Revue médicale de Bruxelles
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Pain is a frequent problem in aged population and often undertreated despite undesirable effects such as depression, malnutrition, sleep disturbance, decreased socialization, impaired ambulation with increased risk of falls problems, adverse effects from multiple inadequate drugs prescriptions, cognitive and behaviour impairments. Detection, diagnosis of the causes, evaluation with specific scales and adapted therapy of pain are essential to preserve quality of life and autonomy. Pharmacological therapy using the three-step analgesic ladder of W. ⋯ O. is appropriate owing to individual age-related sensitivity which requires to follow the rule of "start low and go slow" with regular pain and side effects assessments, particularly for opioids. For chronic pain, non pharmacological strategies optimise pain management in addition to medications. Comprehensive geriatric assessment is recommended to complete the global view of the frailed patient with the help of a multidisciplinary team.
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Acute infections of the upper respiratory tract are reviewed from an ENT point of view. Only the most frequent pathologies are taken into account. Clinical presentation and an update of current treatment are presented.
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Infections of the lower respiratory tract usually occurs during winter and are responsible for a high mortality and morbidity rate. The major clinical syndromes that are observed ranges from acute bronchitis to fatal pneumonia. In order to give optimal treatment and to avoid inappropriate use of antibiotics a careful diagnosis is necessary when signs and symptoms of lower respiratory tract infection are presents. Different clinical lower respiratory tract infections are presented with diagnostic and therapeutic approach considering actual belgium epidemiology.
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We give an overview of the available medical solutions to help a patient with refractory symptoms at the end of his life. Patient "competence" must first be evaluated and, even if their diagnosis is difficult, organic mental disorders and depression must be diagnosed and adequately treated to allow a real, personal and honest dialog. Administration of high doses of morphine is frequently used at the end of life not only to fully relieve pain but also to accelerate death, even if this is not clearly stated. ⋯ Euthanasia is the only technique able to induce a peaceful and rapid death. The proportion of various techniques to actively induce death is probably quite similar in our country than in The Netherlands but, most of the time, these interventions occur at the very end of life when the patient is no longer able to participate in the decision process and thus occur without his explicit request. We think that, as for all medical decisions, the use of one or the other of these various techniques should be selected after a quiet and free discussion between the patient and his physician, preferably in advance and not in a situation of emergency and panic.