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The document addresses the importance of physical activity in elderly people, highlighting the benefits of adapted physical activity (APA) on health. It emphasizes the positive effects of APA on mental well-being, fall and fracture prevention, as well as Alzheimer's disease. It recommends adapted physical activities, while also highlighting the contraindications to consider. The High Health Authority recommends at least 30 minutes of physical activity per day for elderly people. [Extracted from the article]

Respiratory syncytial virus (RSV) is the most common cause of acute lower respiratory tract infection and hospitalization in children. Globally, in 2019, there were an estimated 33 million acute respiratory infections associated with RSV, resulting in 3.6 million pediatric hospitalizations. People 65 years and older are also at risk for severe RSV infection with an estimated 5.2 million cases, 470,000 hospitalizations, and 33,000 hospital deaths among adults ≥ 60 years in high-income countries pupil. A vaccine has just been authorized for pregnant women to prevent RSV infections in infants and two other vaccines (only one of which is marketed in France) for the elderly. What to expect from vaccination? How effective? How long does the protection last? What side effects? [ABSTRACT FROM AUTHOR]

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The elderly are particularly vulnerable to loneliness, which increases the risk of psychiatric, cardiovascular and neurocognitive co-morbidities and mortality. Improving social support can help limit the impact of this. Maisons d'Accueil et Résidence pour Personnes Agées (MARPAs) offer a solution, although their influence on social support has received little attention in the literature. We conducted a qualitative analysis based on a field survey of semi-structured interviews with elderly people living in two establishments in the Loire. Although MARPAs provide effective social support, they only seem to address the problem of loneliness in independent elderly people if it is significant and associated with proven isolation at home. On the other hand, they are increasingly seen as an effective alternative to EHPAD (Établissement d'Hébergement pour Personne Agée Dépendante). [ABSTRACT FROM AUTHOR]

Introduction: obstructive sleep apnea hypopnea syndrome (OSAHS) is a common but often under diagnosed disease among elderly persons. The aim of our study was to determine the clinical and polygraphic characteristics of OSAHS in elderly by comparing them to younger patients. Methods: a retrospective study was performed at Pavillon D pneumology at Abderrahmen Mami Hospital in Ariana including 222 patients with OSAHS, divided into two groups: group 1 including 72 patients aged 18 to 45 years and Group 2 including 150 patients aged 65 and over. Clinical and polygraphic data was collected. Results: elderly patients were more female, less exposed to tobacco but more exposed to biomass smoke. The average consultation time was significantly longer for elderly patients compared to young patients. Diurnal fatigue and memory impairment were more observed in elderly patients. Asthma, hypothyroidism, diabetes, dyslipidemia, hypertension and atrial fibrillation were most commonly observed in elderly patients. Pauses in airflow and tonsillary hypertrophy were less observed in this group. There was no significant difference in OSAHS severity between the 2 groups. Logistic regression analysis showed that elderly apneic patients were more likely to be female, to have more memory impairment and to have more comorbidities with HTA, atrial fibrillation, diabetes and hypothyroidism. Conclusion: the frequency of cardiovascular, metabolic and cognitive comorbidities requires sleep investigation in apneic elderly subject, whether the clinical presentation is typical or not. [ABSTRACT FROM AUTHOR]

Introduction: The use of medicinal plants in Algeria is an ancestral practice that remains relevant today. The population relies on plants to treat various diseases and everyday ailments, which can be dangerous, especially when taking medication [1,2]. The interaction between plants and medication can lead to a modification of the plasma concentrations of the latter, which can impact its therapeutic effectiveness and be responsible for toxicity or therapeutic failure [1,2]. The interaction can also be pharmacodynamic, resulting in the potentiation of the effect or its antagonism. The risk is even higher when the medication has a narrow therapeutic range or presents high inter- or intra-individual variability, such as with vitamin K antagonist anticoagulants., Clinical Case: We report the case of patient B.Z., aged 77, who is suffering from complete atrial fibrillation (ACFA). The patient has been under antivitamin K (AVK) treatment with acenocoumarol for 8 years and has been followed at the central laboratory of Didouche Mourad Hospital since August 2019. The patient has been stable with an INR within the therapeutic target range of 2-3 for 4 years. She is compliant and adheres to the dietary regimen. The dosage of acenocoumarol is alternated between 1/2 tablet and 1/4 tablet. On September 6, 2023, during a routine check-up, the patient's INR was 6.42, and the PT was 17.9%. The recommendation was to stop AVK and perform a control the following day. The interview revealed that the patient had started taking an infusion of oregano (Origanum vulgare), and occasionally verbena, at a rate of one 200 ml cup per day for a week. On September 7, 2023, the INR decreased to 3.80 and the PT to 26.9%, so the recommendation was to resume AVK at a dosage of 1/4 tablet to 1/2 tablet, with discontinuation of the herbal tea intake and an INR check after 72 hours. On the fourth day after resuming the anticoagulant, the INR was 2.5. Despite being informed of the risk of interaction, the patient resumed taking the freshly picked oregano herbal tea from her garden. Given the patient's determination to continue her infusion, the recommendation was made to limit her intake, to prepare much more diluted infusions, and to reduce the dose of acenocoumarol to 1/4 tablet; this allowed the stabilization of the patient's INR. The last check-up was performed on April 7, 2024, with an INR value of 2.3., Results: Oregano, a plant from the Lamiaceae family, is used in herbal tea to treat a wide range of diseases, including joint pain, respiratory conditions, and digestive disorders. Similarly, verbena is also used to combat sleep disorders [2-4]. Origanum and verbena are both plants rich in polyphenols, as well as tannins and flavonoids. These substances are inhibitors of CYP 450, particularly CYP 2C9 and CYP 3A4, which are responsible for the metabolism of many drugs, including painkillers, antihypertensives, central nervous system drugs, and anticoagulants such as acenocoumarol. Origanum also exhibits anticoagulant activity due to its high content of carvacrol and thymol [4-6]. These two modes of interaction lead to an increase in the pharmacodynamic effect of acenocoumarol and, therefore, an increased risk of bleeding. This was the case for our patient, who saw her INR increase to more than twice the normal level, coinciding with the intake of oregano and verbena infusions, which normalized after their discontinuation., Conclusion: Oregano is an endemic plant widely used in Algeria, whose anti-inflammatory properties are well established. However, its side effects, toxicity, and risk of interaction when combined with medications are less known. The interaction between oregano and AVK (acenocoumarol) exists and deserves to be recognized and monitored, especially in a population with a traditional culture where the use of plants is common. This practice should be accompanied by national phytovigilance., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Introduction: The aim of the study was to assess the level of treatment optimization after follow-up at discharge., Methods: We conducted a retrospective study carried out from January 1st, 2016 to December 31st, 2018 in Abidjan Heart Institute with patients hospitalized for heart failure and reviewed in consultation., Results: The study involved 350 patients with an average age of 53.53 ± 16.38 years (54% were males). The prescription of diuretics (92%) after optimization was at the mean and with maximum doses of 29.1% and 7.7%. ACEIs/ARBs (77.1%) had optimal and mean doses for ACEIs of 14.3% and 29.7%. With beta-blockers (72.6%) there was an improvement in doses at 35.4% for the average doses and 3.1%. for the maximum dose. Spironolactone (44.3%) kept the same average dose at 5.7% The median time of optimization was 287.05 days with a median of 140 days. Only 13.4% of patients were receiving optimal treatment at optimal doses. By logistic regression, the presence of LVEF ≤ 0,40 or LVEF= 0.41-0.49 or global heart failure (P < 0.001) favored drug optimization (OR = 24.68[7.15-82.22], P < 0.001); (OR = 11.39[3.25-39.86], P < 0.001) on the other hand, a high serum creatinine level was an obstacle for treatment optimization (OR = 0.92[0.88-0.96], P < 0.001)., Conclusion: The optimization of the treatment of heart failure is insufficient with too long delays in our context. The optimization time was so long. It could be improved by setting up a clinic to optimize the treatment of heart failure., Competing Interests: Déclaration de liens d'intérêts Les auteurs déclarent ne pas avoir de liens d'intérêts., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Introduction: Heart failure is a major public health problem because of the number and duration of hospitalizations. Patients with heart failure may have mixed etiologies that are not mutually exclusive, and etiologies vary between high-income and developing countries. The aim of our work was to study the contribution of coronary angiography in the etiological investigation of heart failure with impaired LVEF in the cardiology department of HPD., Methodology: This was a descriptive and analytical cross-sectional study with retrospective data collection on 103 patients hospitalized in the cardiology department of DAKAR's Hospital Principal presenting with heart failure with impaired LVEF and who underwent coronary angiography from January 2019 to December 2022., Results: Our study included 103 patients with a clear male predominance 79.6% and a sex ratio of 3.7. Their mean age was 64±13.5 years. Diabetes was prevalent at 24.3% (p=0.033). All patients had impaired segmental and/or global left ventricular kinetics. Mean ejection fraction was 28.1±6.8. The right radial route was predominantly used 83.7% of the time, and there were no procedural incidents or accidents. Diabetes was significantly associated with coronary involvement (p=0.033). Coronary angiography was normal in 37.8% of patients and showed tri-truncular lesions in 19.4% of patients and bi-truncular lesions in 17.4%. We found 91 significant lesion and 67 non-significant lesion. A total of 41 patients had ischemic heart disease, equivalent to 39.8%., Conclusion: Our study shows that ischemic heart disease plays an important role in the etiology of heart failure with impaired LVEF, and that coronary angiography should be performed routinely., Competing Interests: Déclaration de liens d'intérêts Les auteurs déclarent n'avoir aucun lien d'intérêt en relation avec cet article., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Sexual health is a central aspect of the well-being and quality of life of cancer patients. Through two separate surveys, one conducted among patients and the other among professionals, we assessed the needs and practices relating to sexual health in cancer care. The results showed that the importance attached to taking intimate and sexual life into account was fairly high, but that 44% of patients had discussed the subject with a professional, and the majority had done so on their own initiative. The types of support requested were a dedicated consultation (38%) and exchanges with other people with cancer (21%). More than half of the professionals did not discuss sexual health with their patients. The needs identified were specific training, time to exchange and share experiences with other professionals, and resources (documentation, reference websites). Professional training and appropriate tools seem necessary to meet patients' expectations., (Copyright © 2024 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Neurocognitive disorders are a major public health challenge, affecting 55 million people, and are projected to triple by 2050. This year's research highlights pathological mechanisms such as mitochondrial dysfunction and brain inflammation. Modifiable risk factors, such as vision loss, underscore the importance of early prevention. A Swiss study reveals a high prevalence of inappropriate drug prescriptions in the elderly. Anti-amyloid treatments, such as lecanemab and donanemab, show promising results. Lastly, anticoagulation for atrial fibrillation may reduce the risk of dementia. An integrated approach is essential to alleviate the burden of neurocognitive disorders., Competing Interests: les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Introduction: Acute decompensation represents a remarkable event in cirrhotic patients, particularly if it is complicated by Acute-on-Chronic Liver Failure (ACLF). Epidemiological data of ACLF are limited., Aim: To determine the prevalence and predictive factors of ACLF in patients hospitalized for decompensated cirrhosis., Methods: We conducted a retrospective study. We included patients with decompensated cirrhosis. ACLF was defined according to the CLIF-C OF score. Prevalence and predictive factors of ACLF were determined., Results: We included 100 patients. The prevalence of ACLF was 37%. Renal failure was the most frequent organ failure. In univariate analysis, predictive factors for the occurrence of ACLF were female gender, hepatic encephalopathy, upper digestive haemorrhage, the presence of an infection, CRP level, bilirubin level and creatinine level. Prognostic scores (Child-Pugh, MELD, and CLIF-C OF) were also predictive of ACLF. In multivariate analysis, only creatinine level was an independent predictive factor of ACLF. The most frequent precipitating factor of ACLF was infection. The overall mortality rate for patients with ACLF was 65%., Conclusion: Our study showed that the prevalence of ACLF was 37 %. The main predictive factor of ACLF was creatinine level. The mortality rate was high at 65 %.

Introduction-Aim: Spontaneous bacterial peritonitis (SBP) is a common complication in cirrhotic patients and is associated with a high mortality rate. The aim of this study is to determine the epidemiological and bacteriological profile of spontaneous bacterial peritonitis, as well as antibiotic resistance among hospitalized patients at CHU Mohammed VI, in order to guide empirical antibiotic choices for better management. Methods: This is a prospective study conducted over a period of 12 months, from January to December 2023, focusing on all requests for bacteriological examination of ascitic fluid samples. All samples received at the microbiology laboratory were processed according to the Medical Microbiology Reference Standard (Remic) Results: A total of 137 ascitic fluid samples were included. The main etiologies implicated in ascites were cirrhosis (50.36% of cases), followed by neoplastic pathology (24.1% of cases). The prevalence of spontaneous bacterial peritonitis was 13.87%, of which 63.16% corresponded to neutrocytic ascites with negative culture. The rate of bacterascite was 74.07%. Gram-positive cocci constituted the majority of pathogens (56.67%), with 43.33% corresponding to Gram-negative bacilli. 28.57% of coagulase-negative Staphylococci were methicillin-resistant. Quinolone resistance was observed in 23.53% of Gram-positive cocci, and 69.23% of isolated Enterobacteriaceae were multidrug-resistant. Conclusion: The prevalence of SBP due to Gram-positive and multidrug-resistant bacteria has increased in recent years. The currently recommended empirical antibiotic therapy, based on third-generation cephalosporins, carries a high risk of failure and may need to be reassessed.

Introduction-Aim: Type 2 diabetes (T2D) is a major public health problem. To succeed its management and prevent its complications, good therapeutic adherence must be ensured. The objectives of our work were to estimate the prevalence of poor therapeutic adherence in our patients and to identify its associated factors., Methods: we conducted a cross-sectional, single-center study that included type 2 diabetic outpatients. Therapeutic adherence to antihyperglycemic agents was assessed by the 8-item Morisky Medication Adherence Scale (MMAS-8)., Results: We included 172 patients. The mean age was 59.7±9.5 years. The mean duration of T2D was 11.7±8.5 years. Glycemic targets were achieved in 35% of patients with a mean HbA1c of 8.5±1.8%. The prevalence of poor adherence was 66.1%. Factors associated with poor adherence were age <65 years (p=0.007), low educational level (p=0.026), diabetes follow-up < 2 consultations/year (p=0.004), non-practice of self-monitoring of blood glucose (p=0.008) and ignorance of glycemic targets (p=0.001)., Conclusion: Poor adherence affects a large proportion of our T2D patients. In order to improve it, therapeutic adherence should be an important theme in the education of patient.

Introduction: After a pulmonary rehabilitation (PR) program, 30 to 70% of patients fail to pursue maintenance of physical activity. This study aimed to identify psychosocial markers associated with MPA subsequent to an initial outpatient PR course (≥10 sessions)., Material and Methods: Patients were enrolled in an exploratory quantitative monocentric retrospective study. Clinical data were extracted from the PR center database. Psychosocial data were collected by a postal questionnaire. A telephone interview assessed maintenance of physical activity at 12months, which was defined as self-reported physical activity≥30min,≥2 times per week., Results: Among 134 patients (age 67years [31-88], 88% COPD, FEV1 55% [25-103]), 95 (71%) reported maintenance of physical activity at 12months. Multivariate logistic regression analysis showed that compared with subjects without maintenance of physical activity, those with the latter: (1) reported greater self-efficacy and internal locus of control, (2) considered their health status as less severe and (3) resided closer to the PR center., Conclusion: Patient-declared self-efficacy and locus of control internalization were independently associated with maintenance of physical activity 12months after an initial PR program., Competing Interests: Déclaration de liens d’intérêts Les auteurs déclarent ne pas avoir de liens d’intérêts., (Copyright © 2024 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

An analysis of 1771 Canadian adults who smoke or used to smoke cigarettes was conducted using data from the 2022 International Tobacco Control Four Country Smoking and Vaping Survey. Using weighted data, we estimated the prevalence of Canadian adults who tried to quit smoking between 2020 and 2022, and the use of a nicotine vaping product (NVP) and the flavours and devices used most often at their most recent quit attempt. Overall, 36.5% made a quit attempt; of those, 19.4% used an NVP. Those who were younger and quit smoking were more likely to have used an NVP. Prefilled cartridges or pods (36.3%) and fruit flavours (39.5%) were used most frequently., Competing Interests: KMC has served and continues to serve as a paid expert witness in litigation against cigarette manufacturers. GTF has served as an expert witness or consultant for governments defending their country’s tobacco policies or regulations in litigation and was a member of the Health Canada Vaping Products Scientific Advisory Group (2017–2020; unpaid). All other authors have no conflicts of interest to declare.

Out-of-hospital cardiac arrests represent impactful events. Despite the evolution of care, they are still associated with high morbidity and mortality. We present the analysis of our activity included in the 2023 CHC - Bcar registry in Liege area (Belgium). A cardiac massage is initiated by bystander in more than 50 % of cases. However, we must remember the crucial aspect of early resuscitation and defibrillation to improve outcome, just like the training of the general public in life-saving actions.

Introduction: This study provides a descriptive overview of the prevalence of posttraumatic stress disorder (PTSD) in Canada, across sociodemographic characteristics, mental health-related variables and negative impacts of the COVID-19 pandemic., Methods: Data were obtained from cycles 1 and 2 of the Survey on COVID-19 and Mental Health (SCMH), collected in fall 2020 (N = 14 689) and spring 2021 (N = 8032). The prevalence of PTSD was measured using the PTSD Checklist for DSM-5 (PCL-5) Cross-sectional associations were quantified using logistic regression, while controlling for sociodemographic characteristics., Results: The overall prevalence of PTSD was 6.9%. Factors associated with higher PTSD prevalence were female gender; younger age; lower income (females only); living in an urban area; frontline worker status or not being at work in the past week (males only); fair or poor mental health; a weak sense of community belonging; symptoms of generalized anxiety disorder and major depressive disorder; suicidal ideation; heavy alcohol use; daily cannabis use; increased alcohol and cannabis use since the start of the pandemic; decreased alcohol consumption since the start of the pandemic (males only); concerns about violence in the home; and negative impacts of the pandemic., Conclusion: PTSD prevalence in Canada varies significantly across sociodemographic groups and is more common among those with indicators of lower mental health and well-being, as well as those more adversely affected by the COVID-19 pandemic. Ongoing and enhanced surveillance of PTSD in Canada is important to better understand and address the burden and impacts of this condition., Competing Interests: The authors have no conflicts of interest to disclose.

Objectives: The aim of our study was to assess the proportion of high-grade histological lesions, according to HPV type, in patients referred for colposcopy involving a positive HPV-HR test and ASC-US cytology., Methods: This is a retrospective descriptive study of asymptomatic patients aged 25 to 65 with a positive HPV-HR test and ASC-US cytology. Data were collected at the Nord Franche-Comté Hospital from September 2019 to February 2022. The primary outcome was the proportion of high-grade histological lesions in patients with ASC-US cytology combined to HPV 16 or 18 (associated or not with other HPV type), compared with HPV no 16 no 18., Results: Among the 298 patients included, 67% were HPV no 16 no 18, 22% HPV 16 associated or not with others and 11% HPV 18 associated or not with others. We found significantly fewer high-grade lesions in patients with ASC-US cytology and HPV no 16 no 18 than in patients with HPV 16 or 18 (8.5% versus 22.7%, P<0.01). In patients presenting an ASC-US cytology with HPV no 16, no 18: 53% of the biopsies found no histological lesion compared with 30% for the other HPVs (P<0.01)., Conclusions: We have highlighted the reality of colposcopists: a high ratio of normal coloscopy associated with normal or low-grade biopsies, in patients with a positive HPV-HR test no 16, no 18 and ASC-US cytology., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Objective: To evaluate in a real-world setting an intravitreal clindamycin treatment protocol for ocular toxoplasmosis., Methods: This was a single-center, retrospective review with a 6-month follow-up. Our protocol proposed an IVT of clindamycin as first-line treatment, and management was chosen according to the patient's status (past medical history of ocular toxoplasmosis or not). We evaluated the gain in best corrected visual acuity (BCVA) at 6months, the therapeutic burden and anatomical outcomes., Results: The study included 38 eyes of 38 patients. The 6-month follow-up was reached for 23 patients. In the whole cohort, 6 patients experienced one recurrence, and one patient had two recurrences (mean time to recurrence 65±36days), for a total number of 46 occurrences. BCVA gain was 0.24±0.49 logMAR (P-value 0.023). Cicatrization of the chorioretinal lesion was obtained with a mean number of 1.3 (62/46) IVT of clindamycin (1 to 4 IVTs per patient per episode) and a mean time between 2 IVT for the same occurrence of 15.9±8.5days. The percentage of occurrences resolved with a single IVT was 67% (31/46). Oral corticosteroid therapy was started in 26 patients (68%). We demonstrated no adverse effects of IVT, except for one patient who developed a retinal detachment., Conclusion: Our study shows the efficacy and tolerance of our intravitreal treatment protocol with clindamycin for ocular toxoplasmosis., Competing Interests: Déclaration de liens d’intérêts Les auteurs déclarent ne pas avoir de liens d’intérêts., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Background: Superficial leiomyosarcoma is a rare malignant soft tissue tumor arising from smooth muscle cells, accounting for 2-3% of superficial sarcomas, with limited literature available on the subject. It is typically observed in patients aged 50-60 years and affects both men and women equally in the subcutaneous subtype, whereas the cutaneous subtype predominantly affects men., Objective: This study aims to examine the clinicopathological features and therapeutic outcomes of patients with leiomyosarcoma., Method: This is a descriptive retrospective study of 26 cases of cutaneous and subcutaneous leiomyosarcomas, with histological confirmation., Results: We identified 10 (38.5%) subcutaneous leiomyosarcomas and 16 (61.5%) cutaneous leiomyosarcomas. The majority of tumors were located in the lower limbs, accounting for 13 (50%) cases. During follow-up, 6 patients experienced recurrence, and 7 developed metastases, including 2 of the 7 patients who had R0 resection margins. Among these, 3 out of the 6 recurrent cases and 3 out of the 7 metastatic cases were subcutaneous leiomyosarcomas. The average time to recurrence was 6.2 years., Conclusion: The observed risk of metastases and recurrences, despite clear surgical margins, in both cutaneous and subcutaneous leiomyosarcomas, along with the delayed onset of these events, justifies prolonged patient follow-up. The lungs, bones and liver have been identified as the most common site of metastasis., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Objectives: The objective of our study is to take stock of the cranioplasty implants used within our establishment., Materials and Method: We analyzed the patients files who underwent craniectomy followed by cranioplasty between 2017 and 2023, with at least 1 year of follow-up after cranioplasty (n=75). The data were extracted from the computerized patient file (DxCare®, Dédalus) and the pharmaceutical management tool for drugs and sterile medical devices (Pharma®, Computer Engineering). The sex ratio, indication for craniectomy, operating time, time between craniectomy and cranioplasty, complications and aesthetic result were statistically analyzed., Results: The main indications are stroke (n=59; 78.5%) and aneurysms (n=7; 9.5%). Among the 75 patients, 52 benefited from the placement of a custom implant (PolyEtherEtherCetone/PEEK or Hydroxyapatite) and 23 from cementoplasty. The operating time was significantly shorter (P<0.05) for custom cranioplasty (1.93±0.61h vs. 1.62±0.53). Only 4 patients (5.3%) were not satisfied with the aesthetic result following the placement of a custom implant. A greater risk of infection was found in the context of cementoplasty (43% for cementoplasties vs. 25% for the custom implant, so χ 2 (P=0.1095), this difference not being statistically significant., Conclusion: This collaborative work between the pharmacy and the adult neurosurgery department served to establish an initial register for monitoring patients who have undergone cranioplasty for whom the ideal implant remains to be determined., (Copyright © 2024 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: Pleural procedures are painful interventions. While there exist recommendations aimed at preventing pain induced by local anesthesia, they have never been evaluated with regard to the thoracic wall. The objective of this study was to evaluate the effectiveness of buffered lidocaine local anesthesia in pleural procedures., Methods: Descriptive, monocentric, prospective study, including all initial pleural procedures performed in our unit. Pain was assessed 20minutes after the procedure using the VAS (Visual Analog Scale) or the NRS (Numerical Rating Scale)., Results: Two hundred and fifty-one patients were included. The procedures included thoracocentesis (58%), pleural or pulmonary biopsy (28%), or drainage (14%). Average pain intensity was 0.6 on a scale of 10. Over two thirds (68%) of patients had a VAS or NRS score of 0, and 91%≤2. Infectious pleuritis, pneumothorax, and drainage were associated with more pain. The pain levels were acceptable (average VAS/NRS scores of 1.3, 1.8, 1.7 respectively)., Conclusion: Buffered lidocaine local anesthesia provides excellent pain control for pleural procedures, regardless of their nature. Recommendations regarding local anesthesia apply to the thoracic wall, and their dissemination is essential to reduction of the pain induced by pleural procedures., (Copyright © 2024 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

The presence of a bar at the heart of a home for the dependent elderly is a project that benefits everyone - residents, families and care teams. The associations that take charge of this place, which favors social ties, propose innovative organizational methods. Here, psychiatric patients are invited to run the bar, a genuine therapeutic tool. Here, the bistro is of particular benefit to people suffering from psychiatric disorders. The commitment of the volunteers contributes to the well-being of the residents and to the success of their therapeutic accompaniment., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Introduction: The success of surgeries involving free flaps largely depends on accurate preoperative mapping of perforator arteries. Various imaging techniques, such as Doppler ultrasound and CT angiography, are typically used, each having its advantages and disadvantages in terms of cost, accuracy, and patient risk. The main objective of our study is to compare the effectiveness of the FLIR One device for detecting these arteries compared with traditional methods. Thermal imaging appears to be a simpler, less expensive, and less invasive alternative for surgical planning., Material and Method: The study, conducted at the Regional Hospital Center of Nancy, included 25 free flaps (DIEP) on an exclusively female cohort of 22 patients, with follow-up from 2022 to 2023. Before the procedure, an abdominal-pelvic CT angiography was performed, followed by additional evaluation with thermal imaging using FLIR One and acoustic Doppler examination on the eve of the operation. This approach aimed to provide precise mapping of vascular perforators for each patient. Three different operators performed these markings, and the results were then compared with intraoperative observations. The imaging protocol also included a Doppler examination to validate the results of the thermal imaging. Statistical analyses with intraclass correlation coefficients (ICC) were performed to evaluate the correlation between different preoperative localization methods of perforating vessels., Results: In 22 patients undergoing 25 DIEP flaps for breast reconstructions, three imaging techniques were used to identify vascular perforators: thermal imaging with FLIR, acoustic Doppler, and CT angiography. FLIR identified the most perforators (n=137), followed by acoustic Doppler (n=128) and CT angiography (n=126). Comparing these with intraoperative results, 66% of perforators identified by FLIR were confirmed, 70% for acoustic Doppler, and 95% for CT angiography. The ICCs shows a significant correlation between these imaging techniques and intraoperative results. FLIR demonstrated a strong correlation with intraoperative observations (ICC of 0.74, P<0.001), followed by a moderate correlation with acoustic Doppler (ICC of 0.56, P<0.03) and CT angiography (ICC of 0.52, P<0.006)., Conclusion: The study concludes that thermal imaging with FLIR is a reliable and effective tool for locating vascular perforators. Although the study and FLIR have their own limitations, the tool presents several advantages such as ease of use, speed, and affordability. These characteristics make FLIR particularly attractive as a complement to traditional detection methods, such as acoustic Doppler and CT angiography., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Introduction: Fever is a cosmopolit zoonosis due to Coxiella burnetii. The diagnosis of chronic Q fever can be really misleading. The growth of this bacterium is difficult and blood cultures are often negatives., Case Presentation: We rapport here the case of a 69-year-old man presenting with an alteration of his general condition and low back pain. He suffered from a well-controlled HIV infection and lower limb arteriopathy treated with a cross-femoral bypass. A computed tomography scan revealed a L3-L4 abscessed spondylodiscitis but multiple blood cultures remained sterile, and the transthoracic echocardiography was normal. PET scan showed a hypermetabolism on L3-L4 vertebrae but also indicated an intense uptake of the cross-femoral bypass. C. burnetii serology was in favour of a chronic Q fever. The management of this chronic Q fever needed a multidisciplinary discussion. Three months after the treatment initiation, C. burnetii serology was reduced by a titer and has stabilized 6months to a year., Conclusion: Chronic Q fever and mostly osteoarticular diseases are difficult to diagnose. We have to evoke the diagnosis of osteoarticular chronic Q fever in case of insidious inflammatory syndrome, negatives blood cultures spondylodiscitis especially when associated to endocarditis or vascular infection, and in case of spondylodiscitis with a granulomatous histology without Mycobacterium tuberculosis. Although there are many complementary tests (PET scanner, PCR), serology remains the cornerstone of diagnosis., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Aim: describe the epidemiological, clinical, etiological and therapeutic aspects of hypercalcemia seen in the rheumatology department of Cocody University Hospital., Methods: Descriptive cross-sectional study carried out in the rheumatology department of Cocody University Hospital from January 2013 to July 2022 and covering the files of patients with hypercalcemia., Results: The hospital frequency of hypercalcemia was 0.88%, or 60 cases out of 6771 hospitalizations during the study period. The workforce included 35 men and 25 women (M/F ratio=0.14), aged on average 56±11.52 years (range 25 and 80 years). The main reason for consultation related to the underlying disease was osteoarticular pain syndrome. The signs related to symptomatic hypercalcemia were digestive (23.33%), neurological (8.33%) and cardiovascular (5%). The main extra-articular signs were asthenia (90%) and weight loss (78.33%). On the biological level, there was a clear predominance of mild hypercalcemia (76.67%), followed by moderate hypercalcemia (10%) and severe hypercalcemia (13.33%). The etiologies were dominated by multiple myeloma (45%), followed by bone metastases (40%), granulomatosis (13.33%) and secondary hyperparathyroidism (1.67%). The molecules used for the treatment of hypercalcemia were corticosteroids and biophosphonates. The outcome was favorable in 18.33% of patients, and unspecified in 66.67% of cases due to the patient's transfer to another department. There were 9 deaths, or 15% of cases., Conclusion: Hypercalcemia is rare and most often asymptomatic in rheumatological hospitalizations in Abidjan. Multiple myeloma is the main etiology.

Introduction: Metabolic syndrome (MS) is responsible for the increased cardiovascular risk in patients with type 2 diabetes. Few studies have focused on MS in type 1 diabetes mellitus (T1DM)., Aim: To describe the clinical, biochemical and therapeutic characteristics of T1DM patients affected by MS., Methods: A retrospective study was carried out. It included 36 patients, suffering from T1DM and MS, hospitalized in the Endocrinology-Diabetology Department of the Hédi Chaker University Hospital of Sfax-Tunisia, from 1997 to 2020. MS was defined according to the NCEP-ATP III criteria., Results: The mean age of the patients was 53 years. The mean duration of diabetes was 15 years. The MS appeared after a mean duration of diabetes of 13.7 years. Hypertension was reported in 21 patients (58.3%). The mean BMI was 26 kg/m2. The mean total cholesterol level was 4.59 mmol/l ±1.18, and the mean triglycerides level was 1.67 mmol/l ±0.81. The mean HDL-cholesterol level was 0.96 mmol/l ±0.29. In the majority of cases (80%), MS was the combination of dyslipidemia, hypertension and diabetes. Therapeutically, the average dose of insulin used was 0.8 IU/kg/day. The combination of metformin was necessary in 18 cases (50%). Microvascular complications were present in all patients. The cardiovascular risk was very high in all patients., Conclusion: The prevalence of MS during T1DM is increasing. It indicates an increased risk of micro and macrovascular complications.

Objectives: To evaluate survival after osteoporotic fractures of the upper femur and determine its associated factors., Methods: Cross-sectional study of patients hospitalized for fractures of the upper end of the femur during 2020 at Monastir University Hospital. Outcome was determined up to 2 years. The Kaplan-Meier curve is used for survival analysis., Results: Eighty one patients with mean age of 77.46 ± 17,36 years and a sex ratio of 0.61 were evaluated. The femoral neck fracture was observed in54% of cases. Overall survival was 84.6% at 6 months, 75.4% at 1 year and 63.4% at 2 years. Median survival was 30 months. Patients older than 75 years had a shorter survival (68% versus 83% at one year and 55% versus 72% at 2 years ; p < 10-3)., Conclusion: The osteoporotic fracture of the upper femur is serious due to its severe outcome. One-year mortality was aboutt 25%. Increased mortality was associated to elderly population.

Odors are known to entertain a special link with memory: once the meaning of an odor has been learned, it naturally acts as a retrieval cue of the learning context, along with the emotions and behaviors associated with it. The existence of this link has for several years inspired the study of olfactory function in Alzheimer's disease (AD), known for the memory disorders it causes. The aim of this review is to summarize the current scientific knowledge on the almost paradoxical dual role played by odors in the management of AD, as both screening and therapeutic tools. In fact, while the existence of a specific olfactory deficit is confirmed in AD - as is its ability to screen for the disease - its properties do not prevent from taking advantage of the link between odors and memory to stimulate cognition and behavior in these patients. Current scientific data, albeit limited and with sometimes inconsistent results, suggest that this idea seems relevant. However, interventions based on impaired processing in AD, such as the recognition and naming of olfactory stimuli, must be avoided.

Despite the growing deployment of the Montessori method in nursing homes, there is no instrument to measure its implementation fidelity, limiting the interpretation of results. Our aims are to i) develop an evaluation grid for the Montessori method in nursing homes; ii) explore its sensitivity to practice heterogeneity among institutions pre-training; and iii) study its sensitivity to change after the training. Based on literature and expert opinions, we created an evaluation grid. This grid was completed by 333 professionals before training in 29 nursing homes. Of these, 125 completed it again post-deployment. Before training, the degree of application of the method's principles varied. After training, effects were noted on various aspects targeted by the method. The developed grid is a valid tool for evaluating the fidelity of Montessori method implementation in nursing homes.

The personalized prescription plan (PPP) summarizes the changes made to a patient's prescription on discharge from hospital. The aim of the present study was to evaluate 30-day medication continuity in older patients whose PPP was implemented at hospital discharge. Prospective randomized controlled trial including people aged at least 75 discharged from an acute geriatric unit. The intervention consisted of medication reconciliation and review, and standardized transmission of a PPP (explaining medication changes during hospitalization) to primary care practitioners. The control group received no specific intervention. Reasons for and rates of change in discharge prescribing by primary care practitioners were assessed 30 days after discharge. The study population comprised 109 patients, 70 of whom were selected for modified intention-to-treat analysis (intervention group 34; control group 36). The mean age (standard deviation) of patients was 87.4 (6.6) years. One month after discharge, the discharge prescription was modified for 26.7% of patients in the intervention group and 31.2% in the control group (0R = 0.80, CI(95%)=[0.25; 2.45]; p = 0.91). Reasons for change were mainly adaptation to clinical events (83.3%). Medication continuity after the implementation of a PPP is similar to that of routine care, one month after hospital discharge of the elderly.

People suffering from a neurodegenerative disease, at a stage still allowing physical activity, encounter more difficulties to access to re-education and rehabilitation care. A trial unit specialized in medical care and rehabilitation (SMR) was created to handle these patients, who suffered a morbid intercurrent event not related to the neurocognitive disorder. The trial unit was created thanks to a dedicated funding from the Brittany Health Regional Agency (ARS) following-up a call for projects in October 2021. A retrospective monocentric descriptive study focusing on the overall evolution of the patient. To describe the social and medical characteristics of admitted patients and access the benefits regarding the patients regain of independence. Results: One hundred forty-nine patients (55 men, 94 women) were included, average age 85 ± 6.5 years. The average length of stay was 24 ± 11 days and the rehabilitative load was high (scores RR 275,2 ± 175,2). A significant improvement in the autonomy of patients was noted, of their physical dependence scores (p < 0,001) and cognitive dependence scores (p < 0,001), of their overall physical condition at SPPB (p<0,001) as well as a decrease in the use of psychotropic drugs (p < 0,001); their nutritional status was unchanged (p = 0.2). One in two patients went home. Our work seems to confirm the importance of specialized units in the care of patients suffering from neurodegenerative disease in SMR.

Older patients are at risk of falling, making fall prevention a critical component of training for future health professionals. To understand the expectations of health students regarding falls in the elderly, four consecutive focus groups were organized at the Angers hospital. The aim was to assess students' views on the effectiveness of using an educational or serious game to complement their traditional training. From the discussions, six key themes emerged: the definition of a fall, participants' emotional responses to falls, lessons learned to enhance their knowledge, the benefits and techniques of simulation games and board games, and the role of games in everyday life. Among the game formats discussed, simulation games, including escape rooms, were the most popular.

A quarter of nursing home residents dies in hospital. Few data are available about early in-hospital deaths of nursing home residents. The aim of the study was to describe the characteristics of early in-hospital deaths of nursing home residents after an admission in emergency department and to identify factors associated with a decision of limitation of care in emergency department. This retrospective monocentric descriptive study included all nursing home residents hospitalized and who died early (less than 3 days) after being admitted to the emergency department between 2017 and 2019. Patients' characteristics were collected in the medical record. These characteristics were compared by a logistic regression according to the existence or not of a limitation of care. 12,440 admissions of nursing home residents were identified and 332 patients died early in hospital. Half of them died in the emergency department. The first reason for admission was dyspnea (57.4%) and the main cause of death was pneumonia (41.7%). A limitation of care at emergency department was reported in 66.7% of cases. The factors independently associated with a limitation of care were the existence of active cancer (OR=5.34 [1.35-39.2], p=0.041) and severe dependence (OR=16.1 [1.60-415], p=0.034). Early in-hospital deaths of nursing home residents are common and most often related to pneumonia, dyspnea motivating the transfer. The anticipation of the care project and especially of end of life is mandatory in these patients.

Homicides-suicides within couples are rare situations but can be considered preventable deaths. Various studies have identified risk factors for these couples, regardless of their age, such as a history of domestic violence, psychiatric disorders, addictions, or substance abuse. However, it appears that homicides-suicides among elderly couples have specific characteristics unique to this population. The objective of this study is to draw on recent scientific literature and concrete cases to raise awareness and consider preventive measures for these fatal acts among older individuals. It appears that particular attention should be given in cases where the man is the primary caregiver, when there is a recent deterioration in one partner's health, when hospitalization or institutionalization is being discussed, or when a firearm is present in the household.

The objective of our work was to study the impact of a mobile health unit of geriatric psychiatry (EMGP) on the number of consultations to the emergency medical service and on the rate of readmissions. This was an observational, retrospective, single-center cohort study, which aimed to identify the number of visits to the Troyes SAU for psychiatric reasons. This in patients who have previously benefited from hospitalization in the Aube geriatric-psychiatry department called Ellipses. The "patients exposed" group was exposed by the existence of EMGP during hospitalization between January 1, 2018 and December 31, 2019. The group not exposed by the non-existence of the system between January 1, 2014 and December 31, 2015. Our results suggest that the actions implemented by the EMGP tend to reduce the frequency of visits to the emergency room after hospitalization, among people aged 65 and over (p<0.001) as well as their duration of hospitalization (p=0.003).

The risk of herpes zoster (HZ) and postherpetic neuralgia (PHN) increases rapidly after the age of 50 years old. The incidence of herpes zoster and PHN appears to be correctly measured albeit irregularly and the immediate and long-term complications are so poorly measured that the perception of a benign disease remains entrenched among professionals and in the general population. Because acute-phase treatments are only marginally effective in reducing the severity and duration of complications, zoster vaccines have been developed over the last twenty years. The first available vaccine was a live attenuated vaccine recommended in France in 2013 in very specific age groups, and in the absence of an implementation campaign, vaccine coverage has remained less than 1%. A second vaccine that can reduce the incidence of shingles by 90%, even in the oldest age groups and that can also be used in immunosuppressed members of the population, has been recommended since March 2024 by the French Haute Autorité de santé (HAS). However, it requires two injections, two and six months apart, and side effects are frequent, although mostly local. The implementation strategy for this new vaccine will need to be complemented by awareness campaigns among both health care professionals and users if we want to reduce the incidence of shingles as we should hope.

The 2007 French Haute Autorité de santé recommendation on the diagnosis of malnutrition in the elderly was revised in 2021. The main objective was to compare the prevalence of malnutrition according to the recommendations. The secondary objectives were to compare 3-month mortality and assess the prevalence of sarcopenia and sarcopenic obesity. The 2021 criteria were applied retrospectively to a cohort. Concordance analysis was carried out using Cohen's kappa coefficient and statistical analysis of mortality using Fisher's exact test. There were 135 patients, 60% malnourished with 35% severely malnourished according to HAS 2007, 49% malnourished with 62% severely malnourished according to HAS 2021 with moderate agreement. There were 25 cases of confirmed sarcopenia and one case of sarcopenic obesity. Moderately to severely malnourished people had an increased risk of death at 3 months (HAS 2021).

There is still much room for improving the self-advocacy of elderly female patients with breast cancer. Subjects (168 in total) were selected from elderly female patients with breast cancer who had been hospitalized from May to December 2022 using the convenience sampling method. Assessment was conducted for the status quo of self-advocacy of subjects using the Chinese version of Female Self-Advocacy in Cancer Survivorship (FSACS). The general data of patients were investigated to find out the possible related factors. The FSACS score was 79.23±10.58 points in the 168 elderly female patients with breast cancer, showing significant differences among the patients at different ages and with various levels of education, self-efficacy, perceived social support and psychological resilience (P<0.05). The following equation was acquired by multiple linear regression analysis: Y=88.762+0.881X1-2.447X2-5.763X3-1.617X4-4.259X5. An advanced age was a non-independent risk factor for the self-advocacy of elderly female patients with breast cancer (B>0, P>0.05), while high levels of education, self-efficacy, perceived social support and psychological resilience served as protective factors (B<0, P<0.05). Elderly female patients with breast cancer exhibit a medium level of self-advocacy, which may be associated with age, education level, self-efficacy, perceived social support, and psychological resilience.

Introduction: Immune checkpoint inhibitors (ICIs) are a key component of standard anticancer systemic therapy. While their immune-related adverse effects (irAEs) have been widely described, there are few data on grade≥3 irAEs. The primary aim of our descriptive study was to evaluate their incidence and characteristics., Methods: An observational, retrospective, monocentric study was conducted. It included patients with locally advanced or metastatic melanoma, non-small cell lung cancer or renal cell carcinoma who initiated ICI therapy between 2016-2021 and experienced at least one grade≥3 irAEs coded according to the MedDRA® system., Results: All cancer types and ICIs combined, the incidence of grade≥3 irAEs was estimated at 11.7% [9.6-13.9]. These were mainly hepatobiliary (22%), gastrointestinal (17%), musculoskeletal (16%) and respiratory (16%) disorders. They occurred on average 6.2±6.2 months after the start of treatment, resulting in hospitalization or prolonged hospitalization in over 40 and 20% of cases, respectively. Resolution without sequelae was observed in 56% of cases, but four patients died., Discussion: This real-world study investigated three cancers and several ICIs, unlike previously published studies that focused on a single cancer and/or one ICI. It provides a better understanding of grade≥3 irAEs, most of which are reversible, which an aim to optimize patient care., (Copyright © 2024 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Objectives: The aim of the study was to determine the prevalence of AF in the cardiology department of the Hospital Principal of Dakar, then to evaluate the clinical, paraclinical, etiological and evolutionary profiles of AF and finally to identify the limits of its management in our context., Patients and Methods: This was a retrospective, descriptive, analytical, mono-centric study carried out at Hospital Principal of Dakar from January 2019 to August 2021. Were included, all patients admitted for atrial fibrillation, or patients who presented an atrial fibrillation during hospitalization, confirmed by electrocardiogram or long-term electrocardiographic recording during the study period., Results: The prevalence of atrial fibrillation during the period of our study compared to the hospital population was 7.71%, with a sex ratio of 1.03. The mean age was 67.88 ± 14.09 years. We noted that 83.64% of patients had at least one cardiovascular risk factor, with 56.36% suffering from hypertension, 50.91% of sedentary person and 23.64% of diabetics. Clinically, 92.72% of the patients were symptomatic, with dyspnea predominating (70.91%). Cardiac arrhythmia was present in 85.45% of patients, and congestive heart failure in 47.27%. Long-term electrocardiographic recording was performed in 10 patients, showing 50% of paroxysmal atrial fibrillation. Sixty-three patients (57.27%) had permanent AF, twenty-three patients (20.91%) had persistent AF, fourteen patients (12.73%) had long-term persistent AF and ten patients (9.09%) had paroxysmal AF. Transthoracic echocardiography showed 57.27% of left atrial dilatation and 72.3% of reduced left ventricular ejection fraction. Etiologies for cardiac causes were dominated by dilated cardiomyopathy (21.82%), followed by ischemic heart disease (17.27%). In terms of treatment, the most commonly used molecule was bisoprolol (38.18%), followed by digoxin (21.81%). Anticoagulants were used in 85.46% of cases. Acenocoumarol alone was used in 69.09% of patients. Drug-induced cardioversion was attempted in 2 patients without success, and 4 patients benefited from external electric shock with 3 successes. Most patients had a favorable outcome, but 34.54% suffered hemodynamic complications (18.18%) and thromboembolic ones as well (16.36%). In-hospital mortality in our series was 20%. It was significantly related to heart failure, with a left ventricular ejection fraction < 35% (p < 0.001)., Conclusion: Atrial fibrillation is serious because of its hemodynamic, thromboembolic and rhythmic complications. The high mortality is explained by the underlying condition, but also by the delay in management with late diagnosis and, above all, the unavailability of ablation procedures in our context., Competing Interests: Déclaration de liens d'intérêts Les auteurs déclarent n'avoir aucun lien d'intérêt., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)