Étude du rapport entre les manifestations d'agitation et l'inconfort de la personne âgée atteinte de démence (pad) au moment de la toilette en milieu hospitalier spécialise

Les personnes âgées atteintes de démence (PAD) souffrent de troubles importants de la communication associés à des manifestations psychologiques et comportementales comme l'agitation. La plupart de ces personnes hospitalisées sont en outre atteintes de comorbidités physiques ou psychologiques pouvant provoquer de l'inconfort. Ce travail décrit la fréquence des comportements d'agitation et de l'inconfort des PAD durant les soins d'hygiène et vérifie si ces deux phénomènes sont associés durant la toilette. La mise en perspective infirmière des résultats de l'étude est effectuée à partir des écrits scientifiques et du cadre théorique du confort de Kolcaba.

Immunoglobulin G4-related disease: autoimmune pancreatitis and extrapancreatic manifestations

Abstract We present a case of immunoglobulin G4 (IgG4)-related disease with pancreatic and extrapancreatic involvement, including the biliary and renal systems. Given the importance of imaging methods for the diagnosis of IgG4-related disease and its differentiation from pancreatic adenocarcinoma, we emphasize important abdominal computed tomography and magnetic resonance imaging findings related to this recently recognized systemic autoimmune disease.

Tuberous sclerosis complex with oral manifestations: A case report and literature review

Introduction: Tuberous sclerosis complex (TSC) is a neurocutaneous syndrome produced by a number of genetic mutations. The disease is characterized by the development of benign tumors affecting different body systems. The most common oral manifestations of TSC are fibromas, gingival hyperplasia and enamel hypoplasia. Clinical Case: A 35-year-old woman diagnosed with TSC presented with a reactive fibroma of considerable size and rapid growth in the region of the right lower third molar. Discussion: In the present case the association of TSC with dental malpositioning gave rise to a rapidly evolving reactive fibroma of considerable diameter. Few similar cases can be found in the literature. Patients with TSC present mutations of the TSC1 and TSC2 genes, which intervene in cell cycle regulation and are important for avoiding neoplastic processes. No studies have been found associating TSC with an increased risk of oral cancer, though it has been shown that the over-expression of TSC2 could exert an antitumor effect. Careful oral and dental hygiene, together with regular visits to the dentist, are needed for the prevention and early detection of any type of oral lesion. The renal, pulmonary and cardiac alterations often seen in TSC must be taken into account for the correct management of these patients.

Manifestations of the American Dream: A Secret History

Pro gradu -tutkielmassani tarkastelen, miten amerikkalainen unelma on Yhdysvaltain historian saatossa kehittynyt yhteiskunnallisen kontrollin välineeksi. Amerikkalaisen unelman yksilölliset ja kollektiiviset kokemukset ovat ristiriidassa unelman sisäisten rakenteiden kanssa, jotka kätkeytyvät sen vahvan retoriikan taakse. Täten unelmasta muodostuu ideologia ja ideologinen valtakoneisto marxilaisen yhteiskuntateoreetikon Louis Althusserin määritelmien mukaisesti. Tutkielmassani tarkastelen amerikkalaisen unelman ilmenemistä amerikkalaisessa populaarikulttuurissa. Populaarikulttuuri tavoittaa laajan yleisön, ja sen arkipäiväiset aiheet välittävät ja uusintavat amerikkalaista unelmaa tehden siitä luonnollisen ja sisäistetyn osan amerikkalaisia toiminta- ja ajattelumalleja. Populaarikirjallisuutta esimerkkinä käyttäen pyrin selvittämään, miten amerikkalainen unelma ideologisena valtakoneistona käyttää hyväksi yksilön subjektiviteetin rakenteita taatakseen oman jatkuvuutensa. Teoreettisen viitekehyksen subjektiviteetin tarkastelulle luo ranskalaisen semiotiikantutkijan Julia Kristevan psykoanalyyttinen teoria, jonka mukaan subjektiviteetti rakentuu yksilön piilotajunnan ja tietoisuuden vuorovaikutuksesta. Amerikkalainen unelma hyödyntää tätä vuorovaikutusta peilaamalla yksilön piilotajuisia pelkoja ja haluja. Kristeva käsittelee piilotajuisia haluja käyttäen apunaan ranskankielistä termiä jouissance, joka viittaa sellaiseen tiedostamattomaan haluun tai tarpeeseen, joka toimii elämän elinehtona ja selviytymisviettinä. Pelkoja Kristeva puolestaan tarkastelee abjektion käsitteen kautta. Abjekti tarkoittaa sellaista tunnistamatonta pelkoa, joka purkautuu tietoisuuteen piilotajunnan ja tietoisuuden vuorovaikutuksen ansiosta. Sekä abjekti että jouissance ilmenevät tietoisuudessa ahdistuksen kokemuksena, johon amerikkalainen unelma tarjoaa ratkaisun asettamalla abstrakteja ja konkreettisia tavoitteita, jotka yksilön tulisi saavuttaa. Amerikkalainen unelma ei kuitenkaan koskaan toteudu. Se perustuu liikkeeseen jonka keskiössä on jatkuva muutos ja kehitys.

Renal and extrarenal manifestations of autosomal dominant polycystic kidney disease

The objective of the present study was to determine the frequency of the most common clinical features in patients with autosomal dominant polycystic kidney disease in a sample of the Brazilian population. The medical records of 92 patients with autosomal dominant polycystic kidney disease attended during the period from 1985 to 2003 were reviewed. The following data were recorded: age at diagnosis, gender, associated clinical manifestations, occurrence of stroke, age at loss of renal function (beginning of dialysis), and presence of a family history. The involvement of abdominal viscera was investigated by ultrasonography. Intracranial alterations were prospectively investigated by magnetic resonance angiography in 42 asymptomatic patients, and complemented with digital subtraction arteriography when indicated. Mean age at diagnosis was 35.1 ± 14.9 years, and mean serum creatinine at referral was 2.4 ± 2.8 mg/dL. The most frequent clinical manifestations during the disease were arterial hypertension (63.3%), lumbar pain (55.4%), an abdominal mass (47.8%), and urinary infection (35.8%). Loss of renal function occurred in 27 patients (mean age: 45.4 ± 9.5 years). The liver was the second organ most frequently affected (39.1%). Stroke occurred in 7.6% of the patients. Asymptomatic intracranial aneurysm was detected in 3 patients and arachnoid cysts in 3 other patients. In conclusion, the most common clinical features were lumbar pain, arterial hypertension, abdominal mass, and urinary infection, and the most serious complications were chronic renal failure and stroke. Both intracranial aneurysms and arachnoid cysts occurred in asymptomatic patients at a frequency of 7.14%.

Three-year follow-up study of respiratory and systemic manifestations of chronic obstructive pulmonary disease

Few studies show patient outcomes over time in chronic obstructive pulmonary disease (COPD). In the present study, we monitored forced expiratory volume in the first second (FEV1) and other manifestations of the disease over 3 years in 133 COPD patients (69% males, age = 65 ± 9 years, FEV1 = 59 ± 25%) evaluated at baseline. During follow-up, 15 patients (11%) died and 23 (17%) dropped out. Measurements for 95 (72%) COPD patients alive after 3 years were analyzed. FEV1, body mass index (BMI), 6-min walking distance (6MWD), Medical Research Council scale (MRC), Saint George’s Respiratory Questionnaire (SGRQ), Charlson Comorbidity index, and BODE index were obtained at baseline and after 3 years. At baseline, 17 patients (18%) presented mild, 39% moderate, 19% severe, and 24% very severe COPD. Predicted FEV1 % and BMI did not change over the period (P > 0.05). FEV1 in liters [1.25 (0.96-1.72) vs 1.26 (0.88-1.60) L; P < 0.001], 6MWD (438 ± 86 vs 412 ± 100 m; P < 0.001), MRC [1 (1-2) vs 2 (1-3); P = 0.002], Charlson index [3 (3-4) vs4 (3-5); P = 0.009], BODE index (2.2 ± 1.8 vs 2.6 ± 2.3; P = 0.008), and total SGRQ (42 ± 19 vs 44 ± 19%; P = 0.041) worsened after 3 years compared to baseline measurements. These data show that COPD patients deteriorated during the 3-year follow-up despite the fact that they had only minor modifications in airway obstruction and body composition. They support the need for comprehensive patient assessment to better identify disease progression.

Association of postalimentary lipemia with atherosclerotic manifestations

We identified different lipemic and metabolic responses after the ingestion of a standardized meal by healthy adults and related them to atherosclerotic markers. Samples from 60 normolipidemic adults were collected before and after a liquid meal (40 g fat/m² body surface) at 0, 2, 4, 6, and 8 h for measurements of lipids, free fatty acids (FFA), insulin, cholesteryl ester transfer protein (CETP), autoantibodies to epitopes of oxidized LDL (oxLDL Ab), lipolytic activities, and apolipoprotein E polymorphism. Mean carotid intima-media thickness (cIMT) was determined by Doppler ultrasound. The volunteers were classified into early (N = 39) and late (N = 31) triacylglycerol (TAG) responders to the test meal. Late responders showed lower HDL cholesterol concentration at fasting and in the TAG peak, lower insulin and higher FFA concentrations compared to early responders. Multivariate regression analyses showed that mean cIMT was associated with gender (male) and age in early responders and by cholesterol levels at the 6th hour in late responders. oxLDL Ab were explained by lipoprotein lipase and negatively by hepatic lipase and oxLDL Ab (fasting period) by CETP (negative) and FFA (positive). This study is the first to identify a postalimentary insulin resistance state, combined with a reduced CETP response exclusively among late responders, and the identification of the regulators of postalimentary atherogenicity. Further research is required to determine the metabolic mechanisms described in the different postalimentary phenotypes observed in this study, as well as in different pathological states, as currently investigated in our laboratory.

Manifestations à Damas : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 60352

Le mouvement d'indépendance en Syrie, manifestations dans les rues de Damas : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 60353

Mouvement d'indépendance en Syrie, des Arabes se joignent aux manifestations de Damas : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 60354