Presse Med
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When psychological and behavioral disorders of Alzheimer's disease appear suddenly, somatic, iatrogenic and reactive or relational psychological causes must be ruled out or treated before concluding that the cause is lesional. Non-pharmacological interventions should be privileged for the prevention and management of behavioral manifestations of mild to moderate intensity: psychological support of the patient (short therapies), training the caregiver, work on daily habits, reorganization of the home, behavioral measures against apathy and especially agitation, rehabilitation strategies, and therapy involving music, light, aromas, etc. Pharmacological therapies are only moderately effective in these disorders. ⋯ Atypical neuroleptics are better tolerated than the classic ones. They are most effective in this context but must be reserved for specific indications and limited in time because of the increased risk of stroke. Other psychotropics (benzodiazepines, carbamates, antiepileptics) should be used cautiously in this context.
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Review Comparative Study
Systemic adverse effects of topical ocular treatments.
Some eyedrops, gels or ointments may cause adverse effects as serious as those observed with systemic therapies. Because of their relatively poor penetration into eye tissue, ophthalmic drugs usually contain high concentrations of their active ingredient. Asking patients about these drugs to prevent interactions is useful when prescribing a new systemic treatment. Conversely, it is advisable to ask about ophthalmic drugs during the etiological investigation of possible iatrogenic effects.
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Infection with Mycobacterium marinum is rare and usually produces cutaneous lesions. We report here two cases of tenosynovitis of abductor muscles. ⋯ These cases of tenosynovitis followed deep inoculation. A mycobacterial infection should be considered in cases of synovitis, especially when limited to an area of the hand in patients without other rheumatic disorders.
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Screening strategies among pregnant women have decreased the incidence of group B Streptococcus, which causes severe neonatal infections. The incidence of these infections has increased among diabetic patients, however. ⋯ Group B streptococcal foot infections often occur in fragile patients with immune depression or severe arterial disease. Despite intensive antibiotic therapy and adequate debridement, amputation is often required in diabetic patients because of severe damage to the tissue and poor vascularization.
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Decisions to withhold or withdraw active life support treatment in situations with no hope of improvement remain difficult for critical-care specialists and families; they are not always well understood by the public. This report describes terminal extubation, a particular method of withdrawing ventilator support. ⋯ So-called "terminal" extubation, very common in the United States, but much less so in France, reinforces the transparency of end-of-life decisions in intensive care units and immediately makes tangible the end of the aggressive treatment for which critical-care specialists have been reproached. Since this first series of patients, extubation has been practiced in our department, principally in situations of irreversible neurological damage.