[Iron deficiency in adults : to understand what biological evaluation should be carried out]. / Déficit en fer chez l'adulte : comprendre quel bilan biologique réaliser.

Iron is a major mineral in the human body. It participates in various metabolisms, including oxygen transport in hemoglobin. Iron deficiency (ID) is characterized by a deficit in circulating iron. There are two types of ID : 1) absolute ID (AID), in case of decrease in iron reserves and circulating iron, or 2) functional ID (FID), in case of decrease in circulating iron, while reserves are preserved or increased. AID is mainly due to bleeding, usually gastrointestinal, while FID is linked to the inflammatory syndrome. AID is characterized by low serum ferritin and transferrin saturation (TS). Hypochromic microcytic anemia is frequent. FID is characterized by elevated serum ferritin, normal or low TS, and normal sTfR levels. Furthermore, C-reactive protein levels are high, and there is non-regenerative non-macrocytic anemia. New biological tests (serum hepcidin) may be useful in case of doubt. However, they are not yet commonly used.

Le fer, oligoélément capital, participe à divers métabolismes chez l'être humain, dont le transport d'oxygène dans l'hémoglobine. La carence martiale (CM) peut être de deux types : 1) absolue (CMA), en cas de réduction des réserves martiales et du fer circulant, ou 2) fonctionnelle (CMF), avec une réduction du fer circulant et des réserves au contraire préservées ou augmentées. La CMA est principalement secondaire à un saignement, souvent digestif, tandis que la CMF est liée au syndrome inflammatoire. La CMA est attestée par une ferritinémie et un coefficient de saturation de la transferrine (CSTf) abaissés. Une anémie microcytaire hypochrome est fréquente. La CMF se caractérise par une ferritinémie normale ou élevée, un CSTf normal ou abaissé, un taux de récepteurs solubles de la transferrine non élevé, une C-réactive protéine élevée et une possible anémie non macrocytaire arégénérative. De nouveaux biomarqueurs (hepcidine sérique) peuvent être utiles en cas de doute. Cependant, ils ne sont pas encore couramment réalisés.

[The seasonal flu vaccination among caregivers in geriatric units: Up-to-date]. / La couverture vaccinale contre la grippe saisonnière du personnel soignant en gériatrie : mise au point.

BACKGROUND: 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.

[Evaluation of the prescription of furosemide in persons aged 75years and older in a geriatric acute-care unit]. / Évaluation de la prescription du furosémide chez la personne âgée de 75 ans et plus dans un service de gériatrie aiguë.

INTRODUCTION: Furosemide is very often prescribed in France. It may cause important adverse effects especially in elderly persons. In order to limit its misuse and excessive expenditure for health insurance organizations, the European Society of Cardiology drafted strict guidelines for its prescription. We conducted a study in this population to determine the rate of prescription of furosemide in elderly persons outside the guidelines. METHOD: This was a prospective, single-centre, observational study bearing on elderly persons aged 75years and more admitted to a geriatric acute-care unit over a period of 6months. The prevalence of furosemide prescription and the proportion of prescriptions outside guidelines were calculated. The sociodemographic and medical characteristics of patients treated with furosemide were studied as were the modalities of furosemide prescription. RESULTS: In the 818 patients hospitalized during the period of the study, 267 were taking furosemide at admission (32.6%). Among these prescriptions, 69.2% were outside the guidelines. Arterial hypertension was the leading indication for furosemide (38.2%), followed by chronic heart failure (24.3%). CONCLUSION: This study confirmed the high prevalence of furosemide prescription and its misuse. Furosemide is often re-prescribed with no medical re-evaluation.