[Haute-Marne (France) experience during the 5th COVID-19 epidemic wave in a geriatric short-stay unit]. / Expérience haute-marnaise (France) au cours de la 5ème vague épidémique COVID-19 au sein d'une unité de court séjour gériatrique.

OBJECTIVE: The objective is to study the contribution of vaccination against COVID-19 in elderly subjects infected with COVID-19. METHOD: a retrospective study with screening of medical records was carried out among patients affected by an infection linked to COVID-19 during the 5th epidemic wave that required admission in a French hospital. RESULTS: 51 subjects were included, with 25 women (49 %), mean age 85 y+/-6 years. Among the 51 patients, 28 patients were hospitalized specifically for the management of COVID-19 infection and 25 (49 %) patients showed signs of severity on admission; 35 patients (68.6 %) were vaccinated, with a complete vaccination schedule (2 doses). We noted 16 deaths (31.4 %). Oxygen saturation on admission was significantly associated with the rates of COVID lesions on chest CT (p = 0.018), yet the correlation remained moderate. Vaccination had a significant protective effect on patient death (p = 0.0236). CONCLUSION: Vaccination is more than ever the only weapon of prevention against serious complications related to COVID-19 infection, especially in very elderly subjects, exposed to several comorbidities and polymedication. Prevention efforts and dedicated health explanations are the keys to a useful vaccination being targeted on elderly populations at risk.

: Objectif : L'objectif du travail est d'étudier l'apport de la vaccination contre la COVID-19 chez les sujets âgés infectés par la COVID-19. Méthode : une étude rétrospective sur consultation de dossiers médicaux a été réalisée avec inclusion de patients atteints par une infection liée à la COVID-19 au cours de la 5e vague épidémique en France. Résultats : 51 sujets ont été inclus dont 25 femmes (49 %), avec un âge moyen de 85 ± 6 années. Parmi ceux-ci, 28 patients étaient hospitalisés spécifiquement pour la prise en charge de cette infection; 25 (49 %) patients présentaient des signes de gravité à leur admission; 35 patients (68,6 %) étaient vaccinés (schéma vaccinal complet avec 2 doses). Nous avons noté 16 décès (31,4 %). On note que la saturation en oxygène à l'admission est significativement associée aux taux de lésions COVID au scanner thoracique (p = 0,018), même si la corrélation reste modérée. La vaccination a un effet de protection significatif concernant les décès (p = 0,0236). Conclusion : La vaccination est plus que jamais la seule arme de prévention contre les complications graves liées à l'infection COVID-19, notamment chez les sujets très âgés, présentant diverses comorbidités et polymédiqués. Les efforts de prévention et les explications sanitaires sont les clés pour une vaccination utile et ciblée sur des populations à risque telles que les sujets âgés.

[Type 2 diabetes and the elderly : a real problem]. / Diabète de type 2 et le sujet âgé : une réelle problématique.

Type 2 diabetes in the elderly remains a major concern for all healthcare professionals, this disease being considered a real global «pandemic¼. Its prevalence is high and will continue to increase in the years to come, becoming significant in the elderly and the very old. We offer you a general summary and a focus on diabetes in the elderly with the GERODIAB study.

Le diabète de type 2 chez le sujet âgé reste une préoccupation majeure pour l'ensemble des professionnels de santé, cette maladie étant elle-même considérée comme une réelle «pandémie¼ mondiale. Sa prévalence est élevée et continuera de s'accroître dans les années à venir, devenant prégnante chez le sujet âgé et très âgé. Nous proposons ici une synthèse générale et un focus sur le diabète du sujet âgé avec l'étude GERODIAB.

[Diabetes and frailty in the elderly. A prospective study of an outpatient population supported by general practitioners]. / Diabète et fragilité chez la personne âgée. Etude prospective d'une population ambulatoire prise en charge en Médecine générale.

INTRODUCTION: Elderly people with diabetes represent a large and growing part of the general practitioners patient database, but their state of frailty compared to the non-diabetic population is poorly understood. OBJECTIVE: To study the relationship between diabetes and frailty in people aged 65 and over in primary care. METHOD: Frailty syndrome was assessed by the Fried Scale and compared between populations of diabetic and non-diabetic patients; 268 patients were studied, including 129 diabetic patients. RESULTS: Frailty was found in 27.9 % of older diabetic patients. The observed mean Fried score was 1.76 in people with diabetes versus 1.39 in non-diabetics, with more frail diabetic subjects (p = 0.007). In this study, HbA1c levels showed no significant association to frailty. CONCLUSION: Larger studies in several general practice clinics should be performed on subjects over 65 years of age with or without diabetes.

INTRODUCTION: Les personnes âgées diabétiques représentent une part importante et croissante de la patientèle des médecins généralistes, mais leur état de fragilité par rapport à la population non diabétique est mal connu. Objectif : Etudier les relations entre diabète et fragilité chez la personne âgée de 65 ans et plus en médecine générale. Méthode : La fragilité a été évaluée par l'échelle de Fried et comparée entre les populations de patients diabétiques et non diabétiques; 268 patients ont été inclus dont 129 patients diabétiques. Résultats : La fragilité concernait 27,9 % des diabétiques. Le score de Fried moyen observé était de 1,76 chez les personnes diabétiques versus 1,39 chez les non-diabétiques, avec des sujets diabétiques plus fragiles (p = 0,007). Dans cette étude, le taux d'HbA1c n'est pas significativement associé à la fragilité. CONCLUSION: Des études de plus grande ampleur sur plusieurs sites ambulatoires devraient être réalisées en médecine générale chez les sujets âgés de plus de 65 ans, diabétiques ou non.

[Frailty of the elderly and physical activity in general practice: A prospective study]. / Étude de la fragilité de la personne âgée et de l'activité physique en médecine générale : à propos d'une étude prospective.

INTRODUCTION: Frailty is a transient and reversible condition that can lead to significant morbidity and mortality and to the loss of autonomy. It is one of the key issues in public health and the prevention of addiction. Physical activity is often described as a protective factor against addiction and as a factor in limiting frailty. Our goal is to analyze the relationship between physical activity and frailty among the elderly METHODS: A cross-sectional observational study was carried out in three general practice clinics located in the French department of Eure. Patients aged 65 and over were included during a consultation with their GP. Dependent patients under the ADL scale were excluded. Level of physical activity was assessed by the Ricci and Gagnon questionnaire, which defines an active profile as a score≥18 points. Frailty was sought out by the Fried scale and the SEGA A grid. Multivariate analysis was performed to adjust frailty scores to age, gender, and level of physical activity. RESULTS: Out of the 70 patients included, 36 were active (51%) and 34 inactive (49%). They were predominantly female with 47 women (67%). Average age was 75.3years. Twelve patients were diagnosed as frail (17%) with the Fried scale and 24 (34%) with the SEGA A grid. Bivariate analysis revealed a greater frailty according to the Fried criteria in the inactive than in the active patients (mean for active patients 0.56 IC95 [0.31; 0.80], compared to 1.76 [1.21; 2.32] in the inactive patients, p<0.0001). The difference in mean was likewise significant regarding the SEGA A score (6.42 IC95 [5.34, 7.49] in the active population, as opposed to 8.65 IC95 [7.15, 10.15] among the inactive, p=0.017). In multivariate analysis, the Fried scale was primarily influenced by age and ADL, while the SEGA score was impacted by female gender and level of physical activity. CONCLUSION: Physical activity seems to have a positive effect on frailty. It would be interesting to propose systematic screening for frailty in general medicine and to institute preventive measures, including physical activity. Initiatives encouraging and promoting seniors' physical activity should be strengthened.

[Frailty syndrome : a major concept in the prevention of geriatric syndromes]. / Syndrome de fragilité : concept majeur dans la prévention des syndromes gériatriques.

The frailty syndrome is a dynamic and evolving geriatric concept, involving many dimensions of everyday life and leading to a risk of developing a loss of daily life and autonomy. Although there is no consensual definition, the consequences remain major : risk of functional decompensation, multiplication of hospitalizations, dependence in the activities of the daily life, institutionalization and increase of the mortality.

La fragilité de la personne âgée est un concept gériatrique dynamique et évolutif, impliquant de nombreuses dimensions de la vie courante et entraînant un risque de développer une perte d'autonomie. Bien qu'il n'y ait pas de définition consensuelle, les conséquences restent majeures : risque de décompensation fonctionnelle, multiplication des hospitalisations, dépendance dans les actes de la vie quotidienne, institutionnalisation et hausse de la mortalité.

[Physical activity among seniors : what benefits on geriatric criteria ?] / Activité physique chez les seniors : quels impacts sur les critères gériatriques ?

The elderly population is growing in our societies. Prevention policies are strongly supported by public authorities and one of them is the promotion of physical activity. We propose to detail, through a literature review, the impact of physical activity on the main geriatric criteria.

La population âgée est en augmentation croissante dans nos sociétés. Les politiques de prévention sont fortement soutenues par les pouvoirs publics et l'une d'entre elles est la promotion de l'activité physique. Nous détaillons, au travers d'une revue de littérature, l'impact de l'activité physique sur les principaux critères gériatriques.

[Spinalcord compression secondary to metastases from a non-previous diagnosed thyroid cancer]. / L'image du mois. Compression médullaire liée à une métastase d'un cancer thyroïdien préalablement non diagnostiqué.

We presented a case of a 73-year-old woman presenting to the emergency department with a spinal cord compression secondary to a T2 mass lesion and needing emergency surgery. The lesion was consistent with a papillary thyroid carcinoma. The patient had a previous history of thyroidectomy in a setting of a multinodular goiter 6 years before. A rereading of the previous anatomopathological thyroid tissue confirmed the presence of a papillary thyroid carcinoma that was initially misdiagnosed.

Nous présentons le cas clinique d'une femme âgée de 73 ans se présentant au service des Urgences avec une compression de la moelle épinière secondaire à une lésion de masse au niveau de la vertèbre T2 et nécessitant une intervention chirurgicale d'urgence. La lésion est compatible avec un carcinome papillaire de la thyroïde. La patiente avait bénéficié d'une thyroïdectomie dans un contexte de goitre multinodulaire 6 ans auparavant. Une relecture de la pièce anatomopathologique confirme la présence d'un carcinome papillaire de la thyroïde non diagnostiqué au départ.

[Feasibility of assessing frailty in general medicine patients aged over 65]. / Faisabilité de l'évaluation de la fragilité chez les patients de 65 ans et plus en médecine générale.

INTRODUCTION: Frailty is a complex concept that can be assessed with multiple instruments. Its assessment has often been implemented in hospitals. However, first-line prevention of the frailty syndrome is paramount in general medicine. The aim of the study was to test the feasibility and the concordance of two instruments for assessing frailty and to test the adequacy between the level of frailty and the presence of caregivers. METHODS: We conducted a descriptive, analytical cross-sectional study in Reims during two months. Patients included were 65 and older. Second consultations were not retained. We collected the patients' the SEGA and Fried scores as well as the opinions of the doctor and the resident student on the presence of frailty and the presence or not of home-help. RESULTS: There was an excellent concurrence between the doctor's assessment and the SEGA score (Kappa=0.89) and a moderate concurrence with the Fried score (Kappa=0.46) compared to 0.95 and 0.50 respectively for the resident student's assessment. The agreement between the assessments of the resident student and the doctor was excellent (Kappa=0.95) the concurrence between frailty and the home-helpers showed that when patients displayed frailty symptoms home-helpers were absent in 69.6% of the cases, but planned in 82.6%. CONCLUSION: To conclude, in general medicine, there is no reference score for fraily assessment, whereas the SEGA score is easy to use and reproducible. It can be used as a score of reference for patient assessment and monitoring.

[Clinical semiology of anemia in patients over 75 years: a prospective study conducted in France by the SiFMI group]. / Sémiologie clinique de l'anémie chez des patients âgés de plus de 75 ans : une étude prospective menée en France par le groupe SiFMI.

INTRODUCTION: Anemia remains one of the main concerns of the day-today life of Internist since it ranks third among the pathologies seen in Internal Medicine Departments. OBJECTIVE: it seemed appropriate for the SiFMI Group (Common Situations in Internal Medicine of the SNFMI) to carry out a study of anemia evaluating the contribution to the diagnosis of the «classical¼ semiology of the anemic syndrome. This work reports the results from the study of 204 patients aged 75 years and more. METHOD: A prospective, non interventional multicenter study was carried out in Internal and Geriatric Departments in the period September 2015-September 2017. Clinical and biological variables were collected. RESULTS: 204 patients from 10 Internal or Geriatric Departments were included in the period September 2015-September 2017. They were assigned into two groups with and without anemia. According to this study, it seems that the following parameters : asthenia, dyspnea (NYHA stages III and IV), palpitations, chest pain, tachycardia, hypotension as well as confusion, falls, depression and MMSE showed no significant statistical difference between both groups in contrast to pallor, edema, albumin and ECG. CONCLUSION: Clinical diagnosis of anemia in elderly individuals remains a challenge. It is difficult to establish a diagnostic protocol in this population.

INTRODUCTION: L'anémie reste une des préoccupations majeures du quotidien de l'Interniste, puisque classée troisième parmi les pathologies prises en charge dans les services de Médecine Interne. Objectif : Il a semblé? opportun au Groupe SiFMI (Situations Fréquentes en Médecine Interne de la Société Nationale Française de Médecine Interne - SNFMI) de s'attacher à l'étude des anémies au travers de l'apport au diagnostic de la sémiologie «classique¼ du syndrome anémique. Méthode : Etude prospective, non interventionnelle, multicentrique, menée de septembre 2015 à septembre 2017, dans des services de Médecine Interne et de Gériatrie. Des données cliniques et biologiques ont été recueillies. Résultats : 204 patients ont été inclus par 10 services de Médecine Interne et de Gériatrie de septembre 2015 à septembre 2017. Ils ont été répartis en deux groupes, avec et sans anémie. Dans ce travail, il apparaît que les différents paramètres suivants : asthénie, dyspnée de stades III et IV de la NYHA, palpitations, douleur thoracique, tachycardie, hypotension, mais également confusion, chute, dépression et MMSE, sont sans différence notable sur le plan statistique entre les deux groupes, à l'exception de la pâleur cutanéomuqueuse, des œdèmes des membres inférieurs, du taux d'albuminémie et de l'ECG. CONCLUSION: Le diagnostic clinique de l'anémie au sein d'une population de sujets âgés s'avère être un vrai défi. Il reste difficile d'établir une démarche diagnostique standardisée au sein de cette population.

[Thyroid abscess due to Salmonella enteritidis in an immunocompetent patient]. / Le cas clinique du mois. Abcès thyroïdien à Salmonella enteritidis chez un patient immunocompétent.

The thyroid gland is usually resistant to infections due to its anatomy. However, suppurative thyroiditis could be found in immunocompromised patients or those with previous thyroid diseases. We report a case of thyroid abscess secondary to Salmonella enteritidis infection in an immunocompetent patient. We were not able to establish the source of infection. Clinical improvement was achieved under antibiotic treatment without complications. Early diagnosis is important as thyroid abcess may be a life threatening condition.

La thyroïde est une glande endocrine généralement résistante aux infections en raison de sa localisation et présentation anatomique. Cependant, une thyroïdite suppurée est susceptible de survenir chez des patients immunodéprimés ou ayant déjà présenté un dysfonctionnement thyroïdien. Nous rapportons un cas d'abcès thyroïdien consécutif à une infection à Salmonella enteritidis chez un patient immunocompétent. Nous n'avons pas pu établir la source de l'infection. Une amélioration clinique a été obtenue sous traitement antibiotique sans complications. Un diagnostic précoce est essentiel afin d'éviter toutes complications graves mettant en jeu le pronostic vital.

[Screening of frailty in the Emergency Unit : myth or reality ?] / Evaluation de la fragilité du sujet âgé au service des Urgences : mythe ou réalité ?

At present, it is recognized that screening for frailty in the elderly is a major public health issue. Frailty screening in emergency unit is essential to optimize the management of elderly patients in hospital. Ideally, the role of a mobile geriatric team seems essential, taking over the frailty screening carried out in the emergency department, in order to optimize intra-hospital management and consequently reduce further intra-hospital visits and possible risks of decompensation of geriatric syndromes.

A l'heure actuelle, il est acquis que le dépistage de la fragilité chez le sujet âgé est un enjeu majeur de santé publique. Le dépistage de la fragilité dès l'admission au service des Urgences est indispensable afin d'optimiser la prise en charge du sujet âgé en milieu hospitalier. Idéalement, le rôle d'une équipe mobile de gériatrie (EMG) nous paraît essentiel, prenant le relais du dépistage de la fragilité réalisé aux Urgences (Infirmière d'Accueil/Urgentistes). Cette approche permettrait d'optimiser au mieux la prise en charge intra-hospitalière du patient et de réduire, en conséquence, son passage intra-hospitalier et d'éventuels risques de décompensation de syndromes gériatriques.

[Screening of frailty in family practice by the modified SEGA grid]. / Evaluation de la fragilité du sujet âgé en cabinet de médecine générale par la grille SEGA modifiée.

The objective of this study was to evaluate frailty by the use of the modified SEGA grid in a population aged 75 years and older. This cross-sectional study was carried out in Marne (Champagne Ardenne), including subjects aged 75 years or more, who can go to medical general practitioners consultation. Frailty was assessed by the modified SEGA tool. In total between May 02, 2016 and May 08, 2017, 64 patients were included, aged 80 years ± 3.87, with a majority of women (58 %). The mean frailty score was 6.3 ± 3.6, with an average time of 3 minutes 55 seconds ± 1.13. The SEGAm grid had a good discriminating capacity for age (p = 0.041), comorbidities (p = 0.016), MMS (p = 0.011), presence of home helpers (p = 2.9e-05). There was also good agreement between the obtained SEGAm score and the subjective opinion of the general practitioners with a Cohen Kappa score of 0.66. The modified SEGA grid proves to be a good tool for frailty screening for the general practitioners, allowing preventive strategies and a personalized care project to be set up for each patient.

L'objectif de cette étude était d'évaluer la fragilité par la grille SEGA («Short Emergency Geriatric Assessment¼) modifiée sur une population de sujets âgés de 75 ans ou plus. Etude transversale réalisée dans la Marne (Champagne Ardenne), incluant des sujets âgés de 75 ans ou plus, pouvant se rendre en consultation. La fragilité a été évaluée par l'outil SEGA modifiée. Entre le 02 mai 2016 et le 08 mai 2017, 64 patients ont été inclus, âgés en moyenne de 80 ans ± 3,87, avec une majorité de femmes (58 %). Le score moyen de fragilité était de 6,3 ± 3,6, avec un temps moyen de réalisation de 3 minutes 55 secondes ± 1,13. La grille SEGAm avait une bonne capacité discriminante pour l'âge (p = 0,041), le niveau de comorbidités (p = 0,016), le MMS («Mini Mental State¼) (p = 0,011), la présence d'aides à domicile (p = 2,9e - 05). Il y avait également une bonne concordance entre le score SEGAm obtenu et l'avis subjectif du médecin traitant, avec un score Kappa de Cohen à 0,66. La grille SEGA modifiée se révèle être un bon outil de dépistage de la fragilité pour le médecin généraliste, permettant de mettre en place des stratégies préventives et un projet de soin personnalisé.

[Rheumatoid arthritis and cardiovascular risk factor : literature review]. / Polyarthrite rhumatoïde et facteur de risque cardiovasculaire. Revue de littérature.

The rheumatoid arthritis remains a common condition and constitutes a diagnostic and therapeutic challenge, especially in the elderly. Rheumatoid arthritis is known to be associated with increased mortality, including coronary and cerebrovascular atherosclerosis. A literature review is conducted on the role of rheumatoid arthritis as a cardiovascular risk factor.

La polyarthrite rhumatoïde demeure une affection courante et constitue un défi diagnostique et thérapeutique, notamment chez le sujet âgé. Il est établi que la polyarthrite rhumatoïde est associée à une augmentation de la mortalité, notamment par athérosclérose coronaire et cérébrovasculaire. Une revue de littérature est réalisée sur le rôle de la polyarthrite rhumatoïde comme facteur de risque cardiovasculaire.

[Retrospective study of the assessment and management of benzodiazepine withdrawal syndrome in hospital between 2000 and 2015]. / Étude rétrospective de l'évaluation et de la prise en charge du syndrome de sevrage brutal en benzodiazépine en milieu hospitalier entre 2000 et 2015.

INTRODUCTION: Benzodiazepines are prescribed in many indications and are provider of adverse effects in case of abrupt withdrawal or poorly framed. Withdrawal rules are established by the High Authority for Health. METHODS: To evaluate the diagnostic and therapeutic modalities of the benzodiazepine withdrawal syndrome, we performed a retrospective single-center study at the University Hospital of Reims, between January 2000 and May 2015, in patients with a withdrawal syndrome following hospital coding. A collection of clinical and laboratory data was performed for each patient, as well as how to obtain the diagnosis, their care and their future. RESULTS: Sixty-eight cases were initially collected, but 16 cases were included. In benzodiazepine withdrawal took place outside the hospital in 68% of cases. The causes were varied: lack of renewal, not issued by the pharmacist, pill errors. Disorders found during the withdrawal symptoms were variable, there were particular digestive, neurological and psychiatric disorders. The use of biological assessments did not provide diagnostic support, however, in 68% of cases a toxicological assay has helped to support. The management of the withdrawal syndrome has been done primarily by reintroducing the same treatment (60%), while in 27% of alprazolam is introduced relay benzodiazepines. It is noted one death possibly linked to the withdrawal syndrome. CONCLUSION: Despite recommendations and information about the terms of stops, some clinical situations result in withdrawal symptoms, a patient died in our study, death appears in connection with the withdrawal situation. Note that the human factor is the main factor related to the circumstances of occurrence of withdrawal.

Evolution in geriatric syndromes and association with survival over 5 years in the GERODIAB cohort of older French diabetic patients.

PURPOSE: Although one in three patients with diabetes in Western countries is over 70 years-old, geriatric syndromes and their relationship with survival remain seldom studied. The present aim of the GERODIAB study was to examine the evolution of geriatric disorders and their relationship with survival in older type 2 patients with diabetes with initial sufficient autonomy. METHODS: We performed a prospective, observational study over 5 years in patients with diabetes aged 70 years or above. A total of 987 consecutive type 2 patients with diabetes (mean age 77 years, range 70-94 years, 65.2% were 75 years and above, 52.1% women) were included from 56 French diabetic centres. Individual characteristics, diabetes parameters and geriatric parameters (autonomy, nutrition, cognitive alteration, depression, orthostatic hypotension, falls) were annually recorded. Survival was analysed using the Kaplan-Meier method and proportional hazards regression models. RESULTS: Institutional living, impaired activity and difficulties in instrumental daily activity, cognitive disorders, malnutrition, depression, orthostatic hypotension and hypoglycaemia strongly increased during the follow-up. Institutional living, impaired activity and difficulties in instrumental daily activity, cognitive disorders and hypoglycaemia were strongly associated with reduced survival, but not falls. In hazard ratio models, living in an institution (HR = 2.39; CI = 1.77-3.24; p < 0.0001) and impaired Activity of Daily Living scale score were the most significant and independent predictors of death (HR = 1.59; CI = 1.19-2.13; p = 0.0016), associated with HbA1c ≥ 70 mmol/mol (HR = 1.62; CI = 1.12-2.36; p = 0.011). CONCLUSION: Our findings show the considerable alteration of geriatric parameters and their relationship with decreased survival after a 5-year follow-up in type 2 patients with diabetes, independent of HbA1c and age. They, therefore, confirm the prognostic interest of using yearly geriatric markers in older diabetic patient management, especially the ADL, IADL and MMSE scales. Taking into account these prognostic parameters should contribute to target appropriate HbA1c goals. TRIAL REGISTRATION: Registered at clinicaltrials.gov (21/01/2011): NCT01282060.

State of the art review: oral and nasal vitamin B12 therapy in the elderly.

The objective of this narrative review was to provide an update on oral and nasal vitamin B12 (cobalamin) therapy in elderly patients. Relevant articles were identified by 'PubMed' and 'Scholar Google' search from January 2010 to July 2018 and through hand search of relevant reference articles. Additional studies were obtained from references of identified studies, the 'Cochrane Library' and the 'ISI Web of Knowledge'. Data retrieved from international meetings were also used, as was information retrieved from commercial sites on the web and data from 'CARE B12' research group. For oral vitamin B12 therapy, four prospective randomized controlled trials, eight prospective studies, one systematic and four reviews fulfilled our inclusion criteria. The studies included mainly or exclusively elderly patients (≥65-year-olds). In all of the studies, the mean age of the patients was at least 70 years except for two. The present review documents that oral vitamin B12 replacement at 1000 µg daily proved adequate to cure vitamin B12 deficiency, with a good safety profile. The efficacy was particularly marked when considering the noticeable improvement in serum vitamin B12 levels and haematological parameters, such as haemoglobin level, mean erythrocyte cell volume and reticulocyte count. The effect of oral cobalamin treatment in patients presenting with severe neurological manifestations has not yet been adequately documented. For nasal vitamin B12, only a few preliminary studies were available. We conclude that oral vitamin B12 is an effective alternative to intramuscular vitamin B12 injections in elderly patients. Oral vitamin B12 treatment avoids the discomfort, inconvenience and cost of monthly injections.

[The sleep apnoea syndrome: Clinical characteristics of affected patients in the hospital population of Château-Thierry]. / Syndrome d'apnées du sommeil : caractéristiques cliniques des patients atteints dans la population hospitalière de Château-Thierry.

INTRODUCTION: The sleep apnoea syndrome (SAS) is a public health problem particularly due to its involvement in cardiovascular and metabolic disorders. The aim of this study was to investigate the epidemiological characteristics of the affected population in order to facilitate screening for SAS. MATERIALS AND METHODS: The study was retrospective, monocentric and observational. It was undertaken at the Château-Thierry hospital from 01/01/2010 to 31/12/2014. Several epidemiological parameters were collected. Two groups were created according to the apnoea/hypopnoea index (AHI) and compared with the R software. RESULTS: In all, 629 patients were included and separated into two groups with a division at an AHI limit of 15/h: 425 sick patients (AHI>15/h) and 204 healthy (AHI<15/h). Differences in sex were observed (more sick men, P<0.05), of age (sick patients were older P<0.001), obesity (sick patients were on average 5kg heavier, P<0.05) and of cardiovascular history (hypertension P<0.05, coronary disease P<0.05 and arhythmic heart disease P<0.05). We found no difference using the Epworth scale, nor in benzodiazepine consumption or the presence of dementia. CONCLUSION: This study highlights several risk factors for sleep apnoea in this population but also shows that the Epworth scale is not a good screening tool.

Telemedicine and Cardiology in the Elderly in France: Inventory of Experiments.

Telemedicine is now in vogue, allowing through computer and communication tools to be deployed in the field of health, such as cardiology, area in which it has shown interest, in international studies. As the population ages, older people are increasingly concerned with this innovative practice. We take a look at telemedicine projects in France concerning the elderly, in the field of cardiology.

Telemedicine and Geriatrics in France: Inventory of Experiments.

Telemedicine is now in vogue, being deployed through computer and communication tools in various health fields, such as diabetology, nephrology, dermatology, neurology, and cardiology. With population ageing, geriatrics is coming into sharp focus. Telemedicine practices differ for home-based or institutionalized patients in long-term care homes. We take a look at telemedicine projects in France concerning the elderly.

Association pernicious anemia and autoimmune polyendocrinopathy: a retrospective study.

OBJECTIVE: To investigate the association between pernicious anemia and other autoimmune diseases. METHODS: This retrospective and bicentric study was conducted at Reims and Strasbourg University Hospitals and involved 188 patients with pernicious anemia examined between 2000 and 2010 in order to search for other autoimmune diseases and to evaluate the role of pernicious anemia in autoimmune polyglandular syndrome. RESULTS: A total of 74 patients with a combination of pernicious anemia and other autoimmune diseases were included in the study. Our study revealed the privileged association of pernicious anemia with autoimmune thyroiditis. The association of pernicious anemia and autoimmune thyroiditis are a part of the autoimmune polyglandular syndrome type 3b. CONCLUSION: We suggest undertaking a systematic clinical examination and laboratory investigations in search of autoimmune thyroiditis in patient(s) with the diagnosis of pernicious anemia. The association of pernicious anemia and autoimmune thyroiditis is frequent and a part of autoimmune polyglandular 3b.