Traumatologie de la personne âgée : une urgence nutritionnelle ? [Elderly orthopedic patients: Is nutritional support needed?]

La fracture de hanche chez la personne âgée reste un problème de santé publique. Elle est la conséquence d'une chute neuf fois sur dix et survient chez des personnes fragilisées par une ostéoporose, une sarcopénie, une dénutrition. Dans un service de traumatologie, la dénutrition protéino-énergétique est fréquente. Présente dès l'admission chez environ un patient sur deux, elle va souvent s'aggraver pendant le séjour hospitalier et favoriser la survenue de complications. Une prise en charge nutritionnelle doit impliquer une équipe multidisciplinaire qu'il faut coordonner. Elle doit être envisagée précocement pendant le séjour hospitalier et privilégier la voie orale. L'assistance nutritionnelle sous forme de CNO a prouvé son efficacité dans la réduction de la morbidité postopératoire. Son impact sur la mortalité, sur le pronostic fonctionnel et social reste discuté. Il faudra attendre l'étude de nouvelles cohortes dans lesquelles la compliance au traitement est nettement améliorée avant de conclure de manière définitive.

Comparison between a linear ion trap and a triple quadruple MS in the sensitive detection of large peptides at femtomole amounts on column.

In addition to the importance of sample preparation and extract separation, MS detection is a key factor in the sensitive quantification of large undigested peptides. In this article, a linear ion trap MS (LIT-MS) and a triple quadrupole MS (TQ-MS) have been compared in the detection of large peptides at subnanomolar concentrations. Natural brain natriuretic peptide, C-peptide, substance P and D-Junk-inhibitor peptide, a full D-amino acid therapeutic peptide, were chosen. They were detected by ESI and simultaneous MS(1) and MS(2) acquisitions. With direct peptide infusion, MS(2) spectra revealed that fragmentation was peptide dependent, milder on the LIT-MS and required high collision energies on the TQ-MS to obtain high-intensity product ions. Peptide adsorption on surfaces was overcome and peptide dilutions ranging from 0.1 to 25 nM were injected onto an ultra high-pressure LC system with a 1 mm id analytical column and coupled with the MS instruments. No difference was observed between the two instruments when recording in LC-MS(1) acquisitions. However, in LC-MS(2) acquisitions, a better sensitivity in the detection of large peptides was observed with the LIT-MS. Indeed, with the three longer peptides, the typical fragmentation in the TQ-MS resulted in a dramatic loss of sensitivity (> or = 10x).

Screening for post-traumatic stress disorder (PTSD) in a psychiatric emergency setting

Background and Objectives: (i) to assess the prevalence of PTSD in a psychiatric emergency setting by means of a diagnostic instrument and to compare it with PTSD-prevalence of a clinically evaluated, historical sample; and (ii) to assess psychiatric residents' perception of the systematic use of this diagnostic instrument. Methods: A consecutive sample of patients (N = 403) evaluated for a psychiatric emergency was assessed with the module J (PTSD) of the MINI, the historical sample (N = 350), assessed by chart review, consisted of consecutive patients of the same setting evaluated one year prior to the study period. Residents' perceptions were assessed by means of a focus group. Results: While in only 0.57% of the historical sample (N = 350) a diagnosis of PTSD was recorded, 20.3% (N = 64) of the patients assessed with the diagnostic instrument (N = 316) qualified for a diagnosis of PTSD. Higher prevalence rates were observed in refugees and those without legal residency status (50%); patients from countries with a recent history of war (47.1%); those with four (44.4%) or three psychiatric co-morbidities (35.3%); migrants (29.8%) and patients without professional income (25%). Residents felt that the systematic use of the tool was not adequate in the psychiatric emergency setting for various reasons (e.g.: not suitable for a first or single consultation, negative impact on the clinical evaluation). Conclusions: The study confirms that PTSD is underdiagnosed in the psychiatric emergency setting. To improve the situation, targeted screening or educational and institutional strategies are needed.

Wien, Cambridge, Königsberg: filosofisia tapahtumia 1929-1930

Kirjoittaja on Oulun yliopiston aatehistorian professori. Kirjoittajalta on aiemmin julkaistu Tieteessä tapahtuu -lehdessä Wienin piiriä sivuavat artikkelit "Eino Kaila ja tie Wienin piiriin" (TT 2/ 2002), "Kaila ja kahden tunnistamistavan ero" (TT 4/2002), "Realisti Wienin piirin väittelyissä" (TT 7/2002) ja "Positivismin kriitikosta positivistiksi"(TT 8/2002).

Santé en milieu pénitentiaire: vulnérabilité partagée entre détenus et professionnels de la santé [Health in prison: shared vulnerability between detainees and health professionals]

In prison, the health professional has to take the sanitary needs of a temporary of chronically vulnerable population. His practice has to meet laws and recommendations, as well as the field reality and its numerous constraints. This puts him in a "shared vulnerability and stigmatization". He attempts to maintain or restore a health status in a deteriorating environment, at least psychologically. He is in the penitentiary world's eye which he depends upon in many ways to achieve his mandate. His activity is scarcely known and recognised by his peers from whom he can be very out of touch. To ensure a humanistic, efficient and equivalent-of-care practice, the health professional must rely on sound knowledge of general healthcare, ethics, deontology and medical laws. Basic and continuous training is a mainspring, like networking and development of federal recommendations.

Association between bipolar disorder and monoamine oxidase A gene polymorphisms: results of a multicenter study

OBJECTIVE: Although genetic factors have been implicated in the etiology of bipolar disorder, no specific gene has been conclusively identified. Given the link between abnormalities in serotonergic neurotransmission and bipolar disorder, a candidate gene association approach was applied to study the involvement of the monoamine oxidase A (MAOA) gene, which codes for a catabolic enzyme of serotonin, in the susceptibility to bipolar disorder. METHOD: In France and Switzerland, 272 patients with bipolar disorder and 122 healthy subjects were typed for three polymorphic markers of the MAOA gene: the MAOA-CA repeat, the MAOA restriction fragment length polymorphism (RFLP), and a repeat directly adjacent to the variable number of tandem repeats (VNTR) locus. RESULTS: A significant difference in the distribution of the alleles for the MAOA-CA repeat was observed between the female bipolar patients and comparison group. CONCLUSIONS: The results obtained in the French and Swiss population confirm findings from two studies conducted in the United Kingdom.