Therapeutic education for cardiac failure patients: the I-care programme

Therapeutic education is becoming increasingly important in the management of chronic diseases including cardiac failure. The I-CARE programme consists of an evaluation of the role of therapeutic education in France, creating standardised tools and setting up training sessions for therapeutic education in the context of cardiac failure. Approximately two thirds of the French centres contacted perform therapeutic education with their available means. The lack of personnel, space, and training tools represent obstacles to the development of therapeutic education. The tools developed in the programme fall into 5 areas: diagnosis education, understanding the illness, diet, physical activity/daily life, and treatment. Training sessions were organised for the teams, consisting of at least one cardiologist and nurse. The I-CARE programme should allow the expansion of therapeutic education for cardiac failure and improve the multidisciplinary management of this disease which increasingly affects often elderly subjects.     

Pulmonary mucormycoses (author's transl)]

Mucormycoses are rare, acute infections, most often fatal, occurring usually in a host with decreased immunity. The agents are ubiquitous fungi belonging to the Mucoraceae family, an ordinary saprophyte becoming pathogenous in patients with a severe disease (malignant hemopathy, diabetes) or treated by immunosuppressive drugs. Pulmonary localizations remained exceptional (128 cases found in the literature). The observations reported draws its originality from: -- the etiological circumstances: an aged patient with no hemopathy or diabetes, without immunosuppressive treatment but undergoing a prolonged antibiotic therapy; -- the clinical signs: discovery on X-ray of excavated infiltrates in a background of a severe infection with a very poor physical condition; -- the diagnosis criteria with the demonstration of the responsible mucor in the sputum, the endobronchial aspiration and transparietal puncture; -- the great efficiency of Amphotericin B at rather small doses. A review of the literature underlines the exceptional character of the cure.     

Acceptability of Elderly Cancer Patients and Tolerance to COVID-19 Vaccination in the Brittany Region<br/>L’acceptabilité du Patient Âgé Porteur de Cancer et la Tolérance à la Vaccination Anti-COVID-19 dans la Région Bretagne

Context: Since January 2021, vaccination for COVID-19 has been made possible in France for people aged 75 and over. Patients suffering from a cancer disease are part of a group at risk to develop severe complications to COVID-19. Method: The « Unité de coordination en Onco-Gériatrie région Bretagne » (the Brittany This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Coordinating Unit in Onco-Geriatrics) has wished to set up an inquest about the acceptability and the tolerance to COVID-19 vaccination by old-aged patients suffering from cancer in the Brittany region. Results: The study has been carried out between May 1, 2021 and August 31, 2021 in 7 Breton centers. 50 patients have been included in the study with an average age of 84 (72-93). At the time of inclusion, 43 patients had already been vaccinated (80% having had 2 injections and 8% only one). Among them, 86% have declared they had had a very good tolerance to the first injection of the vaccine, and 90% to the second injection. 12% of the patients had not been vaccinated. Conclusion: Overall, in our study, old-aged patients suffering from cancer haven’t been reluctant to the antiCOVID-19 vaccination and have shown a very good tolerance to these vaccines. However, seen the profile of these patients and the period of inclusion, the number of patients showing a complete vaccinal outline should have been more consistent, indeed even total.

RÉSUMÉ
Contexte: Depuis le 25 janvier 2021, la vaccination de la COVID-19 a pu être réalisée en France auprès des personnes âgées de 75 ans et plus. Les patients souffrant d’une maladie cancéreuse font partie des groupes à risque de développer des complications sévères à la COVID-19. Méthode: L’Unité de Coordination en Onco-Gériatrie région Bretagne a souhaité mettre en place une enquête sur l’acceptabilité du patient âgé porteur de cancer et sur la tolérance à la vaccination anti-COVID 19 dans la région Bretagne. Résultats: L’étude a été réalisée entre le 1^er mai 2021 et le 31 août 2021 dans 7 centres bretons. 50 patients ont été inclus avec un âge médian de 84 ans (72–93). 43 patients au moment de l’inclusion avaient été vaccinés (80% ayant eu 2 injections et 8% une seule injection). Parmi eux, 86% ont déclaré avoir eu une très bonne tolérance à la première injection du vaccin et 90 % à la seconde injection. 12% des patients n’étaient pas vaccinés. Conclusion: Globalement, dans notre étude, les patients âgés porteurs de cancer ne présentaient pas de réticence à lavaccination anti-COVID19 et ont eu une très bonne tolérance à ces vaccins. Cependant, au vu du profil de ces patients et de la période d’inclusion, le nombre de patients présentant un schéma vaccinal complet aurait pu être plus conséquent.     

Bolus of methylprednisolone and Horton's disease/rhizomelic pseudo-polyarthritis. Preliminary results of a pilot study of treating the bolus with low doses of corticoids]

The aim of this study was to reduce the side effects of corticosteroid therapy responsible for high morbidity in giant cell arteritis. Nine patients were admitted consecutively for temporal arteritis (7 cases) or polymyalgia rheumatica (2 cases) without ocular involvement (mean age: 69.3 years; positive temporal biopsy: 6 cases). The following protocol was used: methylprednisolone, 500 mg/d, i.v., for 3 consecutive days, then low doses (an average of 22.5 mg/d) of prednisone or an equivalent drug. The mean length of follow-up was 15.1 months (range: 6-22 months). The mean lapse of time until the erythrocyte sedimentation rate returned to normal was 10.6 days (range: 3-30 days). The mean dose of prednisone or an equivalent drug at 6 months was 13 mg/d (range: 5-22.5 mg/d). One patient was cured after 17 months of treatment. Another suffered a biological relapse after 13 months of treatment. All the other patients were asymptomatic with no biological signs of an inflammatory syndrome. The complications included: electrocardiogram modifications without necrosis during pulse therapy in 1 woman; unstable angina developed 2 months after the onset of treatment in 1 man; recurrent urinary infections in 1 predisposed male patient. No bone or metabolic side effects have been noted to date. We think that 3 days of intensive intravenous corticotherapy followed by low doses of cortico?ds per os constitute an effective and well-tolerated regimen. Additional studies including comparison with conventional treatments should be carried out to confirm these results and, even better, to evaluate the long-term benefits of this protocol in terms of side effects.     

Activités enzymatiques d'oxydation dans la rétine normale et dans des rétines atteintes d'une dégénérescence héréditaire du neuro-épithelium. Recherches histochimiques chez la souris

Résumé Les auteurs ont effectué une étude histochimique comparée du développement de quelques activités enzymatiques d'oxydation dans les couches externes de la rétine, chez la Souris normale et chez des souris atteintes d'une dégénérescence héréditaire du neuro-épithélium rétinien. Il ne semble pas que l'on puisse attribuer la dégénérescence élective des cellules visuelles observée chez les souris rd à une déficience précoce de l'une ou de l'autre des activités enzymatiques d'oxydation prises en considération.

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Summary The histo-chemical examination of some oxydative enzymes in eyes of mice with a heredo-degeneration of the retinal neuro-epithelium did not indicate that a defect in these enzymes is the cause of this degeneration.

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Zusammenfassung Die sich entwickelnde Aktivität einiger oxydativer Fermente in den äußeren Netzhautschichten der normalen Maus sowie der von Heredo-degeneration des retinalen Neuro-epithels befallenen Maus, wurde einer vergleichenden histochemischen Untersuchung unterzogen. Die experimentellen Ergebnisse erlauben es nicht, die bei den rd Mäusen auftretende selektive Degeneration der Sehzellen einem frühzeitigen Abfallen dieser oder jener der untersuchten Ferment-aktivitäten zuzuschreiben.

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Institut de Biologie Médicale, Faculté de Médecine, Strasbourg.     

Hospital admissions related to influenza in France during the 2006/2007 epidemic

BackgroundThe data available on hospital admissions related to influenza mostly concern in-patients admitted via the emergency department. Severe cases have been collated by intensive care practitioners since 2009. For this survey, we searched French hospital admission databases to estimate the prevalence rate of hospital admissions related to influenza and to record qualitative data.MethodAll case studies identified between October 2006 and September 2007 were split into two groups: the first displaying symptoms of clinical influenza and the second suffering from influenza as an associated diagnosis.ResultsWe collected 6797 hospital admissions, 2126 of which were closely related to clinical influenza. Fifty percent of cases concerned the elderly and young people. Fifty-six hospital deaths were recorded in which influenza was the underlying cause in 21% of the cases (12). When influenza was an associated diagnosis (44/56), cardiovascular or respiratory diseases were the main causes (26/44).ConclusionDuring the same period (2006–2007), the French Sentinel Surveillance identified only 105 hospital admissions related to influenza. Our survey was therefore more exhaustive and was able to record qualitative data. Inclusion of hospital admissions with an associated diagnosis of influenza is debatable because this decreases specificity. The relationship between the principal diagnosis and all the associated diagnoses is difficult to study, although exclusion of this type of hospitalization could significantly underestimate these figures. Despite certain limitations, French hospital admissions databases should complement French Sentinel Surveillance data.