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1.
Rev Med Interne ; 42(1): 58-60, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33168352

RESUMO

Since Hippocrates, the cornerstone of medical practice has been the doctor-patient relationship. The question here is whether these basic principles are still compatible with this unusual COVID-period. This pandemic represents a serious threat to human health, leading to profound changes in behavior in daily life but also in health care. Because of limited resources, health-managers must choose well-balanced solutions able to protect patients and citizens on the one hand and to provide maximal benefit for the society on the other hand. We are going through a moment of rupture that we must acknowledge. Here, we discussed how the doctor-patient relationship could be compromised. Doctors are focused on cares whereas patients are focused on scare. Profound changes occur presently, from the way we present ourselves to each other (including the masks), the poor conditions for physical examination, the mental suffering of both patient and caregiver until sometimes terrible end-of-life conditions. The historical point-of-view helps us to keep in mind previous experiences, and the philosophical perspective helps to contextualize this unedited situation. We should stop briefly our daily rush to put these considerations into perspective to overcome these challenges. Nothing is as effective as trust: let's rebuild it.


Assuntos
COVID-19/psicologia , Relações Médico-Paciente , Padrões de Prática Médica/história , Padrões de Prática Médica/normas , Confiança , COVID-19/epidemiologia , Epidemias/história , História do Século XVII , História do Século XXI , Humanos , Pandemias/história , Padrões de Prática Médica/tendências , Medicina de Precisão/psicologia , Medicina de Precisão/normas , SARS-CoV-2/fisiologia , Telemedicina/normas , Telemedicina/tendências
2.
Rev Med Interne ; 42(11): 756-763, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34303548

RESUMO

INTRODUCTION: We aimed to evaluate the impact of an immersive simulation session on the experience of the beginning of residency. METHODS: The interventional group consisted of newly recruited residents in 2019, who participated in the workshop presenting four emergency scenarios frequently encountered during night shifts; the control group comprised residents who had begun their internship in 2018, without having participated in the simulation workshop. The level of psychological stress and self-confidence were self-estimated in the simulation group before and immediately after the workshop. During the second semester of residency, stress, self-efficacy and anxiety were evaluated in both groups with the Perceived Stress Scale (PSS), General Self-efficacy Scale (GSES), and Generalized Anxiety Disorder-7 (GAD-7) scale. RESULTS: In the second semester 2020, the PSS, GSES and GAD-7 were 20.71±8.15 and 22.44±5.68 (P=0.40); 26.88±6.30 and 27.11±3.95 (P=0.87); 6.94±5.25 and 8.89±4.78 (P=0.22) for the simulation (n=17, 89.5% of participation) and control (n=9, 75%) groups, respectively. In the simulation group, the level of self-confidence had significantly improved from 1.82±0.95 before the session to 2.29±1.16 after the session (P=0.05). Interestingly, this improvement in self-confidence was significantly correlated with GAD-7 (P=0.014) and PSS (P=0.05), and tended to be correlated with GSES (P=0.09). CONCLUSION: Our study showed a significant improvement in self-confidence between before and after the simulation session. Residents who experienced an improvement in self-confidence saw their stress and anxiety levels decrease during the second semester reevaluation, in favor of a prolonged benefit from the session.


Assuntos
Internato e Residência , Treinamento por Simulação , Competência Clínica , Humanos , Estresse Psicológico/epidemiologia
3.
Rev Med Interne ; 30(7): 585-91, 2009 Jul.
Artigo em Francês | MEDLINE | ID: mdl-19447528

RESUMO

The objective of this review is to analyze the relationship between moderate decrease in renal function and cardiovascular (CV) risk and to discuss the potential mechanisms of this association. Prevalence of chronic kidney disease (CKD) is increasing in developed countries. Several studies have shown that a moderate fall in glomerular filtration (GFR) or the presence of microalbuminuria is associated with an increase in CV risk, independently of the traditional CV risk factors. Mechanisms are probably multiple and could include anemia, calcium/phosphate metabolism, inflammation, but also large arteries function. In order to achieve primary or secondary prevention of CV risk, DFG should be estimated from serum creatinine and microalbuminuria should be assessed in every high risk subject. The finding of CKD implies optimal management of all traditional CV risk factors. Future studies are needed in order to evaluate the efficacy and safety of specific therapeutic approach to reduce CV risk in CKD.


Assuntos
Doenças Cardiovasculares/complicações , Nefropatias/complicações , Albuminúria/complicações , Doença Crônica , Taxa de Filtração Glomerular , Humanos , Risco
4.
J Frailty Aging ; 5(4): 233-241, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27883170

RESUMO

The Région Languedoc Roussillon is the umbrella organisation for an interconnected and integrated project on active and healthy ageing (AHA). It covers the 3 pillars of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA): (A) Prevention and health promotion, (B) Care and cure, (C) and (D) Active and independent living of elderly people. All sub-activities (poly-pharmacy, falls prevention initiative, prevention of frailty, chronic respiratory diseases, chronic diseases with multimorbidities, chronic infectious diseases, active and independent living and disability) have been included in MACVIA-LR which has a strong political commitment and involves all stakeholders (public, private, patients, policy makers) including CARSAT-LR and the Eurobiomed cluster. It is a Reference Site of the EIP on AHA. The framework of MACVIA-LR has the vision that the prevention and management of chronic diseases is essential for the promotion of AHA and for the reduction of handicap. The main objectives of MACVIA-LR are: (i) to develop innovative solutions for a network of Living labs in order to reduce avoidable hospitalisations and loss of autonomy while improving quality of life, (ii) to disseminate the innovation. The three years of MACVIA-LR activities are reported in this paper.


Assuntos
Envelhecimento , Política de Saúde , Promoção da Saúde , Vida Independente , Medicina Preventiva , Acidentes por Quedas/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Comorbidade , União Europeia , França , Hospitalização , Humanos , Múltiplas Afecções Crônicas , Saúde Bucal , Autonomia Pessoal , Polimedicação , Qualidade de Vida , Doenças Respiratórias
5.
Presse Med ; 32(26): 1213-5, 2003 Aug 09.
Artigo em Francês | MEDLINE | ID: mdl-14506458

RESUMO

INTRODUCTION: Despite its rare occurrence in Caucasians, thyreotoxic periodic paralysis should be evoked in young male Caucasians presenting with episodes of pseudo-paralytic hypokalemia. OBSERVATION: A 37 year-old Caucasian was admitted in intensive care for an acute episode of hypotonic tetraplegia and hypokalemia during which laboratory tests revealed hyperthyroidism due to Basedow's disease. The clinical course was rapidly favourable after a small dose of intravenous potassium. Antithyroid treatment avoided any new occurrence of similar episodes. DISCUSSION: In Caucasians, sporadic acute paralysis with hypokalemia requires testing for hyperthyroidism. Though it is well know that hypokalemia results from potassium intracellular shift, the underlying mechanism remains poorly elucidated. Treatment includes potassium administration with caution and/or beta blockers but the specific treatment is that of hyperthyroidism.


Assuntos
Doença de Graves/complicações , Paralisia Periódica Hipopotassêmica/diagnóstico , Paralisias Periódicas Familiares/diagnóstico , Tireotoxicose/complicações , População Branca , Adulto , Diagnóstico Diferencial , Doença de Graves/tratamento farmacológico , Humanos , Infusões Intravenosas , Masculino , Potássio/administração & dosagem , Potássio/uso terapêutico
6.
Ann Cardiol Angeiol (Paris) ; 63(3): 120-3, 2014 Jun.
Artigo em Francês | MEDLINE | ID: mdl-24952676

RESUMO

Because the functional interaction between the LV and arterial systems, termed ventricular-arterial coupling, is recognized as a key determinant of LV performance, the objective of the present study was to assess the impact of uncomplicated HT without LVH on LV performance using simultaneously echocardiography and carotid tonometry. LV maximal power (PmaxVG), cardiac power output (CPO), LV efficiency (CPO/PmaxVG), input aortic and output LV elastance (Ea and Ees) were assessed in 20 normotensive control subjects (NT) and 10 patients with untreated HT. PmaxVG was calculated according to the integral of the product of LV wall stress with strain rate (as an index of gradient velocity). Cyclic variation of wall thickness and SR were measured by speckel-tracking. Ea and Ees were derived and modelized from the pressure-volume curve. No difference in age, BMI and sex ratio was observed between NT and HT. Systolic BP (160±18 vs. 119±10mmHg), LV mass (99±15 vs. 76±12g/m(2)), PWV (9.7±2 vs. 6.9±1m/s) were significantly higher (P<0.01) in HT when compared to NT. In HT increased of CPO and Ea was compensated by an increase of LV (15±4 vs. 12±3%, P<0.02) and Ees (5.5±2 vs. 4.5±1.5mmHg/mL), which are significantly elevated in HT (P<0.05). No difference was observed in Ea/Ees between NT and HT. In conclusion at the early phase of HT, in patients without LVH, LV performance and ventricular-arterial coupling were adapted to post-load elevation. This adaptation may be the result of an increased of LV contractility.


Assuntos
Aorta/diagnóstico por imagem , Débito Cardíaco , Ecocardiografia , Hipertensão/diagnóstico por imagem , Manometria , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Aorta/fisiopatologia , Índice de Massa Corporal , Artérias Carótidas/fisiopatologia , Estudos de Casos e Controles , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Manometria/métodos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
7.
Ann Cardiol Angeiol (Paris) ; 61(2): 111-7, 2012 Apr.
Artigo em Francês | MEDLINE | ID: mdl-21885031

RESUMO

Mortality in rheumatoid arthritis (RA) is doubled when compared to the general population. This excess in mortality can be explained in half of cases by cardiovascular (CV) events. The risk of myocardial infarction is increased by about 60% in RA. Mortality secondary to cerebrovascular stroke is increased by 50% even if the incidence of stroke is not increased. Indeed, the risk of fatal CV events is increased in RA when compared to the general population. The increased CV risk cannot be explained only by traditional CV risk factors, even if smoking and changes in lipid profile may be implied. It is mainly related to the chronic inflammatory condition that causes many metabolic disturbances. Other parameters such as treatments used in RA also play a role. Thus, it is essential for proper management of RA patients to be aware of this risk and to treat any modifiable CV risk factors.


Assuntos
Artrite Reumatoide/epidemiologia , Doenças Cardiovasculares/epidemiologia , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/efeitos adversos , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Humanos , Inflamação/epidemiologia , Metotrexato/uso terapêutico , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Fator de Necrose Tumoral alfa/antagonistas & inibidores
9.
Eur Respir J ; 22(3): 408-12, 2003 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-14516127

RESUMO

The pathogenesis of pulmonary arterial hypertension (PAH) remains uncertain. Both the serotonin and endothelin (ET) systems are believed to be involved. Recent studies pointed to the importance of the serotonin 2B receptor as a limiting step. The current authors investigated the lung tissue expression of serotonin receptors and of the serotonin transporter (5-HTT) by real-time-quantitative polymerase chain reaction in chronic overcirculation-induced PAH in growing piglets, with and without treatment with the dual ET receptor blocker bosentan. Pulmonary haemodynamic changes were described by pulmonary arterial impedance spectra. Three months after the surgical anastomosis of the left subclavian artery to the pulmonary arterial trunk, there was a shift of the impedance spectra to higher ratios of pressure and flow moduli, with increases in both 0 Hz impedance and characteristic impedance, and these changes were completely prevented by bosentan therapy. There was an increase in the expression of the serotonin 1B receptor. There was no change in the expression of the 5-HTT, and of the serotonin 2B, 1D, and 4 receptors. The overexpression of the serotonin 1B receptor was partially prevented by bosentan therapy. The present authors conclude that this early pulmonary arterial hypertension model is characterised by an endothelin receptor-dependent increased expression of the serotonin 1B receptor.


Assuntos
Hipertensão Pulmonar/metabolismo , Pulmão/metabolismo , Proteínas de Membrana Transportadoras , Proteínas do Tecido Nervoso , Receptor 5-HT1B de Serotonina/biossíntese , Animais , Anti-Hipertensivos/uso terapêutico , Bosentana , Proteínas de Transporte/biossíntese , Hipertensão Pulmonar/tratamento farmacológico , Glicoproteínas de Membrana/biossíntese , Reação em Cadeia da Polimerase , Circulação Pulmonar , Receptores de Endotelina/fisiologia , Serotonina/metabolismo , Proteínas da Membrana Plasmática de Transporte de Serotonina , Sulfonamidas/uso terapêutico , Suínos
10.
Eur Respir J ; 21(1): 31-6, 2003 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-12570105

RESUMO

The purpose of this study was to determine the site of increased resistance using the arterial occlusion technique in patients with severe pulmonary hypertension. Pulmonary vascular resistance was partitioned in arterial and venous components based on double exponential fitting analysis of the pulmonary artery pressure decay curve: after balloon occlusion in 36 patients with pulmonary arterial hypertension (PAH); at baseline and during the inhalation of 20 parts per million of nitric oxide (NO); in four patients with chronic thromboembolic pulmonary hypertension; and in two patients with pulmonary veno-occlusive disease. In the patients with PAH, at baseline, mean pulmonary artery pressure was 56+/-2 mmHg (mean+/-SE), with an arterial component of resistance of 63+/-1%. Inhaled NO did not change the partition of resistance. The arterial component of resistance amounted on average to 42% and 77% in the patients with veno-occlusive disease and the patients with thromboembolic pulmonary hypertension, respectively. However, the partitioning of resistance did not discriminate between these three diagnostic categories. The occlusion technique may help to locate the predominant site of increased resistance in patients with severe pulmonary hypertension, but does not allow for a satisfactory differential diagnosis on an individual basis.


Assuntos
Oclusão com Balão , Hipertensão Pulmonar/fisiopatologia , Resistência Vascular , Cateterismo Cardíaco , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/fisiopatologia , Circulação Pulmonar/fisiologia , Pneumopatia Veno-Oclusiva/fisiopatologia , Pressão Propulsora Pulmonar
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