquent un allongement de la repolarisation cardiaque, mesuré sur l’électrocardiogramme (ECG) par la prolongation de l’intervalle QT, ont été associés à une augmentation du risque pro-arythmique, et plus particulièrement à la survenue de Torsades de pointes, une tachycardie ventriculaire polymorphe potentiellement mortelle. Les méthodes d'analyse du QT conventionnelles se restreignent à l’extraction de quelques complexes ECG. Cette pratique se traduit par de nombreuses limitations. L’inclusion de tous les battements enregistrés sur 24h et mesurés par des méthodes automatiques de mesure ECG a le potentiel de résoudre ces inconvénients. Ce travail de thèse a démontré que les méthodes de mesure ECG automatisées et les analyses continues peuvent supplanter les méthodes conventionnelles pour l'analyse de la prolongation du QT lors des essais cliniques. Des recommandations ont été établis afin de permettre une utilisation optimale des méthodes d'analyse ECG continues. / Drugs which induce a delay in cardiac repolarization measured as QT interval prolongation on the electrocardiogram (ECG) have been associated with a potential to increase the risk of arrhythmias, especially Torsades de pointes (TdP), a potentially lethal polymorphic ventricular tachycardia. The analyses performed using conventional methods are restricted to the extraction of a few ECG complexes. This practice is associated with several limitations. In contrast, the inclusion of all beats measured by computerized methods from continuous 24 h recordings could resolve all of these deficiencies. The current work demonstrated that automated ECG measurement methods employing continuous analysis can supplant conventional methods for the evaluation of QT prolongation in clinical studies. Recommendations have been established to provide an optimal use of continuous ECG analysis.