Patients âgées vulnérables au cabinet: comment les identifier et quelles ressources mobiliser [Vulnerable older patients in primary care how to identify them? Which ressources to mobilize? ].

Trust is essential to foster and preserve a long-term relationship between primary care physicians and their patients suffering from chronic diseases. However, this relation remains insufficient to successfully manage more complex situations, such as those of older patients with multiple diseases and disability. For the primary care physician, a significant limitation is the time required to plan and coordinate interventions supplied by different health and social care providers. This article describes a structured approach to support primary care physicians in this difficult task and help them to identify vulnerable older patients requiring to mobilize and coordinate health and social care resources. Current and future resources available to family physicians to complete this challenging task are further described.

Comment prescrire les hormones thyroïdiennes [How to prescribe thyroid hormones]

Thyroid substitution is generally considered easy as well by general practitioners as by specialists, considering that a single hormone levothyroxin is recommended and that laboratory tests are readily available for measurement of free T4 and TSH. However cross sectional studies have shown that about 45% of patients are over-treated and under-treated. This paper summarizes the critical information useful to facilitate a better management of hypothyroid patients by promoting long lasting euthyroidism.

Aphtes récidivants: comment faire face [How to cope with recurrent aphthous stomatitis].

Recurrent aphthous stomatitis (RAS) is the most common oral mucosa ailment. This condition is frequently considered as idiopathic due to the doubts about its etiology, probably related to a minor immunological dysregulation in a context of genetic predisposition. However, ulcers that resemble recurrent aphthous stomatitis in some respects can be found in systemic disorders that must be ruled out for the differential diagnosis of SAR, particularly when they appear after adolescence and/or when associated lesions exist out of the oral cavity. SAR management lies on the elimination of predisposing factors (drugs, oral trauma, food allergies...) and if needed, topical corticosteroids are the first choice regimen. More severe cases may require systemic regimens.

Comment parler du divin ? langage mythique et conception des dieux chez Dion de Pruse

Le sophiste Dion de Pruse s'est interrogé sur l'expression du divin dans quatre discours datés entre la seconde moitié du Ier et le début du IIe siècle après J.-C. (Or. XI, XII, XXX et XXXVI). Sa réflexion fait d'abord apparaître un problème de langage : il s'agit de recourir aux symboles qui conviennent le mieux au divin et qui offrent le meilleur medium de communication. Dion cherche, d'une part, à renouveler le langage mythique issu des poèmes d'Homère et d'Hésiode, car celui-ci répand des représentations immorales qui ne correspondent plus à la sensibilité religieuse du Haut Empire et qui sont incompatibles avec l'ordre civique et avec l'image du pouvoir. Il ne souhaite pas, d'autre part, rompre avec les cadres de la piété traditionnelle, et en cela il se présente bien comme un représentant de la Seconde Sophistique impliqué dans le culte traditionnel des dieux et cherchant à diffuser une religion philosophique

Comment diminuer son risque cardiovasculaire avec l'alimentation? Rôle des graisses consommées [Nutritional advice to help reduce the cardiovascular risk. Update of the Swiss Federal Office of Public Health's recommendations on fat consumption].

The Swiss Federal Office of Public Health's (FOPH) updated its recommendations on fat consumption in 2013. The report recommends that maximum 10% of the daily caloric intake should come from saturated fatty acids, and the total fat intake should account for 20-35%. There is no limitation to dietary cholesterol consumption. Recent studies have shown that replacing consumption of saturated fatty acids by unsaturated fatty acids is more beneficial in terms of cardiovascular prevention than a low fat diet. The purpose of this article is to review the FOPH recommendations on dietary fat as well as the current evidence about their cardiovascular benefit, and to provide a translation of these scientific recommendations into clinical advice.

Analysis of sensitivity with respect to a compositional parameter : A comment on 'Local sensitivity analysis for compositional data with application to soil texture in hydrologic modelling' by L. Loosvelt and co-authors

A comment about the article “Local sensitivity analysis for compositional data with application to soil texture in hydrologic modelling” writen by L. Loosvelt and co-authors. The present comment is centered in three specific points. The first one is related to the fact that the authors avoid the use of ilr-coordinates. The second one refers to some generalization of sensitivity analysis when input parameters are compositional. The third tries to show that the role of the Dirichlet distribution in the sensitivity analysis is irrelevant

Comment on 'The Molecular Evolutionary Patterns of the Insulin/FOXO Signaling Pathway'

Letter to the Editor on Wang M, Wang Q, Wang Z, Zhang X, Pan Y. The molecular evolutionary patterns of the insulin/FOXO signaling pathway

Comment explorer une exophtalmie? [How to investigate a patient with exophthalmos?]

Exophthalmos is the main symptom revealing orbital masses. This sign needs to be imaged mainly by MRI and/or CT. As Graves disease is the main etiology of exophthalmos, CT scan should be performed as the initial imaging modality. Indications for US and Doppler are mostly limited to the study of ocular masses, and eventually may help the characterization of extra-ocular lesions. In all cases, imaging is useful to characterize: the precise location of the lesion which can be the intra-conal space (including muscles), the extra-conal space (associated or not to an extra-orbital lesion), or the eyeball; the features of the lesion (density, signal, enhancement.). These findings are used to generate a differential diagnosis. Imaging is also useful to precise the extension of the mass, and in some cases to select the appropriate surgical approach, and for follow-up.