Principes d'evaluation et de prise en charge des patients agés polymorbides: guide a l'intention des cliniciens [Principles for the assessment and management of polymorbid elderly patients: a guide for clinicians].

Providing care to multimorbid older patients is complex, not only because of the coexistence of multiple chronic conditions, but also because of their frequent intrication with psychological and social problems. This article describes a guide for clinicians to assess and manage multimorbid older patients. This guide was adapted from the work of a group of expert US geriatricians. It proposes seven steps: identification of the main problem; identification of patients' preferences; setting of goals of care; estimation of life expectancy; identification of relevant evidence in the literature; revision of the plan of care; and discussion of the options with the patient. The use of this guide is illustrated by a clinical case.

Physiologie du protecteur (2e édition) / par un aveugle clairvoyant de la Chaussée-d'Antin [Jacques Arago]...

Référence bibliographique : Lhéritier, 24

Physiologie du rentier de Paris et de province / par MM. de Balzac et Arnould Frémy ; dessins par Gavarni, Henri Monnier, Daumier et Meissonier

Référence bibliographique : Lhéritier, 52

Physiologie du député [première partie] / par P. Bernard ; dessins de Henry Émy

Référence bibliographique : Lhéritier, 38

The systemic lupus erythematosus IRF5 risk haplotype is associated with systemic sclerosis

Systemic sclerosis (SSc) is a fibrotic autoimmune disease in which the genetic component plays an important role. One of the strongest SSc association signals outside the human leukocyte antigen (HLA) region corresponds to interferon (IFN) regulatory factor 5 (IRF5), a major regulator of the type I IFN pathway. In this study we aimed to evaluate whether three different haplotypic blocks within this locus, which have been shown to alter the protein function influencing systemic lupus erythematosus (SLE) susceptibility, are involved in SSc susceptibility and clinical phenotypes. For that purpose, we genotyped one representative single-nucleotide polymorphism (SNP) of each block (rs10488631, rs2004640, and rs4728142) in a total of 3,361 SSc patients and 4,012 unaffected controls of Caucasian origin from Spain, Germany, The Netherlands, Italy and United Kingdom. A meta-analysis of the allele frequencies was performed to analyse the overall effect of these IRF5 genetic variants on SSc. Allelic combination and dependency tests were also carried out. The three SNPs showed strong associations with the global disease (rs4728142: P  = 1.34×10(-8), OR  = 1.22, CI 95%  = 1.14-1.30; rs2004640: P  = 4.60×10(-7), OR  = 0.84, CI 95%  = 0.78-0.90; rs10488631: P  = 7.53×10(-20), OR  = 1.63, CI 95%  = 1.47-1.81). However, the association of rs2004640 with SSc was not independent of rs4728142 (conditioned P  = 0.598). The haplotype containing the risk alleles (rs4728142*A-rs2004640*T-rs10488631*C: P  = 9.04×10(-22), OR  = 1.75, CI 95%  = 1.56-1.97) better explained the observed association (likelihood P-value  = 1.48×10(-4)), suggesting an additive effect of the three haplotypic blocks. No statistical significance was observed in the comparisons amongst SSc patients with and without the main clinical characteristics. Our data clearly indicate that the SLE risk haplotype also influences SSc predisposition, and that this association is not sub-phenotype-specific.

Vigilancia ambiental de casos esporádicos de legionelosis en el municipio de Córdoba (España), 2005-2010

We examined the information of legionellosis surveillance system in the municipality of Cordoba (Spain) as a preventive resource for environmental health management and describes the public health implications of sporadic cases investigations. A multidisciplinary team analyzed information on surveillance of water sites potentially contaminated by Legionella and clinical data of the patients classified like community case; mapping patient's home address using geographic information systems (GIS). Legionella pneumophila serogroup 1 was identified in 31 sporadic cases. 53 suspected sources, mainly cooling towers have been investigated. In no event is managed to locate infection source even if poorly maintained systems, structural deficiencies and operational failures were apparent. The use of GIS allowed us to identify two geographic areas where cases are concentrated within one radius of less than 500 meters. The finding of two suspected urban advised to reorient the preventive strategy in public health

Habitat, morphology and karyotype of the Saharan shrew Crocidura tarfayaensis (Mammalia : Soricidae)

The Saharan shrew Crocidura tarfayaensis Vesmanis and Vesmanis, 1980, has a limited disribution along the Atlantic coast of Sahara, south of Agadir (Morocco) through Western Sahara into Mauritania and is only known from few captures and some owl pellets. Here we report field data from the successful trapping of five specimens of C. tarfayaensis in the Guelmim region. The habitat was characterized by sand dunes along a river, with dense shrubberies of Tamarix sp., the huge grass Erianthus ravennae (Poaceae) and flat bushes of Atriplex glauca var. ifniensis (Chenopodiaceae). Morphological discrimination with C. whitakeri were examined. The chromosomes of C. tarfayaensis revealed a karyotype of 2n = 36, similar to that of the Canary shrew C. canariensis and the Sicilian shrew C. sicula. In conclusion, C. tarfayaensis seems to be a descendant of the presumed continental ancestor of the two island species.

Fructose toxicity: is the science ready for public health actions?

PURPOSE OF REVIEW: The assumption that fructose may be toxic and involved in the pathogenesis of noncommunicable diseases such as obesity, diabetes mellitus, dyslipidemia, and even cancer has resulted in the call for public health action, such as introducing taxes on sweetened beverages. This review evaluates the scientific basis for such action. RECENT FINDINGS: Although some studies hint towards some potential adverse effects of excessive fructose consumption especially when combined with excess energy intake, the results from clinical trials do not support a significant detrimental effect of fructose on metabolic health when consumed as part of a weight-maintaining diet in amounts consistent with the average-estimated fructose consumption in Western countries. However, definitive studies are missing. SUMMARY: Public health policies to eliminate or limit fructose in the diet should be considered premature. Instead, efforts should be made to promote a healthy lifestyle that includes physical activity and nutritious foods while avoiding intake of excess calories until solid evidence to support action against fructose is available. Public health is almost certainly to benefit more from policies that are aimed at promoting what is known to be good than from policies that are prohibiting what is not (yet) known to be bad.

Le contact Gondwana - péri-Gondwana dans le Zanskar oriental (Ladakh-Himalaya)

A l'Est du fleuve Zanskar (Ladakh), la zone de suture de l'Indus sépare les nappes de la bordure nord-indienne du Gondwana (Haut-Himalaya, nappes du Zanskar, cristallin de Tso Morari) des éléments péri·gondwaniens du Trans-himalaya. Des recherches géologiques entreprises entre l'Indus el la Tsarap ont montré que: - la molasse autochlone du Ladakh est surmontée par un édifice de flysch et molasses tertiaires, rétrocharrié vers le NordEst et coiffé par les conglomérats post· éocène moyen du Stok Kangri et une formation eontinentale de molasse rouge; - - la zone de suture comprend deux unités. principales : a) au Nord et au Nord-Ouest, l'unité volcano-sédimentaire de Dras-Nindam avec des conglomérats et flysch crétacés, des brèches massives à radiolarHes et roches vertes; cette unité est accompagnée d'un mélange coloré à roches ultra-basiques, blocs exoti(Iues divers et une méga lentille de brèche carbonatée polygénique à grands Foraminifères (Nummulites ?) ; b) au Sud, l'unité de la Markha, un flysch à lentilles de calcaires plus ou moins marmoréens datée de la base du Jurassique moyen et que nons corrélons avec le Oysch de Lamayuru ; - l'unité complexe de Nimaling représente la terminaison occidentale du crist allin de Rupshn (Tso MOI'ari) ; il comprend un socle gneissique, des roches vert.es et une couverture de schistes quartzitiques, quartzites el dolomies. Cet ensemble est intrudé pal' un granite porphyrique et il est surmonté, en contact tectonique, par une épaisse série métamorphique de calcschistes, shales et grès de faciès schistes lustrés, d'âge inconnu; dans ce tte série, on note au moins trois phases de fortes déformaljons superposées (linéations replissées) ; le long de la vallée de la Markha, le style st.ructural évoque, avec des plis isoclinaux de 2" phase à axes verticaux, une « zone de racine" et pourrait également témoigner de mouvements horizontaux importants; - l'édifice des napp es du Zanskar a été subdivisé en trois unités; il surmonte vers le Nord-Est les schistes lustrés du groupe de Langtang et vient buter vers le Sud-Ouest, le long d'un aceident chevauchant, contre la nappe de Zangla (Haut Himalaya). Les séries sédimentaires (Trias - Crétacé supérieur) sont d'affinité téthysienne. De nouvelles datations sont apportées et nous mettons en évidence, directement à l'Est du fleuve Zanskar, la présence de Crétacé sous faciès calcaires multicolores à microfaune planctique ; transgressif sur les grès de Giumal, ce faciès calcaire déhut.e déjà dans l'Alhien supérieur, c'est-à-dire nellement plus tôt que dans les régions plus orientales de l 'Himalaya; - les nappes du Haut Himalaya comprennent du Nord-Est vers le Sud-Ouest la nappe de Zangla qui chevauche par l'intermédiaire d'une semelle de « Panjal Traps » des témoins écaillés de Paléozoïque inférieur, puis la nappe de cristallin. La nappe de Zangla correspond à l'unité qui, à l 'Ouest du Zanskar supporte la klippe ophiolitique de Spongtang.

Physiologie complète du rébus / ouvrage illustré par 800 petites figures et rédigé par Blismon

Référence bibliographique : Lhéritier, 131

Lottery Action, July 22-August 4, 2002, Vol. 9 no. 14

Iowa Lottery Authority Retailer Information Newsletter