A Single High Dose of Oral Vitamin D3 Is Not Enough to Correct Insufficiency and Deficiency in a Rheumatologic Population

Introduction: Vitamin D plays a major role in bone metabolism and neuromuscular function. Supplementation with vitamin D is effective to reduce the risk of fall and of fracture. However adherence to oral daily vitamin D supplementation is low. Screening and correcting vitamin D insufficiency in a general rheumatologic population could improve both morbidity and quality of life in these patients with chronic painful disorders and at high risk of osteoporosis. After determining the prevalence of vitamin D deficiency in this population, we evaluated if supplementation with a single high dose of oral 25-OH vitamin D3 was sufficient to correct this abnormality. Methods: During one month (November 2009), levels of 25-OH vitamin D were systematically determined in our rheumatology outpatient clinic and classified into three groups: vitamin D deficiency (<10 μg/l), vitamin D insufficiency (10 to 30 μg/l) or normal vitamin D (>30 μg/l). Patients with insufficiency or deficiency received respectively a single high dose of 300000 IU or 600000 IU oral vitamin D3. In addition, all patients with osteoporosis were prescribed daily supplement of calcium (1 g) and vitamin D (800 IU). 25-OH vitamin D levels were reevaluated after 3 months. Results: Vitamin D levels were initially determined in 292 patients (mean age 53, 211 women, 87% Caucasian). 77% had inflammatory rheumatologic disease (IRD), 20% osteoporosis (OP) and 12% degenerative disease (DD). Vitamin D deficiency was present in 20 (6.8%), while 225 (77.1%) had insufficiency. Of the 245 patients with levels <30 μg/l, a new determination of vitamin D level was available in 173 (71%) at 3 months. Conclusion: Vitamin D insufficiency is highly prevalent in our rheumatologic population (84%), and is not adequately corrected by a single high dose of oral vitamin D3 in more than half of the patients with IRD and DD. In patients with OP, despite association of a single high dose with daily oral vitamin D supplementation, 40% of patients are still deficient when reevaluated at 3 months.

Depression im Alter : was ist anders ? = Dépression chez la personne âgée : quoi d'autre ?

Depressionen treten bei âlteren Menschen wahrscheinlich nicht haufiger auf ais bei jungen Personen. Es bestehen jedoch Unterschiede hinsichtlich der Symptomatik, der Diagnostik und der Therapie der Depression. Haufig werden depressive Symptome ais normale Begleiterscheinungen im Alter verkannt und bleiben deshalb oft unbehandelt. Eine Depression bei âlteren Menschen ist eine Erkrankung, die mit Hilfe von Psychopharmaka und Psychotherapie erfolgreich behandelt werden kann. Les dépressions ne sont probablement pas plus fréquentes chez les personnes âgées que chez les sujets jeunes. Des différences existent cependant au regard de la symptomatologie, du diagnostic et du traitement de la dépression. Les symptômes dépressifs sont fréquemment considérés comme des manifestations normales associées à la sénescence et restent donc souvent sans traitements. Une dépression chez les personnes âgées est une maladie qui peut être traitée efficacement par des psychotropes et une psychothérapie.

Abnormal balance between proliferation and apoptotic cell death in fibroblasts derived from keloid lesions.

A new culture model was developed to study the role of proliferation and apoptosis in the etiology of keloids. Fibroblasts were isolated from the superficial, central, and basal regions of six different keloid lesions by using Dulbecco's Modified Eagle Medium containing 10% fetal calf serum as a culture medium. The growth behavior of each fibroblast fraction was examined in short-term and long-term cultures, and the percentage of apoptotic cells was assessed by in situ end labeling of fragmented DNA. The fibroblasts obtained from the superficial and basal regions of keloid tissue showed population doubling times and saturation densities that were similar to those of age-matched normal fibroblasts. In contrast, the fibroblasts from the center of the keloid lesions showed significantly reduced doubling times (25.9 +/- 6.3 hours versus 43.5 +/- 6.3 hours for normal fibroblasts) and reached higher cell densities. In long-term culture, central keloid fibroblasts formed a stratified three-dimensional structure, contracted the self-produced extracellular matrix, and gave rise to nodular cell aggregates, mimicking the formation of keloid tissue. Apoptotic cells were detected in both normal and keloid-derived fibroblasts, but their numbers were twofold higher in normal cells compared with all keloid fibroblasts. To examine whether apoptosis mediates the therapeutic effect of ionizing radiation on keloids, the cells were exposed to gamma rays at a dose of 8 Gy. Under these conditions, a twofold increase in the population of apoptotic cells was detected. These results indicate that the balance between proliferation and apoptosis is impaired in keloid fibroblasts, which could be responsible for the formation of keloid tumors. The results also suggest that keloids contain at least two different fibroblast fractions that vary in growth behavior and extracellular matrix metabolism.

Shorter time to diagnosis and improved stage at presentation in Swiss patients with retinoblastoma treated from 1963 to 2004

Rapport de synthèse : Le rétinoblastome est la tumeur de l'oeil la plus fréquente chez l'enfant. Un diagnostic précoce est important pour sauver le globe oculaire et la survie du patient. Le but de notre étude est de déterminer l'évolution de l'intervalle diagnostique, c'est-à-dire le délai entre les premiers symptômes et la date du diagnostic officiel du rétinoblastome, sur une période de 40 ans en Suisse. Matériel et méthode : Il s'agit d'une étude rétrospective faite sur 139 patients suisses traités pour rétinoblastome durant trois différentes périodes : (1) 1963-1983 ; (2) 1984-1993 ; et (3) 1994-2004. On compare certaines caractéristiques : le sexe du patient, la latéralité de la maladie, les premiers symptômes, leurs observateurs, l'intervalle diagnostique, l'âge au diagnostic, le stade de la maladie, l'histoire familiale. Résultats : 37 patients (26.6%) ont été traités dans la première période ; 44 (31.7%) dans la période 2 et 58 (41.7%) dans la période 3. L'intervalle diagnostique diminue de façon significative de 6.97 mois dans la période 1 à 3.58 dans la période 2 à 2.25 dans la période 3 pour le total des malades. Ceci reste significatif pour les rétinoblastomes unilatéraux. De plus, dans ce même groupe, on observe une diminution significative des stades avancés de la maladie, groupe E selon Murphree (61.5% dans la période 1 ; 46.7% dans la période 2 et 22.2 % dans la période 3). Lorsque la maladie est bilatérale, les mêmes observations se font de façon un peu moins marquée. Il n'y a aucun patient diagnostiqué au stade E de la maladie en présence d'une anamnèse familiale positive. Leucocorie (48.2%) et strabisme (20.1 %) sont les symptômes les plus fréquents durant les 3 périodes. Les seuls facteurs qui influencent significativement le risque d'avoir un stade E de la maladie sont la durée de l'intervalle diagnostic et la période de diagnostic. Conclusion : On constate un progrès dans le diagnostic du rétinoblastome en Suisse, surtout lors de maladie unilatérale. De même, des améliorations sont notées dans la maladie bilatérale mais de façon non significative. Il est donc important de mieux enseigner aux médecins à reconnaître les symptômes oculaires de la maladie et à référer les patients plus tôt aux spécialistes. Abstract : OBECTIVES : Retinoblastoma is the most frequent intraocular malignancy in children. Early diagnosis is essential for globe salvage and patient survival. The aim of our study was to determine how time to diagnosis of retinoblastoma has evolved over a 40-year period in Switzerland. METHOD AND PATIENTS : A retrospective study of 139 Swiss patients with retinoblastoma was performed comparing 3 periods: (1) 1963-1983; (2) 1984-1993; and (3) 1994-2004. Factors taken into account were gender, laterality of retínoblastoma, age at first symptoms, type and first observer of symptoms, time to diagnosis, age at diagnosis, disease stage, and family history. RESULTS : Thirty-seven patients (26.6%) were treated in period 1, 44 (31.7%) in period 2, and S8 (41.7%) in period 3.Overall, the diagnostic interval decreased in a significant way from 6.97 months in period 1 to 3.58 in period 2 and to 2.25 in period 3. When looking separately at unilateral and bilateral disease, the decrease oí the diagnostic interval remained statistically significant in unilateral retinoblastoma; there was also a significant reduction in the number of patients with advanced group E disease (Murphree classification) (61.5% in period 1, 46.7% in period 2, 22.2% in period 3). In bilateral disease, the same observations were made to a lesser extent. However, there were no cases with group E disease in 10 patients with positive family history. Leukornria (48.2%) and strabismus (20.1 %) were the 2 most frequent symptoms throughout the 3 periods. The only factors that statistically influenced the chances of having a diagnosis of group E disease were the diagnostic interval and period of diagnosis. Conclusion : Progress has been made in the diagnosis of retinoblastoma in Switzerland, notably in unilateral disease. Improvement to a lesser extent has also been observed in bilateral cases but without statistical significance. Greater effort is needed to teach physians-in-training to recognize the importance of ocular symptoms and refer patients earlier.

Genetic analyses reveal a role for vitamin D insufficiency in HCV-associated hepatocellular carcinoma development

BACKGROUND: Vitamin D insufficiency has been associated with the occurrence of various types of cancer, but causal relationships remain elusive. We therefore aimed to determine the relationship between genetic determinants of vitamin D serum levels and the risk of developing hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC). METHODOLOGY/PRINCIPAL FINDINGS: Associations between CYP2R1, GC, and DHCR7 genotypes that are determinants of reduced 25-hydroxyvitamin D (25[OH]D3) serum levels and the risk of HCV-related HCC development were investigated for 1279 chronic hepatitis C patients with HCC and 4325 without HCC, respectively. The well-known associations between CYP2R1 (rs1993116, rs10741657), GC (rs2282679), and DHCR7 (rs7944926, rs12785878) genotypes and 25(OH)D3 serum levels were also apparent in patients with chronic hepatitis C. The same genotypes of these single nucleotide polymorphisms (SNPs) that are associated with reduced 25(OH)D3 serum levels were found to be associated with HCV-related HCC (P = 0.07 [OR = 1.13, 95% CI = 0.99-1.28] for CYP2R1, P = 0.007 [OR = 1.56, 95% CI = 1.12-2.15] for GC, P = 0.003 [OR = 1.42, 95% CI = 1.13-1.78] for DHCR7; ORs for risk genotypes). In contrast, no association between these genetic variations and liver fibrosis progression rate (P>0.2 for each SNP) or outcome of standard therapy with pegylated interferon-α and ribavirin (P>0.2 for each SNP) was observed, suggesting a specific influence of the genetic determinants of 25(OH)D3 serum levels on hepatocarcinogenesis. CONCLUSIONS/SIGNIFICANCE: Our data suggest a relatively weak but functionally relevant role for vitamin D in the prevention of HCV-related hepatocarcinogenesis.

Atributos de agregação indicadores da qualidade do solo em sistemas de manejo na região dos cerrados no sul do estado de Goiás

Os Latossolos sob cerrado têm sido intensivamente incorporados ao processo produtivo agrícola. No entanto, são escassos estudos de qualidade do solo nesse ambiente. O objetivo deste trabalho foi verificar alterações em atributos de agregação indicadores da qualidade do solo, em decorrência da adoção de sistemas de manejo em áreas de cerrado nativo, e selecionar os atributos com melhor desempenho em indicar tais alterações. Foram coletadas amostras nas profundidades de 0-10, 10-20 e 20-40 cm, num Latossolo Vermelho distrófico típico, em Morrinhos (GO) e avaliados: diâmetro médio geométrico, percentagem de agregados maiores que 2 mm (> 2 mm), percentagem de agregados menores que 0,25 mm (< 0,25 mm), índice de floculação, carbono orgânico total e carbono da biomassa microbiana. Os sistemas de manejo consistiram de: (1) cerrado nativo; (2) pastagem; (3) plantio direto irrigado; (4) plantio direto irrigado com histórico de gradagem superficial; (5) plantio convencional irrigado; (6) plantio convencional irrigado recente após pastagem. Os sistemas plantio direto, pastagem e plantio convencional recente não alteraram os atributos de agregação avaliados em relação ao cerrado nativo, enquanto o sistema convencional de longa duração reduziu a estabilidade de agregados em água. Na camada superficial do solo, o teor de carbono orgânico total apresentou correlação positiva com o DMG (0,865*) e com a classe de agregados > 2 mm (0,852*) e negativa com a classe de agregados < 0,25 mm (-0,903**). O DMG e as percentagens de agregados > 2 mm e < 0,25 mm apresentaram bom desempenho em indicar alterações em relação ao cerrado, podendo ser sugeridos como componentes a serem utilizados na elaboração de um índice de qualidade do solo para a região.

Transcatheter aortic valve implantation in failed bioprosthetic surgical valves.

IMPORTANCE: Owing to a considerable shift toward bioprosthesis implantation rather than mechanical valves, it is expected that patients will increasingly present with degenerated bioprostheses in the next few years. Transcatheter aortic valve-in-valve implantation is a less invasive approach for patients with structural valve deterioration; however, a comprehensive evaluation of survival after the procedure has not yet been performed. OBJECTIVE: To determine the survival of patients after transcatheter valve-in-valve implantation inside failed surgical bioprosthetic valves. DESIGN, SETTING, AND PARTICIPANTS: Correlates for survival were evaluated using a multinational valve-in-valve registry that included 459 patients with degenerated bioprosthetic valves undergoing valve-in-valve implantation between 2007 and May 2013 in 55 centers (mean age, 77.6 [SD, 9.8] years; 56% men; median Society of Thoracic Surgeons mortality prediction score, 9.8% [interquartile range, 7.7%-16%]). Surgical valves were classified as small (≤21 mm; 29.7%), intermediate (>21 and <25 mm; 39.3%), and large (≥25 mm; 31%). Implanted devices included both balloon- and self-expandable valves. MAIN OUTCOMES AND MEASURES: Survival, stroke, and New York Heart Association functional class. RESULTS: Modes of bioprosthesis failure were stenosis (n = 181 [39.4%]), regurgitation (n = 139 [30.3%]), and combined (n = 139 [30.3%]). The stenosis group had a higher percentage of small valves (37% vs 20.9% and 26.6% in the regurgitation and combined groups, respectively; P = .005). Within 1 month following valve-in-valve implantation, 35 (7.6%) patients died, 8 (1.7%) had major stroke, and 313 (92.6%) of surviving patients had good functional status (New York Heart Association class I/II). The overall 1-year Kaplan-Meier survival rate was 83.2% (95% CI, 80.8%-84.7%; 62 death events; 228 survivors). Patients in the stenosis group had worse 1-year survival (76.6%; 95% CI, 68.9%-83.1%; 34 deaths; 86 survivors) in comparison with the regurgitation group (91.2%; 95% CI, 85.7%-96.7%; 10 deaths; 76 survivors) and the combined group (83.9%; 95% CI, 76.8%-91%; 18 deaths; 66 survivors) (P = .01). Similarly, patients with small valves had worse 1-year survival (74.8% [95% CI, 66.2%-83.4%]; 27 deaths; 57 survivors) vs with intermediate-sized valves (81.8%; 95% CI, 75.3%-88.3%; 26 deaths; 92 survivors) and with large valves (93.3%; 95% CI, 85.7%-96.7%; 7 deaths; 73 survivors) (P = .001). Factors associated with mortality within 1 year included having small surgical bioprosthesis (≤21 mm; hazard ratio, 2.04; 95% CI, 1.14-3.67; P = .02) and baseline stenosis (vs regurgitation; hazard ratio, 3.07; 95% CI, 1.33-7.08; P = .008). CONCLUSIONS AND RELEVANCE: In this registry of patients who underwent transcatheter valve-in-valve implantation for degenerated bioprosthetic aortic valves, overall 1-year survival was 83.2%. Survival was lower among patients with small bioprostheses and those with predominant surgical valve stenosis.

Activation of the mouse TATA-less and human TATA-containing UDP-glucuronosyltransferase 1A1 promoters by hepatocyte nuclear factor 1.

UDP-glucuronosyltransferase (UGT) 1A1 (UGT1A1) catalyzes the glucuronidation of bilirubin in liver. Among all UGT isoforms identified to date, it is the only relevant bilirubin-glucuronidating enzyme in human. Because glucuronoconjugation is the major route of bilirubin elimination, any genetic alteration that affects bilirubin glucuronosyltransferase activity may result in a more or less severe hyperbilirubinemia. In this study, we report the cloning and characterization of the transcriptional regulation of the mouse UGT1A1 gene. Primary-structure analysis of the mouse Thymidine Adevice promoter revealed marked differences with its human homolog. First, the mouse promoter lacks the highly polymorphic thymidine/adenine repeat occurring in the human promoter, which has been associated with some forms of hyperbilirubinemia. Second, an L1 transposon element, which is absent in the human promoter, is found 480 bp upstream of the transcription start site in mouse. Using the electromobility shift and DNase I footprinting experiments, we have identified a hepatocyte nuclear factor 1-binding site in the mouse UGT1A1 promoter that confers responsiveness to both factors HNF1alpha and HNF1beta in HEK293 cells. Furthermore, we show that this element, which is conserved in the human promoter, also confers strong HNF1 responsiveness to the human UGT1A1 gene. Together, these results provide evidence for a major regulatory function of this liver-enriched transcription factor in UGT1A1 activity in both rodents and human.

IL28B polymorphisms, IP-10 and viral load predict virological response to therapy in chronic hepatitis C.

Aliment Pharmacol Ther 2011; 33: 1162-1172 SUMMARY: Background  Hepatitis C virus (HCV) is a major cause of chronic liver disease, cirrhosis and hepatocellular carcinoma and the identification of the predictors of response to antiviral therapy is an important clinical issue. Aim  To determine the independent contribution of factors including IL28B polymorphisms, IFN-gamma inducible protein-10 (IP-10) levels and the homeostasis model assessment of insulin resistance (HOMA-IR) score in predicting response to therapy in chronic hepatitis C (CHC). Methods  Multivariate analysis of factors predicting rapid (RVR) and sustained (SVR) virological response in 280 consecutive, treatment-naive CHC patients treated with peginterferon alpha and ribavirin in a prospective multicentre study. Results  Independent predictors of RVR were HCV RNA <400 000 IU/mL (OR 11.37; 95% CI 3.03-42.6), rs12980275 AA (OR 7.09; 1.97-25.56) and IP-10 (OR 0.04; 0.003-0.56) in HCV genotype 1 patients and lower baseline γ-glutamyl-transferase levels (OR = 0.02; 0.0009-0.31) in HCV genotype 3 patients. Independent predictors of SVR were rs12980275 AA (OR 9.68; 3.44-27.18), age <40 years (OR = 4.79; 1.50-15.34) and HCV RNA <400 000 IU/mL (OR 2.74; 1.03-7.27) in HCV genotype 1 patients and rs12980275 AA (OR = 6.26; 1.98-19.74) and age <40 years (OR 5.37; 1.54-18.75) in the 88 HCV genotype 1 patients without a RVR. RVR was by itself predictive of SVR in HCV genotype 1 patients (OR 33.0; 4.06-268.32) and the only independent predictor of SVR in HCV genotype 2 (OR 9.0, 1.72-46.99) or genotype 3 patients (OR 7.8, 1.43-42.67). Conclusions  In HCV genotype 1 patients, IL28B polymorphisms, HCV RNA load and IP-10 independently predict RVR. The combination of IL28B polymorphisms, HCV RNA level and age may yield more accurate pre-treatment prediction of SVR. HOMA-IR score is not associated with viral response.

Directrius per a l'accessibilitat al contingut web, versió 1.0

Aquestes directrius expliquen com fer que el contingut web sigui accessible a persones amb discapacitats i s'adrecen a creadors de contingut (autors de pàgines web o dissenyadors de llocs web) i a creadors d'eines d'autor. L'objectiu principal d'aquestes directrius és promoure l'accessibilitat. Tanmateix, l'aplicació de les directrius facilitarà l'accés al contingut a tot tipus d'usuari, sigui quin sigui l'agent d'usuari usat (navegador web, navegador de veu, telèfon mòbil, ordinador de cotxe, etc.) o les condicions de l'entorn de consulta (entorns sorollosos, espais mal il·luminats, entorns en què no es poden usar les mans, etc.). L'aplicació d'aquestes directrius també ajudarà els usuaris a trobar la informació d'una manera més ràpida dins el web. Les directrius no pretenen desincentivar l'ús d'imatges, vídeo, etc., sinó que expliquen com fer que el contingut multimèdia sigui més accessible a una àmplia audiència.Aquest és un document de referència per a uns principis d'accessibilitat i idees de disseny. Algunes de les estratègies comentades tracten d'aspectes relatius a la internacionalització del web i a l'accés des de terminals mòbils. Tanmateix, el document se centra en l'accessibilitat i no tracta exhaustivament dels aspectes relacionats amb altres activitats del W3C. Si voleu més informació sobre aquests temes podeu consultar les pàgines inicials W3C Mobile Access Activity (per a l'accés des de terminals mòbils) i W3C Internationalization Activity (per als aspectes d'internacionalització).Aquest document està pensat per a ser estable en el temps i, per tant, no dóna informació específica sobre si els navegadors funcionen o no amb una determinada tecnologia, ja que aquesta informació varia molt ràpidament. Aquesta informació es pot trobar al web de la Web Accessibility Initiative ,WAI, (Iniciativa d'Accessibilitat Web) [WAI-UA-SUPPORT].Aquest document inclou un annex que organitza tots els punts de verificació ordenats per tema i per prioritat. Els punts de l'annex estan enllaçats a les respectives definicions en el document. Els temes recollits en l'annex inclouen les imatges, el contingut multimèdia, les taules, els marcs, els formularis i els scripts. L'annex es presenta en forma de taula o com a simple llista.Un document a part, amb el títol Techniques for Web Content Accessibility Guidelines 1.0 (Tècniques per a les directrius per a l'accessibilitat al contingut web, versió 1.0) ([TECHNIQUES]) explica com posar a la pràctica els punts citats fins aquí. El document de tècniques explica cada punt amb més detalls i dóna exemples usant el llenguatge d'etiquetatge d'hipertext (HTML), fulls d'estil en cascada (CSS), el llenguatge d'integració multimèdia sincronitzada (SMIL) o el llenguatge d'etiquetatge matemàtic (MathML). Aquest document també inclou tècniques per a provar o validar una pàgina web i un índex dels elements i atributs HTML amb les tècniques que els usen. El document de tècniques està pensat per a seguir de prop els canvis tecnològics i es preveu que s'actualitzi més sovint que les directrius.Nota: Algunes de les característiques descrites en les directrius no estan encara implementades en tots els navegadors o eines multimèdia; en concret pot ser que no es puguin utilitzar funcions noves d'HTML 4.0, de CSS1 o CSS2.Les Directrius per a l'accessibilitat al contingut web, versió 1.0 són part d'una col·lecció de directrius sobre accessibilitat publicades per la Web Accessibility Initiative, WAI (Iniciativa d'Accessibilitat Web). La col·lecció comprèn User Agent Accessibility Guidelines (Directrius d'accessibilitat per a agents d'usuari) [WAI-USERAGENT] i Authoring Tool Accessibility Guidelines (Directrius d'accessibilitat per a eines d'autor [WAI-AUTOOLS].

Loss of Memo, a novel FGFR regulator, results in reduced lifespan.

Memo is a widely expressed 33-kDa protein required for heregulin (HRG)-, epidermal growth factor (EGF)-, and fibroblast growth factor (FGF)-induced cell motility. Studies in mouse embryonic fibroblasts, wild-type or knockout for Memo, were performed to further investigate the role of Memo downstream of FGFR. We demonstrated that Memo associates with the FGFR signalosome and is necessary for optimal activation of signaling. To uncover Memo's physiological role, Memo conditional-knockout mice were generated. These animals showed a reduced life span, increased insulin sensitivity, small stature, graying hair, alopecia, kyphosis, loss of subcutaneous fat, and loss of spermatozoa in the epididymis. Memo-knockout mice also have elevated serum levels of active vitamin D, 1,25-dihydroxyvitamin D3 (1,25(OH)2D), and calcium compared to control littermates expressing Memo. In summary, the results from in vivo and in vitro models support the hypothesis that Memo is a novel regulator of FGFR signaling with a role in controlling 1,25(OH)2D production and normal calcium homeostasis.

Delirium in elderly patients hospitalized in an acute care unit.

Introduction: Delirium is frequent in hospitalized older people, with incidence rate up to 40% in acute care. Delirium is associated with several adverse consequences, including increased mortality and institutionalization. This study aims to investigate the prevalence, incidence, and consequences of delirium in patients hospitalized in an acute care unit for elderly (ACE unit). Methods: Over a 3 months period, every patient (N = 93, mean age 84.1 ± 7.8 years, 66/93(71%) women) admitted to a 28-bed ACE unit were systematically assessed for delirium. Trained nurses used the Confusion Assessment Method (CAM) instrument to determine the presence of delirium at admission and on each subsequent day over patients' stay. Delirium prevalence rate was defined as the proportion of patients with a positive CAM within 24 hours of admission to the ACE unit. Delirium incidence rate was defined as the proportion of patients with a negative CAM at admission whose CAM became positive at least once during their stay. This evaluation was part of a functional assessment, including Basic Activities of Daily Life (Katz BADL, from 0 to 6, higher score indicating better function). Delirium prevention interventions and specific treatment was provided if needed. Results: Overall,25/93(27%)patients had delirium during their stay. Prevalence of delirium at admission was 10/93 (11%), with an incidence of 15/83(18%). Compared with non-delirious patients, those with delirium were more frequently men (10/25(40%) vs 17/68(25%), p <.001) and had reduced functional status at admission(BADL 2.0 ± 1.9 vs 3.6 ± 2.1, p = .004). They tended to be older (86.0 ± 6.7 vs 83.3 ± 8.1 years, p = .110). At discharge, delirium was associated with reduced functional status (BADL 2.0 ± 2.1 vs 4.3 ± 1.9, p <.001), lower rate of home discharge (6/20(30%) vs 28/65 (43%), p = .009) and increased mortality (5/25 (20%) vs 3/68 (5%), p <.001). On average, patients with delirium stayed 5.7 days longer (17.0 ± 9.8 vs 11.31 ± 6.3, p = .011). Conclusion: Delirium occurred in almost a third of these older patients, even though its incidence was relatively low in this frail population. Despite specific management, delirium remained associated with higher risk for adverse outcomes at discharge. These results suggest that early preventive interventions, implemented as soon as possible after hospital admission, might be needed in similar population to achieve better outcomes. Effectiveness of such interventions will be evaluated in future studies.

Prescription d'un traitement hypolipémiant lors d'un syndrome coronarien aigu en fonction du profil lipidique

Introduction: Les données épidémiologiques montrent que seuls25-30% des patients avec syndrome coronarien aigu (SCA) atteignentles valeurs cibles de LDL-cholestérol (LDL-C). Les recommandationsexistantes précisent le choix et le dosage des statines à utiliser enfonction du LDL-C cible souhaité. Le but de cette étude observationnelleétait de connaître les pratiques actuelles au CHUV avant d'introduireune étude d'intervention.Méthode: Pour être inclus, les patients devaient être admis au CHUVpour un SCA avec troponine positive (>= 0.1 microg/l) entre le23.11.2008 et le 29.05.2010. Un bilan lipidique complet (CT, HDL-C,LDL-C, TG) a été dosé à leur admission et un nouveau contrôle desparamètres lipidiques a été effectué à 3 mois. Les hypolipémiantsutilisés durant cette période ont été analysés pour chaque patient.Résultats: 141 patients, 101 hommes (âge moyen 63 ± 13 ans) et 40femmes (âge moyen 73 ± 13 ans) admis aux urgences pour un SCAavec troponine positive ont été inclus. La valeur moyenne du LDL-C àl'admission était de 3,4 ± 1,1 mmol/l (hommes 3,5 ± 1,1; femmes 3,3 ±1,1) et de 2,4 ± 0,8 mmol/l (hommes 2,4 ± 0,8; femmes 2,2 ± 0,7) aucontrôle de 3 mois. Parmi ces 141 patients, 52 (37%) étaient déjàtraités par une statine (36 hommes et 16 femmes). Leur valeur deLDL-C à l'admission était de 2,8 ± 0,9 mmol/l et de 2,5 ± 0,6 mmol/l aucontrôle de 3 mois. 7 patients (13%) ont eu une augmentation dudosage de leur statine, 14 patients (27%) ont eu un changement destatine et 31 patients (60%) n'ont eu aucune modification de leurtraitement. 89 patients n'avaient pas de statine (65 hommes et 24femmes) à leur admission mais ont quitté l'hôpital sous une statine.Leur valeur de LDL-C à l'entrée s'élevait à 3,8 ± 1 mmol/l et à 2,3 ± 0,8mmol/l au contrôle de 3 mois.Conclusion: Chez les patients hospitalisés pour un SCA mais sanstraitement par statine préalable, les résultats montrent une bonneadéquation (peut-être liée au hasard au vu d'une prescriptionstandardisée) entre le traitement prescrit et l'obtention d'un LDL-C ciblesouhaitable à 3 mois. Chez les patients déjà sous traitement de statine,les résultats montrent une faible baisse du LDL-C à 3 mois malgré leurrisque cardio-vasculaire plus élevé. Une prise en charge individualiséesemble d'autant plus nécessaire que le risque est élevé.

[Illustrations de Le Diable boiteux.] / Dubercelle, grav. ; Alain-René Lesage, aut. du texte

Comprend : Tome 1. Frontispice copié d'après le frontispice réalisé par Magdeleine Horthemels de l'édition originale de 1707 :Le Diable boiteux.] El Diablo Coivelo. [Cote : microfilm R.61628] ; [Pl.] Tom.1 Pag. 25 : Dans quel endroit le Diable Boiteux transporta l'Ecolier et des premières choses qu'il lui fit voir. [Le Diable boiteux, en compagnie de l'Ecolier Zambullo, jette un sort sur la ville de Madrid et fait disparaître les toits d ; [Pl.] Tom.1 Pag. 52 : Histoire des amours du Comte de Belflor et de Léonor de Cespedes. [Cote : microfilm R.61628] ; [Pl.] Tom.1 Pag. 164 : Des Prisonniers. [Cote : microfilm R.61628] ; [Tome 1. Pl. en reg p. 244 :] Des foux enfermez. [Cote : microfilm R.61628] ; [Pl.] Tom.1 Pag. 311 : [Querelle de rue opposant des musiciens et quatre hommes armés.] [Cote : microfilm R.61628] ; [Pl.] Tom.1 Pag. 316 : De l'Incendie, et de ce que fit Asmodée en cette occasion par amitiépour Don Cléofas. [Cote : microfilm R.61628] ; [Pl.] Tom.2 Pag. 3 : Des Tombeaux, des Ombres et de la Mort. [Cote : microfilm R.61628] ; [Pl.] Tom.2 Pag. 29 : La force de l'amitié. [Cote : microfilm R.61628] ; [Pl.] Tom.2 Pag. 91 : Du Démêlé d'un Poëte Tragique avec un Auteur Comique. [Cote : microfilm R.61628] ; [Pl.] Tom.2 Pag. 181 : Des Songes. [Cote : microfilm R.61628] ; [Pl.] Tom.2 Pag. 220 : Ce que le Diable fit encore remarquer à Don Cléofas. [Cote : microfilm R.61628] ; [Pl.] Tom.2 Pag. 291 : De ce que fit Don Cléofas après que le Diable Boiteux se fut éloigné de lui; et de quelle façon l'Auteur de cet Ouvrage a jugé à propos de le finir. [Don Cléofas donne la main de sa fille Séraphine au cavalier Léandr