Consentement libre et éclairé

En droit de la santé, le consentement libre et éclairé implique que le médecin est tenu de présenter clairement au patient tous les risques d'une conduite thérapeutique. Le consentement doit être libre, c’est-à-dire en l'absence de contrainte, et éclairé, c’est-à-dire précédé par une information. Droit par pays Droit canadien Droit québécois La règle selon laquelle le consentement doit être libre et éclairé est énoncée à l'article 10 du Code civil du Québec : Cette règle est placée immédiatement avant la section du Code civil du Québec intitulée « des soins ». Elle sert donc de guide pour interpréter les articles 11 à 31 du Code civil du Québec qui traitent du consentement aux soins médicaux et de la garde dans un établissement de santé en vue d'une évaluation psychiatrique. Le consentement libre et éclairé se trouve également à l'article 1399 C.c.Q. qui traite des vices du consentement et à l'article 521.1 C.c.Q. qui porte sur la définition de l'union c

Assessment of occupational exposure to pesticides with multi-class pesticide residues analysis in human hairs using a modified QuEChERS extraction method, case study of gardening areas in Burkina Faso

Luiz Felippe De Alencastro, Edouard René Gilbert Lehmann, Jean-Jacques Stéphane Nfon Dibie, Christelle Oltramare

Pesticides have been proved to potentially cause multiple adverse health effects. The present study is part of a global project focusing on pesticides impacts on the environment and human health in gardening in Burkina Faso. In absence of existing monitoring, the present study aims at proposing a comprehensive indicator of occupational exposure to 48 pesticides identified during field campaigns. As a noninvasive and safe indicator of long term exposure, increasing interest is being observed in hair analysis for biomonitoring of human exposure to pesticides. In order to dissociate occupational and environmental exposure in the study area, two study populations have been randomly selected: fifty gardeners (operators) and fifty non users (reference population). The Ethics Committee of the Burkina Faso approved this study and written informed consent was obtained from all donors. Multiresidue extraction procedure using a modified QuEChERS extraction method has been developed and applied to the collected samples. Briefly, hairs were cut on the posterior of the head, subsequently cut in small pieces and spiked with appropriate 13C- or deuterated surrogates. After overnight incubation, they were extracted in acetonitrile, cleaned-up by Dispersive SPE (dSPE), concentrated and separated prior analysis on GC-MS and LC-MS/MS. Each sample was accompanied by a questionnaire on hair care practices. Different incubation, extraction methods and dSPE sorbents have been tested (temperature, type, volume, etc.). The best method was found to be a modified AOAC 2007.01 QuEChERS procedure, including 12h incubation at 37°C followed by dSPE clean-up with Supelco Z-sep/C18® sorbent. The substances detected in collected samples include pesticides commonly used in the study area such as acetamiprid, imidacloprid, cypermethrin, profenofos but also dieldrin a banned persistent organochlorine. These pesticides were detected in hairs of the gardeners but also in the samples of the reference population indicating the occurrence of passive contamination. This study presents a comprehensive assessment of sample preparation, extraction and clean-up procedure for multi-class pesticide residues analysis in human hairs. The modified QuEChERS extraction procedure proposed offers a simple and robust tool suitable to developing countries for monitoring human exposure and evaluation of compliance with policies. The study design, including comparison between reference and operators populations allowed to dissociate the influence of environmental exposure and direct occupational exposure. Results indicate that potential carcinogen, endocrine disruptor, neurotoxic and persistent pesticides have been detected in collected hairs.

2016

MP2RAGE and Susceptibility-Weighted Imaging in Lesional Epilepsy at 7T

Maxime Olivier Baud, João Pedro Forjaco Jorge, Giannina Rita Iannotti, François Lazeyras, Lijing Xin

BACKGROUND AND PURPOSE: Surgery is the first choice therapeutic approach in case of drug-resistant epilepsy. Unfortunately, up to 43% of patients referred for presurgical assessment do not have a lesion detectable by routine 3T magnetic resonance imaging (MRI) (MRI-negative), although most of them likely have an underlying epileptogenic lesion. Thus, new MRI modalities with increased sensibility for epileptogenic lesions are required. This paper describes the magnetization-prepared two rapid acquisition gradient echoes (MP2RAGE) and susceptibility-weighted imaging (SWI) findings at 7T in a series of patients with drug-resistant epilepsy of different etiologies. METHODS: Prospective pilot study of 7 patients with drug-resistant lesional epilepsy and absence of contraindications for MRI underwent a research 7T head-only scanner. Qualitative analysis of the high-resolution MP2RAGE and SWI sequences is given for each case. This study was approved by the local ethics committee. Written informed consent was obtained from each participant. RESULTS: This study shows that such sequences at ultra-high field are new and valuable approaches to unravel and characterize epileptogenic lesions. Particularly, MP2RAGE shows a better delineation of lesions due to high gray-white matter contrast and structural resolution, and SWI reveals new imaging signs related to improved magnitude and phase contrast imaging. CONCLUSION: MRI at ultra-high field is very promising for the detection of inconspicuous epileptogenic lesions and may facilitate epilepsy surgery of a great number of to-date MRI-negative patients.

2018

Privacy-Preserving Processing of Raw Genomic Data

Erman Ayday, Urs Beda Hengartner, Jean-Pierre Hubaux, Adam Molyneaux, Jean Louis Raisaro

Geneticists prefer to store patients' aligned, raw genomic data, in addition to their variant calls (compact and summarized form of the raw data), mainly because of the immaturity of bioinformatic algorithms and sequencing platforms. Thus, we propose a privacy-preserving system to protect the privacy of aligned, raw genomic data. The raw genomic data of a patient includes millions of short reads, each comprised of between 100 and 400 nucleotides (genomic letters). We propose storing these short reads at a biobank in encrypted form. The proposed scheme enables a medical unit (e.g., a pharmaceutical company or a hospital) to privately retrieve a subset of the short reads of the patients (which include a definite range of nucleotides depending on the type of the genetic test) without revealing the nature of the genetic test to the biobank. Furthermore, the proposed scheme lets the biobank mask particular parts of the retrieved short reads if (i) some parts of the provided short reads are out of the requested range, or (ii) the patient does not give consent to some parts of the provided short reads (e.g., parts revealing sensitive diseases). We evaluate the proposed scheme to show the amount of unauthorized genomic data leakage it prevents. Finally, we implement the proposed scheme and assess its practicality.

2013

Luiz Felippe De Alencastro, Edouard René Gilbert Lehmann, Jean-Jacques Stéphane Nfon Dibie, Christelle Oltramare

2016