Language Was My Home: I had it in my mind - but not on my tongue (Grappling with Aphasia)

Language was my home. I had a prolonged aphasic speech and writing block. Felt as if I was in exile. I slowly fought my way back amongst the ‘language owners’. Because of my funny stroke-induced accent, people tend to treat me like a foreigner. I began to write lyrics and prose to improve my language ability and also to show ‘them’, as well as myself, that I can do it. And that I can say again: language is my home

Quels sont les impacts de l'anorexie mentale et de la boulimie maternelles sur le foetus et l'enfant en bas-âge ?: travail de Bachelor

Introduction : Les troubles du comportement alimentaire durant la grossesse sont encore peu étudiés. Leur prévalence est estimée à 3%, cependant, ils seraient souvent sous-diagnostiqués et par conséquent pris en charge de manière insuffisante. La littérature met toutefois en avant un risque élevé de complications materno-foetales liées aux TCA. But : Le but de ce Travail de Bachelor est de déterminer si l’anorexie mentale et la boulimie maternelles ont un impact sur le taux de prématurité, le poids de naissance et la circonférence crânienne du nouveau-né ainsi que le développement staturo-pondéral du foetus à l’enfant en bas-âge. Méthodologie : Notre travail consiste en une revue systématique de littérature réalisée au sein des bases de données PubMed et Cinahl grâce à des mots-clés prédéfinis. Les études ont été retenues sur la base de critères d’inclusion et d’exclusion déterminés auparavant et la qualité des études sélectionnées a été analysée à l’aide d’une grille standardisée. Les données des études ont été extraites dans différents tableaux et analysées afin de répondre à notre question de recherche. Résultats : Parmi les dix études de cohorte sélectionnées à l’issue de notre revue de littérature, six études décrivent des résultats contradictoires, mais indiquent une tendance plus élevée de prématurité chez les mères atteintes d’AM ou de B. Six études mettent en avant une relation similaire entre les TCA maternels et le faible poids de naissance du nouveau-né. Un risque de poids de naissance inférieur à la normale est présent chez les nouveau-nés de femmes souffrant de B et de façon plus importante chez ceux de mères souffrant d’AM. Trois études affirment que la circonférence crânienne des nouveau-nés de femmes atteintes d’AM ou de B est inférieure à celle des nouveau-nés de mères en santé. Huit études ont étudié l’évolution staturo-pondérale de la progéniture de mères souffrant de TCA et mettent en lumière une courbe staturo-pondérale significativement différente de celle des mères en santé. La croissance foetale est restreinte lors de TCA, particulièrement lors d’AM et les pics de croissance ont lieu plus tardivement chez les enfants de mères souffrant d’AM ou de B. Conclusion : Ce Travail de Bachelor a permis de mettre en évidence les liens entre l’AM et la B et certains impacts négatifs sur le foetus, le nouveau-né et l’enfant en bas-âge. Notre analyse démontre qu’un dépistage et une prise en charge spécialisés, multidisciplinaires et périconceptionnels, actuellement insuffisants, des femmes atteintes de TCA sont essentiels afin de diminuer les risques de complications. Bien que la littérature se soit développée au cours de cette décennie, elle demeure insuffisante et nécessite de plus amples investigations pour mieux comprendre l’implication périconceptionnelle des TCA

Clinical Outcomes and Cataract Formation Rates in Eyes 10 Years After Posterior Phakic Lens Implantation for Myopia.

Intraocular collamer lenses (ICLs) are posterior chamber phakic lenses that provide a refractive surgery option for those with high myopia or astigmatism. The short-term and midterm results indicate good refraction stability, efficacy, and safety. Cataract has been suggested to be an important long-term complication of ICL implantation. To report the rates of cataract development and refractive outcomes 10 years after ICL implantation. The study included 133 eyes of 78 patients undergoing consecutive V4 model ICL implantations, which took place from January 1, 1998, through December 31, 2004, at Jules-Gonin Eye Hospital, Lausanne, Switzerland. Data analysis was performed from January 1, 2014, to May 31, 2014. The lenses implanted were as follows: 53 V4 model ICLs of -15.5 D or greater, 73 V4 model ICLs of less than -15.5 diopter (D), and 7 V4 model toric ICLs for myopia. Rate of cataract surgery, lens opacity, ocular hypertension, refractive safety, predictability, and stability. A total of 133 eyes of 78 patients (34 men and 44 women, with a mean [SD] age of 38.8 [9.2] years at enrollment) met the inclusion criteria. The rate of lens opacity development was 40.9% (95% CI, 32.7%-48.8%) and 54.8% (95% CI, 44.7%-63.0%) at 5 and 10 years, respectively. Phacoemulsification was performed in 5 eyes (4.9%; 95% CI, 1.0%-8.7%) and 18 eyes (18.3%; 95% CI, 10.1%-25.8%) at 5 and 10 years after ICL implantation, respectively. The vault height (distance between the posterior ICL surface and anterior lens surface) measured a mean (SD) of 426 (344) μm immediately postoperatively, decreasing to 213 (169) μm at 10 years. A smaller vault height was associated with the development of lens opacity and phacoemulsification (P = .005 and .008, respectively). The intraocular pressure was 15 mm Hg postoperatively, and there was no significant increase in intraocular pressure observed until the 10-year follow-up (16 mm Hg, P = .02). At 10 years, 12 eyes (12.9%; 95% CI, 5.6%-19.6%) had developed ocular hypertension that required topical medication. At 10 years, the mean (SD) safety index was 1.25 (0.57), with a manifest spherical equivalent of -0.5 D at 1-year postoperatively vs -0.7 D at 10 years postoperatively in eyes aimed at emmetropia. This retrospective single center study indicates that ICL implantation provides good long-term safety and stability of refraction in patients with high myopia compared with similar short-term studies. However, the rates of cataract formation and ocular hypertension at 10 years have important clinical implications, and as such this information should be part of the available patient information before ICL implantation

Association of serum copeptin and urinary uromodulin with kidney function, blood pressure and albuminuria at 6 weeks post-partum in pre-eclampsia

BackgroundPreeclampsia (PE) is associated with subsequent higher risk of cardiovascular and kidney disease. Serum copeptin, as a proxy for vasopressin, and urinary uromodulin, were associated with PE physiopathology and kidney functional mass respectively. We describe concentrations of these proteins in the post-partum period and characterize their association with persistent hypertension (HTN) or albuminuria.MethodsPatients with PE and healthy controls with uncomplicated pregnancy were prospectively included at two teaching hospitals in Switzerland. Clinical parameters along with serum copeptin and urinary uromodulin were measured at 6 weeks post-partum. PE patients were further characterized based on presence of HTN (defined as either systolic BP (SBP) ≥140 mmHg or diastolic (BP) ≥90 mmHg) or albuminuria [defined as urinary albumin to creatinine ratio (ACR) ≥3 mg/mmol].ResultsWe included 226 patients with 35 controls, 120 (62.8%) PE with persistent HTN/albuminuria and 71 (37.1%) PE without persistent HTN/albuminuria. Median serum copeptin concentration was 4.27 (2.9–6.2) pmol/L without differences between study groups (p > 0.05). Higher copeptin levels were associated with higher SBP in controls (p = 0.039), but not in PE (p > 0.05). Median urinary uromodulin concentration was 17.5 (7.8–28.7) mg/g with lower levels in PE patients as compared to healthy controls (p < 0.001), but comparable levels between PE patients with or without HTN/albuminuria (p > 0.05). Higher uromodulin levels were associated with lower albuminuria in PE as well as control patients (p = 0.040).ConclusionSerum copeptin levels at 6 weeks post-partum are similar between PE patients and healthy controls and cannot distinguish between PE with or without residual kidney damage. This would argue against a significant pathophysiological role of the vasopressin pathway in mediating organ damage in the post-partum period. On the opposite, post-partum urinary uromodulin levels are markedly lower in PE patients as compared to healthy controls, potentially reflecting an increased susceptibility to vascular and kidney damage that could associate with adverse long-term cardiovascular and kidney outcomes