Modifications de l’olfaction au cours du vieillissement et de certaines pathologies neurodégénératives: mise au point

International audienceOlfaction is a complex sensory system, and increasing interest is being shown in the link between olfaction and cognition, notably in the elderly. In this literature review, we revisit the specific neurophysiological features of the olfactory system and odorants that lead to a durable olfactory memory and an emotional memory, for which the implicit component produces subconscious olfactory conditioning. Olfaction is known to affect cognitive abilities and mood. We also consider the impairment of olfactory function due to ageing and to neurodegenerative diseases, in particular Alzheimer's disease and Parkinson's disease, through anatomopathological changes in the peripheral and central olfactory structures. The high frequency of these olfactory disorders as well as their early occurrence in Alzheimer disease and Parkinson disease are in favour of their clinical detection in subjects suffering from these two neurodegenerative diseases. Finally, we analyse the impact of olfactory stimulation on cognitive performance and attention. Current observational data from studies in elderly patients with Alzheimer-type dementia are limited to multiple sensory stimulation methods, such as the Snoezelen method, and aromatherapy. These therapies have shown benefits for dementia-related mood and behaviour disorders in the short term, with few side effects. Since olfactory chemosensory stimulation may be beneficial, it may be Proposed in patients with dementia, especially Alzheimer-type dementia, as a complementary or even alternative therapy to existing medical strategies. (C) 2014 Societe nationale francaise de medecine interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved

Successful Management of Heparin-Induced Thrombocytopenia Using Argatroban in a Very Old Woman: A Case Report

Thrombosis due to heparin-induced thrombocytopenia (HIT) is rare but has a severe prognosis. Its management is not always easy, particularly in old patients with renal insufficiency. A 95-year-old woman was hospitalized for dyspnea. Curative treatment with unfractionated heparin was started because pulmonary embolism was suspected. Disseminated intravascular coagulation was then suspected because of thrombocytopenia, hypoprothrombinemia, hypofibrinogenemia, and a positive ethanol gelation test. The first immunoassay for HIT was negative. On the 12th day of hospitalization, bilateral cyanosis of the toes occurred associated with recent deep bilateral venous and arterial thrombosis at duplex ultrasound. New biological tests confirmed HIT and led us to stop heparin and to start argatroban with a positive clinical and biological evolution. Venous and arterial thrombosis associated with thrombocytopenia during heparin treatment must be considered HIT whatever the biological test results are. Argatroban is a good alternative treatment in the elderly

La couverture vaccinale contre la grippe saisonnière du personnel soignant en gériatrie : mise au point

International audienceBackground. - Flu vaccinations for healthcare professionals seems to be one of the most effective preventive actions in the face of a disease that carries a high risk of a potentially serious nosocomial epidemic in a geriatric environment. The aim of this study was to take stock of the flu vaccination status among caregivers in the geriatric units and to understand the reasons for their reluctance to be vaccinated, in order to put forward proposals to improve vaccination coverage.Method. - A literature search of articles published since 2000 in the area of geriatrics, infectious diseases or pneumology was mainly conducted on PubMed using the keywords "caregivers'', "elderly'', "flu'', "influenza'', "nosocomial'' and "vaccination''. After reading all abstracts in English or French and ruling out irrelevant articles, only 64 relevant articles have been listed in bibliography section.Results. - Despite official recommendations, the literature reveals insufficient vaccination coverage of healthcare personnel at both the national and international level. Vaccination coverage seems to be lower among younger female non-medical staff. The factors that determine the likelihood of vaccination are the wish to protect one's self, one's family and patients/residents, as well as the experience of earlier bouts of flu. Factors that oppose vaccination are complex and related to the fear of side effects, the use of other preventive measures, the feeling that vaccination is ineffective, poor understanding of the disease and the vaccine, forgetfulness and problems of organization. Campaigns to promote vaccination that target healthcare professionals must be multidimensional and very incentive. The pedagogical message must be centered on the benefits to the individual and adjusted to socio-professional categories. Mobile strategies in the different departments to encourage staff are a pragmatic solution to this challenge. The referring doctor has an essential role to play, as does the occupational doctor in association with the hospital hygiene services.Conclusion. - Flu vaccinations must be included in the education and training of caregivers.Position du problèmeLa vaccination antigrippale des professionnels de santé semble représenter l’une des actions préventives des plus efficaces face à une pathologie à haut risque d’épidémie nosocomiale et potentiellement grave en milieu gériatrique. Ce travail avait pour objectif de faire une mise au point sur le statut vaccinal antigrippal chez le personnel soignant en gériatrie et les raisons expliquant leur réticence vis-à-vis de cette vaccination, afin d’émettre des propositions d’amélioration de la couverture vaccinale.MéthodeUne recherche bibliographique des articles publiés depuis 2000 dans le domaine de la gériatrie, des maladies infectieuses ou de la pneumologie a été réalisée, essentiellement sur PubMed. Les principaux mots-clés utilisés pour la recherche étaient « caregivers », « elderly », « flu », « influenza », « nosocomial » et « vaccination ». Tous les résumés en anglais ou en français, issus de cette première sélection, ont été lus par les auteurs afin d’écarter les articles hors sujet. Au final, 64 articles ont été cités dans la bibliographie de cette mise au point.RésultatsMalgré les recommandations officielles, la littérature révèle une couverture vaccinale de ce personnel insuffisante à l’échelle nationale et internationale. La couverture vaccinale apparaît plus faible chez le personnel féminin, plus jeune et non médical. Les déterminants pour la vaccination sont le désir de se protéger soi-même, de protéger sa famille et les patients/résidents, ainsi que le vécu grippal antérieur. Les facteurs d’opposition à la vaccination sont complexes, liés à la peur des effets secondaires, au recours à d’autres moyens préventifs, au sentiment d’inefficacité vaccinale, à la mauvaise connaissance de la maladie et du vaccin et aux problèmes organisationnels. Les campagnes de promotion vaccinale, destinées à responsabiliser le professionnel de santé, doivent être multidimensionnelles et fortement incitatives. Le message pédagogique doit être centré sur le bénéfice individuel et adapté selon les catégories socio-professionnelles. Les stratégies incitatives mobiles au sein des services sont déjà une déclinaison pragmatique de ce défi. Le médecin traitant est un pivot incontournable, ainsi que le médecin du travail en lien avec les services d’hygiène hospitalière.ConclusionLa vaccination antigrippale doit s’inscrire dans l’éducation et la formation du personnel soignant

Impact of microbiological samples in the hospital management of community-acquired, nursing home-acquired and hospital-acquired pneumonia in older patients

International audienceWe investigated the positivity rate, the detection rates for non-covered pathogens and the therapeutic impact of microbiological samples (MS) in community-acquired pneumonia (CAP), nursing home-acquired pneumonia (NHAP) and hospital-acquired pneumonia (HAP) in elderly hospitalised patients. Patients aged 75 years and over with pneumonia and hospitalised between 1/1/2013 and 30/6/2013 in the departments of medicine (5) and intensive care (1) of our university hospital were included. Microbiological findings, intra-hospital mortality and one-year mortality were recorded. Among the 217 patients included, there were 138 CAP, 56 NHAP and 23 HAP. MS were performed in 89.9, 91.1 and 95.6 % of CAP, NHAP and HAP, respectively. Microbiological diagnosis was made for 29, 11.8 and 27.3 % of patients for CAP, NHAP and HAP, respectively (p = 0.05). Non-covered pathogens were detected for 8 % of CAP, 2 % of NHAP and 13.6 % of HAP (p = 0.1). The antimicrobial spectrum was significantly more frequently reduced when the MS were positive (46.7 % vs. 10.8 % when MS were negative, p = 10(-7)). The MS positivity rate was significantly lower in NHAP than in CAP and HAP. MS revealed non-covered pathogens in only 2 % of NHAP. These results show the poor efficiency and weak clinical impact of MS in the management of pneumonia in hospitalised older patients and suggest that their use should be rationalised