Comorbidities of COPD

International audienceBy 2020, chronic obstructive pulmonary disease (COPD) will be the third cause of mortality. Extrapulmonary comorbidities influence the prognosis of patients with COPD. Tobacco smoking is a common risk factor for many comorbidities, including coronary heart disease, heart failure and lung cancer. Comorbidities such as pulmonary artery disease and malnutrition are directly caused by COPD, whereas others, such as systemic venous thromboembolism, anxiety, depression, osteoporosis, obesity, metabolic syndrome, diabetes, sleep disturbance and anaemia, have no evident physiopathological relationship with COPD. The common ground between most of these extrapulmonary manifestations is chronic systemic inflammation. All of these diseases potentiate the morbidity of COPD, leading to increased hospitalisations and healthcare costs. They can frequently cause death, independently of respiratory failure. Comorbidities make the management of COPD difficult and need to be evaluated and treated adequately. Extrapulmonary comorbidities are common in COPD and influence prognosis; we propose an exhaustive comorbidities revie

Embolie amniotique (à propos d'un cas et revue de la littérature)

CAEN-BU Médecine pharmacie (141182102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Evaluation des pratiques professionnelles en réanimation (prise en charge diagnostique et thérapeutique des pneumopathies acquises sous ventilation mécanique)

RENNES1-BU Santé (352382103) / SudocSudocFranceF

Evaluation des pratiques professionnelles en réanimation (prise en charge des états septiques graves)

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Les mortiers hydrauliques : synthèse bibliographique et premiers résultats sur des mortiers de Gaule romaine

This article is a bearing «state of the art» on the mortars containing hydraulic lime and the air lime-based mortars with reactive aggregates : natural and artificial pozzolanas. The analyses of these last years on the Gallo-Roman lime mortars show a systematic use of air lime, which supposes a selection of the purest limestone in the geological environment. The field of the Gallo-Roman hydraulic mortars consist mainly in lime mortars with brick dust, natural pozzolanas being not very abundant in Gaule. In the terra cotta, the heat treatment of clays involves the formation of reactive glass, as well as that of pozzolanas. It is considered that only the mortars with fine brick dust make possible to obtain mortars rich in pozzolanic compounds. But the mechanical resistance of many concretes with large fragments of brick and tile proves, following the example junctions between sandy mortars and bricks of a masonry, that the contact reactions between lime and the terra cotta reinforce considerably the mechanical properties of the material. The multispectral image processing allows the study of these edge phenomena.Cet article est un « état de l'art » portant sur les mortiers à base de chaux hydraulique et les mortiers de chaux aérienne mêlés de granulats réactifs : les pouzzolanes naturelles et artificielles. Les analyses de ces dernières années sur les mortiers de chaux gallo-romains montrent un emploi systématique de chaux aériennes, ce qui suppose une sélection dans l'environnement géologique des pierres calcaires les plus pures. Le domaine des mortiers hydrauliques gallo- romains renvoie principalement aux mortiers de chaux et de tuileau, les pouzzolanes naturelles étant peu abondantes en Gaule. Dans les terres cuites, la cuisson des argiles entraîne la formation d'un verre réactif, au même titre que celui des pouzzolanes. On considère que seuls les mortiers à tuileau fin permettent d'obtenir des mortiers riches en composés pouzzolaniques. Mais la résistance mécanique de nombreux bétons à gros fragments de tuileau prouve, à l'instar des jonctions entre des mortiers sableux et les briques d'une maçonnerie, que les réactions de contacts entre la chaux et les terres cuites renforcent considérablement les propriétés mécaniques du matériau. Le traitement des images multispectrales permet l'étude de ces phénomènes de bordure.Coutelas Arnaud, Godard Gaston, Blanc Philippe, Person Alain. Les mortiers hydrauliques : synthèse bibliographique et premiers résultats sur des mortiers de Gaule romaine. In: Revue d'Archéométrie, n°28, 2004. pp. 127-139

Obesity and pre-operative nutritional deficiences

Les carences nutritionnelles sont considérées comme rares au sein de la population occidentale compte tenu de la pléthore alimentaire actuelle. Cependant, en raison d’une alimentation riche en énergie mais pauvre du point de vue nutritionnel (pauvre en protéines, vitamines, minéraux et fibres), des déficiences nutritionnelles en vitamines et minéraux sont fréquemment rapportées chez le sujet obèse. De plus, la chirurgie bariatrique constitue actuellement le traitement le plus efficace de l’obésité morbide, mais une carence en micronutriments représente un problème important dans les suites de la chirurgie, contribuant dès lors à aggraver les carences préexistantes. Dans ce travail, nous envisageons la prévalence des carences nutritionnelles du sujet avec obésité morbide avant chirurgie bariatrique, les conséquences cliniques de ces déficiences et les recommandations pratiques qu’il convient d’appliquer chez ce type de patients.It is a common belief that nutritional deficiencies are rare in the Western world due to a wide variety of food supply. However, obese people usually consume dense-energy food but of poor nutritional value that lacks proteins, vitamins, minerals and fiber; consequently, a high prevalence of micronutrient deficiencies in obese subjects has been reported. Moreover, bariatric surgery has been proven the most effective treatment of morbid obesity, but micronutrient deficiency following bariatric surgery is a major concern, worsening pre-operative nutritional deficiencies. In this article, we reviewed the litterature and highlighted the prevalence of nutritional deficiencies in the morbidly obese population prior to bariatric surgery, clinical consequences of these deficiencies and practical recommendations for these subjects

Increasing Incidence of Severe Epstein-Barr Virus-Related Infectious Mononucleosis: Surveillance Study

Older patients are more susceptible to severe Epstein-Barr virus (EBV)-related infectious mononucleosis (IM). This condition may increase in industrialized countries where primary EBV infection occurs later in life. Between 1990 and 2004, 38 patients were admitted to our department with EBV-related IM. Two patients died. The annual incidence increased significantly (r = 0.623; P = 0.013)

Women and COPD: do we need more evidence?

The increasingly female face of chronic obstructive pulmonary disease (COPD) prevalence among women has equalled that of men since 2008, due in part to increased tobacco use among women worldwide and exposure to biomass fuels. This finding is supported by a number of characteristics. There is evidence of susceptibility to smoking and other airborne contaminants, along with epidemiological and phenotypic manifestations. COPD has thus become the leading cause of death in women in the USA. The clinical presentation is characterised by increasingly pronounced dyspnoea with a marked tendency towards anxiety and depression, undernutrition, nonsmall cell lung cancer (especially adenocarcinoma) and osteoporosis. Quality of life is also more significantly impacted. The theories advanced to explain these differences involve the role played by oestrogens, impaired gas exchange in the lungs and smoking habits. While these differences require appropriate therapeutic responses (smoking cessation, pulmonary rehabilitation, long-term oxygen therapy), barriers to the treatment of women with COPD include greater under-diagnosis than in men, fewer spirometry tests and medical consultations. Faced with this serious public health problem, we need to update and adapt our knowledge to the epidemiological changes