Place de la loi Leonetti dans la décision de passage en soins palliatifs terminaux en gériatrie (étude rétrospective sur 115 dossiers)

Contexte : La loi du 22 avril 2005 relative aux droits des malades dite loi Leonetti, constitue une avancée sur le plan éthique en condamnant l'acharnement thérapeutique, en instituant la possibilité de l'arrêt du traitement dans le cadre d'une procédure collégiale pluridisciplinaire, en mettant en place les conditions pour que le patient puisse faire valoir son souhait. Sept ans après, le rapport Sicard répond que cette loi est insuffisamment appliquée. En raison d'un nombre important de décès après 75 ans, les gériatres sont eux-mêmes confrontés à l'application de la loi au quotidien, mais la mise en pratique de la loi est peu étudiée. Objectif : L'objectif de notre travail était d'évaluer l'application des critères de la loi Leonetti lors de la mise en place d'une procédure de soins palliatifs terminaux en gériatrie, et d'en identifier les difficultés chez la personne âgée. Méthodes : II s'agissait d'une étude monocentrique rétrospective sur une période de 15 mois par le recueil exhaustif des décès observés en gériatrie portant comme diagnostic principal ou associé le code soins palliatifs (Z515 au PMSI), chez les sujets polypathologiques présentant des alternances d'épisodes aigus et de récupérations. Résultats : Sur 115 décès, 67 dossiers correspondaient aux critères d'inclusion (polypathologie instable). 37% des dossiers faisaient part à la fois d'une collégialité entre médecins, d'une information au patient lorsque c'était possible ou à la personne référente dans le cas contraire, et d'une trace écrite du passage en soins palliatifs. Au moment de la décision, 69% des patients avaient perdu leur autonomie décisionnelle. La simplification du traitement pour ne pas imposer une obstination déraisonnable et une réévaluation du traitement ont été réalisés dans 95% et 97% des cas. Aucune directive anticipée écrite n'a été retrouvée, et seulement 4 directives ont été données par oral. Conclusion : L'application au quotidien de la loi Leonetti doit être améliorée, notamment concernant la traçabilité des décisions collégiale et le rôle de la personne de confiance. Néanmoins, certains dispositifs comme les directives anticipées sont difficiles à mettre en œuvre en gériatrie.ST ETIENNE-BU Médecine (422182102) / SudocSudocFranceF

Une vulnérabilité cachée et méconnue du sujet âgé : le syndrôme de Diogène

National audienceLes acteurs de la gérontologie sont confrontés à des situations extrêmes qui témoignent d’une importante vulnérabilité des sujets âgés, dont le syndrome de Diogène est un des exemples les plus emblématiques. Le syndrome de Diogène reste une entité mal définie. Le diagnostic est clinique. Il ne se réduit pas à la seule accumulation d’objets (syllogomanie) et peut revêtir des formes cliniques variées avec un important retard diagnostique. Le but de l’étude est de décrire un profil type à partir de vingt et un patients rencontrés porteurs du syndrome de Diogène, en analysant rétrospectivement les informations cliniques et environ-nementales recueillies et de fournir des outils ou signes cliniques permettant de les repérer. Les cliniciens et les chercheurs utilisent souvent de manière synonyme le terme de fragilité et celui de vulnérabilité pour décrire ces situations cliniques spécifiques. Le syndrome de Diogène représente un tableau caractéristique de l’intrication de ces deux concepts bien distincts

iGEM REPORT: Gotta Detect ‘Em All: a multi-STI sensor based on aptamers

/International audienceNowadays, STIs constitute a major public health issue. Indeed, treatments are often started too late because of belated diagnosis resulting in health problems, such as sterility. If prevention is probably the most effective action one can take to prevent the spread of STIs, early detection could help limit their deleterious effects. In this work, a new diagnosis approach based on aptamers is presented. Bound to paper, they allow the detection of HIV and Hepatitis B biomarkers from a blood sample. The associated device is composed of an anchor, the streptavidin protein, allowing the fixation of the aptamer to the paper via biotin (see graphical abstract). With this system, the HIV-1 Reverse Transcriptase (BBa_K1934060 and BBa_K1934061: protein subunits p51 and p66) and HBsAg (surface antigen of Hepatitis B) are specifically targeted. Then, the biomarker/aptamer complex is detected by two methods. The first one is based on fluorescence. As a proof of concept, a paired ATP/aptamer was used and enabled to successfully detect ATP up to 10 µmol.L-1. However, the signal was not detectable with naked eyes or with a cell phone equipped with blue and green filters either. Therefore, a lateral flow assay with nano-sized latex black beads was tested. This second technique showed that a protein biomarker, such as thrombin, could be complexed with latex beads coated with aptamers, in liquid. Finally, the ultimate step, migration of the latex beads inside paper, needs further optimization. Moreover, to easily handle several STI-tests on a single paper strip, an innovative bio-sourced PLA casing was designed and 3D printed to offer an additional intuitive user-interface

iGEM REPORT: Gotta Detect ‘Em All: a multi-STI sensor based on aptamers

/International audienceNowadays, STIs constitute a major public health issue. Indeed, treatments are often started too late because of belated diagnosis resulting in health problems, such as sterility. If prevention is probably the most effective action one can take to prevent the spread of STIs, early detection could help limit their deleterious effects. In this work, a new diagnosis approach based on aptamers is presented. Bound to paper, they allow the detection of HIV and Hepatitis B biomarkers from a blood sample. The associated device is composed of an anchor, the streptavidin protein, allowing the fixation of the aptamer to the paper via biotin (see graphical abstract). With this system, the HIV-1 Reverse Transcriptase (BBa_K1934060 and BBa_K1934061: protein subunits p51 and p66) and HBsAg (surface antigen of Hepatitis B) are specifically targeted. Then, the biomarker/aptamer complex is detected by two methods. The first one is based on fluorescence. As a proof of concept, a paired ATP/aptamer was used and enabled to successfully detect ATP up to 10 µmol.L-1. However, the signal was not detectable with naked eyes or with a cell phone equipped with blue and green filters either. Therefore, a lateral flow assay with nano-sized latex black beads was tested. This second technique showed that a protein biomarker, such as thrombin, could be complexed with latex beads coated with aptamers, in liquid. Finally, the ultimate step, migration of the latex beads inside paper, needs further optimization. Moreover, to easily handle several STI-tests on a single paper strip, an innovative bio-sourced PLA casing was designed and 3D printed to offer an additional intuitive user-interface

iGEM REPORT: Gotta Detect ‘Em All: a multi-STI sensor based on aptamers

/International audienceNowadays, STIs constitute a major public health issue. Indeed, treatments are often started too late because of belated diagnosis resulting in health problems, such as sterility. If prevention is probably the most effective action one can take to prevent the spread of STIs, early detection could help limit their deleterious effects. In this work, a new diagnosis approach based on aptamers is presented. Bound to paper, they allow the detection of HIV and Hepatitis B biomarkers from a blood sample. The associated device is composed of an anchor, the streptavidin protein, allowing the fixation of the aptamer to the paper via biotin (see graphical abstract). With this system, the HIV-1 Reverse Transcriptase (BBa_K1934060 and BBa_K1934061: protein subunits p51 and p66) and HBsAg (surface antigen of Hepatitis B) are specifically targeted. Then, the biomarker/aptamer complex is detected by two methods. The first one is based on fluorescence. As a proof of concept, a paired ATP/aptamer was used and enabled to successfully detect ATP up to 10 µmol.L-1. However, the signal was not detectable with naked eyes or with a cell phone equipped with blue and green filters either. Therefore, a lateral flow assay with nano-sized latex black beads was tested. This second technique showed that a protein biomarker, such as thrombin, could be complexed with latex beads coated with aptamers, in liquid. Finally, the ultimate step, migration of the latex beads inside paper, needs further optimization. Moreover, to easily handle several STI-tests on a single paper strip, an innovative bio-sourced PLA casing was designed and 3D printed to offer an additional intuitive user-interface

iGEM REPORT: Gotta Detect ‘Em All: a multi-STI sensor based on aptamers

/International audienceNowadays, STIs constitute a major public health issue. Indeed, treatments are often started too late because of belated diagnosis resulting in health problems, such as sterility. If prevention is probably the most effective action one can take to prevent the spread of STIs, early detection could help limit their deleterious effects. In this work, a new diagnosis approach based on aptamers is presented. Bound to paper, they allow the detection of HIV and Hepatitis B biomarkers from a blood sample. The associated device is composed of an anchor, the streptavidin protein, allowing the fixation of the aptamer to the paper via biotin (see graphical abstract). With this system, the HIV-1 Reverse Transcriptase (BBa_K1934060 and BBa_K1934061: protein subunits p51 and p66) and HBsAg (surface antigen of Hepatitis B) are specifically targeted. Then, the biomarker/aptamer complex is detected by two methods. The first one is based on fluorescence. As a proof of concept, a paired ATP/aptamer was used and enabled to successfully detect ATP up to 10 µmol.L-1. However, the signal was not detectable with naked eyes or with a cell phone equipped with blue and green filters either. Therefore, a lateral flow assay with nano-sized latex black beads was tested. This second technique showed that a protein biomarker, such as thrombin, could be complexed with latex beads coated with aptamers, in liquid. Finally, the ultimate step, migration of the latex beads inside paper, needs further optimization. Moreover, to easily handle several STI-tests on a single paper strip, an innovative bio-sourced PLA casing was designed and 3D printed to offer an additional intuitive user-interface

iGEM REPORT: Gotta Detect ‘Em All: a multi-STI sensor based on aptamers

/International audienceNowadays, STIs constitute a major public health issue. Indeed, treatments are often started too late because of belated diagnosis resulting in health problems, such as sterility. If prevention is probably the most effective action one can take to prevent the spread of STIs, early detection could help limit their deleterious effects. In this work, a new diagnosis approach based on aptamers is presented. Bound to paper, they allow the detection of HIV and Hepatitis B biomarkers from a blood sample. The associated device is composed of an anchor, the streptavidin protein, allowing the fixation of the aptamer to the paper via biotin (see graphical abstract). With this system, the HIV-1 Reverse Transcriptase (BBa_K1934060 and BBa_K1934061: protein subunits p51 and p66) and HBsAg (surface antigen of Hepatitis B) are specifically targeted. Then, the biomarker/aptamer complex is detected by two methods. The first one is based on fluorescence. As a proof of concept, a paired ATP/aptamer was used and enabled to successfully detect ATP up to 10 µmol.L-1. However, the signal was not detectable with naked eyes or with a cell phone equipped with blue and green filters either. Therefore, a lateral flow assay with nano-sized latex black beads was tested. This second technique showed that a protein biomarker, such as thrombin, could be complexed with latex beads coated with aptamers, in liquid. Finally, the ultimate step, migration of the latex beads inside paper, needs further optimization. Moreover, to easily handle several STI-tests on a single paper strip, an innovative bio-sourced PLA casing was designed and 3D printed to offer an additional intuitive user-interface

Management of Severe Bleeding in Patients Treated with Direct Oral Anticoagulants

International audienceThe use of prothrombin complex concentrates and the role of plasma concentration of anticoagulants in the management of bleeding in patients treated with direct oral anticoagulants are still debated. Our aim was to describe management strategies and outcomes of severe bleeding events in patients treated with direct oral anticoagulants.METHODS:We performed a prospective cohort study of 732 patients treated with dabigatran, rivaroxaban, or apixaban hospitalized for severe bleeding, included prospectively in the registry from June 2013 to November 2015.RESULTS:Bleeding was gastrointestinal or intracranial in 37% (212 of 732) and 24% (141 of 732) of the cases, respectively. Creatinine clearance was lower than 60 ml/min in 61% (449 of 732) of the cases. The plasma concentration of direct oral anticoagulants was determined in 62% (452 of 732) of the cases and was lower than 50 ng/ml or higher than 400 ng/ml in 9.2% (41 of 452) and in 6.6% (30 of 452) of the cases, respectively. Activated or nonactivated prothrombin complex concentrates were administered in 38% of the cases (281 of 732). Mortality by day 30 was 14% (95% CI, 11 to 16).CONCLUSIONS:Management of severe bleeding in patients treated with direct oral anticoagulants appears to be complex. The use of prothrombin complex concentrates differs depending on bleeding sites and direct oral anticoagulant plasma concentrations. Mortality differs according to bleeding sites and was similar to previous estimates