B Acad Nat Med Paris
-
B Acad Nat Med Paris · Feb 2008
[Analysis of the variables affecting patients' memorization and interpretation of information on thyroidectomy-related risks].
We prospectively analyzed patients' memorisation and interpretation of preoperative information on the risks of thyroidectomy. This study was conducted in an academic tertiary care referral center, based on an inception cohort of 280 patients who were consecutively informed of the risks of thyroidectomy (unilateral laryngeal immobility, bilateral laryngeal immobility, hypocalcemia, common surgical complications, and perioperative death) by the same surgeon during the period 2003-2006. Univariate analysis was used to identify factors affecting memorisation and interpretation of the information delivered. ⋯ The number of preoperative visits and the interval between the final preoperative visit and surgery both affected the patients' interpretation of the information. Patient memorisation of information on surgical risks is poor, and this results in major stress for the patient. After receiving this information, a significant proportion of patients decide to forego surgery.
-
Emerging viral diseases are nothing new. Smallpox probably reached Europe from Asia in the 5th century, and yellow fever emerged in the Americas during the 16th century as a consequence of the African slave trade. Dengue fever arose simultaneously in South-East Asia, Africa, and North America during the 18th century. ⋯ The second half of the 20th century saw the emergence of HIV/AIDS (1981), among other viral diseases. Even more worrying is the fact that emerging and re-emerging viral diseases have had a tendency to spread more quickly and more widely during the last decade, invading whole countries and continents; witness the recent outbreaks of Nipah virus, West Nile, Rift Valley fever, SARS, monkeypox, avian flu (H5N1) and Chikungunya. The complex factors underlying these new trends are briefly discussed.
-
B Acad Nat Med Paris · Nov 2007
[Hypertensive disease in subjects born in sub-Saharan Africa or in Europe referred to a hypertension unit: a cross-sectional study].
Hypertensive disease is reported to be more severe in black patients than in white patients, but most available data concern African-Americans. We studied blood pressure history and levels, the prevalence of associated risk factors, renal and cardiovascular complications, and secondary forms of hypertension in patients born in sub-Saharan Africa and managed in France, by comparison with up to five control patients born in Europe and matched for age and sex. Compared to European hypertensive women, African hypertensive women had a higher body-mass index (28.8 vs 26.3 kg/m2, p<0.001) and were more often diabetic (12 vs 5%, p<0.001). ⋯ However, patients born in sub-Saharan Africa were more likely than their European controls to have primary hyperaldosteronism (12 vs 7%, p=0.001) and less likely to have renovascular disease (1 vs 5%, p=0.001). Thus, the higher prevalence of cardiovascular and renal complications at referral among patients born in sub-Saharan Africa relative to age- and sex-matched European patients does not seem to be explained solely by observed differences in blood pressure or associated risk factors. The difference in the distribution of secondary hypertension warrants further study.
-
Two vaccines against varicella-zoster virus are available in France. These live attenuated vaccines are derived from the Oka strain used in Japan since 1974. They are indicated for healthy subjects from 12 months of age, at a dose of one injection until 12 years of age, and two injections 4-8 weeks apart for older children and adults. ⋯ France has adopted restrictive guidelines on VZV vaccination, but they are expected to be revised when the combined MMR-V vaccine becomes available. Zoster vaccine, prepared with the same strain but at a higher concentration, has moderate efficacy on zoster and on post-zoster neuralgia in patients over 70. This vaccine is not yet recommended in France, because the length of protection is not known and there is a potential risk of delaying the occurrence of zoster and, thus, of increasing the risk of post zoster neuralgia.
-
Brain nutrient sensing permits fine regulation of physiological functions such as food intake and blood glucose regulation related to energy homeostasis. The mechanism of glucose sensing is the most extensively studied, and parallels have been drawn between pancreatic beta cells and neurons. Two types of glucose-sensing neuron have been identified, namely those whose activity is directly proportional to the glucose concentration, and those whose activity is inversely proportional to the glucose concentration. ⋯ Glucose sensing can be modulated by other nutrients (particularly fatty acids) and also by hormones (insulin, leptin and ghrelin) and peptides (NPY). The subtle cellular and molecular mechanisms involved in glucose sensing probably explain reported discrepancies in the expression of glucose transporters, hexokinases and channels. Astrocytes might also be involved in one type of response, thus adding a new level of complexity.