Presse Med
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IMPACT OF PLASMODIUM VIVAX WORLDWIDE: Plasmodium vivax is the most widespread malanal agent in the world. Unlike Plasmodium falciparum, P. vivax can cause early or late recurrence and is not fatal (benign tertian malaria). EMERGENCE OF RESISTANT STRAINS: P. vivax strains resistant to chloroquine, then primaquine, have emerged over the last decade, creating the need for a new therapeutic strategy. ⋯ Mefloquine, quinine and halofantrine are also logical alternatives. TREATMENT OF RECURRENT DISEASE: A schizonticidal agent should be given followed by a hypnozoitocidal agent, primaquine. Primaquine dosage should now be raised or adjusted to the patient's weight.
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Review
[Vaccination and infection protection in patients with acquired or congenital immunodeficiency].
INDICATIONS FOR VACCINATIONS IN IMMUNODEPRESSED PATIENTS: The indication for vaccination depends on the demonstration of their efficacy and tolerance. Few studies have demonstrated a clinical benefit in this heterogeneous population and generally have enrolled splenectomized patients.
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TWO DISTINCT CATEGORIES: Postoperative cognitive disorders include delirium and long-term cognitive dysfunction. DELERIUM: Delirium is an acute state occurring early during the postoperative period. It may be considered as an acute cerebral insufficiency which may be consecutive both to the negative effects of aging and chronic illness on cognitive function, and to the cerebral impact of operative stress. ⋯ The IPOCD1 study conducted in a large cohort of elderly patients has shown that postoperative cognitive dysfunction was present in 25.8% of patients 1 week after surgery and in 9.9% 3 months after surgery. One to two years after surgery, cognitive dysfunction was observed in 10.4% of patients compared with 10.6% in a control population of non-operated patients. We would suggest that in many cases, postoperative cognitive dysfunction may result from preoperative dementia unmasked by surgery.
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PHYSIOLOGY: Vitamin D increases intestinal absorption of calcium favoring the microenvironment necessary for bone mineralization. In addition, vitamin D prevents hypocalcemia via its osteoclastic action. ⋯ Mild to moderate hypovitaminosis D causes secondary hyperparathyroidism increasing the risk of fracture, particularly femoral neck fracture. Vitamin D would also have an antiinflammatory and anticancer effect.