Mise au point sur la rédaction des certificats médicaux et médico-légaux

Le certificat médical est l'attestation écrite des constatations cliniques et paracliniques d'un patient. Sa rédaction doit suivre des règles de prudence et d'objectivité permettant la réponse à l'objet qui a motivé sa demande. Tandis que le certificat médical ordinaire est établi à la demande du patient pour l'obtention d'avantages sociaux ou administratifs, le certificat médico-légal est quant à lui établi à la demande du patient, de l'officier de police judiciaire ou du juge, dans un objectif judiciaire. C'est un document essentiel dans les procédures consécutives à des coups ; blessures. Il doit être écrit avec précision et détails, et indiquer en conclusion la durée de l'incapacité totale de travail (ITT), laquelle, exprimée en nombre de jours permettra au juge de qualifier les dommages corporels. Cette mise au point a donc pour objectifs de rappeler les principales règles de rédaction des certificats médicaux et médico-légaux, et de proposer à titre indicatif des ITT pouvant orienter l'évaluation du médecin

Satisfaction des patients amputés du membre inferieur porteurs de prothèses externes

Objectif . Décrire la satisfaction globale des patients amputés du membre inferieur porteurs de prothèses externes à Yaoundé. Méthodologie. Une étude transversale descriptive a été menée au Centre National de Réhabilitation des Personnes Handicapées-Cardinal Paul Émile Leger et au Centre Jamot de Yaoundé sur une période allant du 7 novembre 2016 au 29 mars 2017. Seuls ceux âgés de plus de 5 ans étaient inclus. Les paramètres de la satisfaction physique étaient : autonomie, mobilité, poids de la prothèse , douleur du moignon, plaie du moignon, facilité du port, facilité de l'entretien , dimensions ,apparence et coût alors que les paramètres de la satisfaction sociale étaient : acceptation par la famille, vie sexuelle , réintégration au travail ou à l'école et acceptation par l'entourage. Résultats. Il a été recruté 77 patients (sex-ratio H/F de 2.85 et moyenne d'âge de 46,02 ans). La prévalence était de 39,44%. L'étiologie principale était traumatique et l'amputation trans-tibiale le siège le plus retrouvé, suivi de l'amputation trans-fémorale. . De manière globale, 75,3% des patients appareillés se disaient satisfaits, et 24.7% des patients appareillés étaient insatisfaits. 39% des patients appareillés étaient physiquement insatisfaits et 11% très insatisfaits. Le taux d'insatisfaction était lié au poids, aux contraintes liées au déplacement, aux douleurs et plaies générées par le port de la prothèse, à l'apparence et au prix élevé. Psychologiquement, 26% des patients étaient insatisfaits et jusqu'à 17% très insatisfaits. L'insatisfaction ici était liée à une faible estime de soi malgré l'appareillage et une faible acceptation de la prothèse. Socialement, près de 17% étaient insatisfaits. La prothèse a favorisé une meilleure acceptation familiale et amicale du handicap. Elle a favorisé un retour aux activités courantes, bien que certains aient signalé des problèmes conjugaux et d'autres une perte d'emploi Conclusion. Si la plupart des patients amputés du membre inférieur appareillés sont globalement satisfaits, la satisfaction vis-à-vis de leur prothèse peut encore être améliorée notamment en matière d'apparence, de poids, des contraintes liées au déplacement, de prix, et de qualité de la prothèse

The Link Between Hyperhomocysteinemia and Hypomethylation: Implications for Cardiovascular Disease

Abstract Increased levels of homocysteine have been established as a risk factor for cardiovascular disease (CVD) by mechanisms still incompletely defined. S-Adenosylhomocysteine (SAH) is the metabolic precursor of homocysteine that accumulates in the setting of hyperhomocysteinemia and is a negative regulator of most cell methyltransferases. Several observations, summarized in the current review, support the concept that SAH, rather than homocysteine, may be the culprit in the CVD risk that has been associated with hyperhomocysteinemia. This review examines the biosynthesis and catabolism of homocysteine and how these pathways regulate accumulation of SAH. In addition, the epidemiological and experimental links between hyperhomocysteinemia and CVD are discussed, along with the evidence suggesting a role for SAH in the disease. Finally, the effects of SAH on the hypomethylation of DNA, RNA, and protein are examined, with an emphasis on how specific molecular targets may be mediators of homocysteine-associated vascular disease.

Large Atrial Septal Defect Closure in a Patient with Severe Pulmonary Arterial Hypertension

Patients with an atrial septal defect (ASD) and severe pulmonary arterial hypertension (PAH) are considered ineligible for defect closure surgery because of the risk of right ventricular decompensation and death after the operation. We report the case of a patient with large ASD and severe PAH who was able to undergo defect closure surgery successfully following long-term use of combined oral sildenafil and beraprost.

Large Atrial Septal Defect Closure in a Patient with Severe Pulmonary Arterial Hypertension

Patients with an atrial septal defect (ASD) and severe pulmonary arterial hypertension (PAH) are considered ineligible for defect closure surgery because of the risk of right ventricular decompensation and death after the operation. We report the case of a patient with large ASD and severe PAH who was able to undergo defect closure surgery successfully following long-term use of combined oral sildenafil and beraprost.

It's Not Easy Being Blue-Green

No abstract available.

Effects of hypothyroidism and hyperthyroidism on insulin-like growth factors and IGF-binding proteins

Normal thyroid status is a prerequisite for the normal growth and development of many tissues. The interrelationships between the thyroid and pituitary-GH-insulin-like growth factor [IGF] axes are complex and not yet fully understood. Subjects and Method: We have studied the effects of hyperthyroidism [n = 22, aged 33.14 +/- 5.41 years] and hypothyroidism [n = 22, clinical = 10 and subclinical = 12, aged 34.5 +/- 5.26 years] on levels of serum immunoreactive [IR] IGF-I and IGF-binding protein 3 [IGFBP-3] measured by IRMA kit. Twenty persons were also included as a normal control group. Eight hyperthyroid and 8 hypothyroid patients were followed up 3 months after specific treatment. The mean IGF-I and IGFBP-3 Z-values were not significantly higher in hyperthyroid patients [-0.40 +/- 0.90 and 2 -0.53 +/- 0.72 respectively] than in the control group [-1.07 +/- 1.05 and -0.99 +/- 0.63 respectively] but they were significantly higher than clinical hypothyroid cases [-1.92 +/- 0.62 and -1.50 +/- 0.76respectively, p < 0.05]. After 3 months of Antithyroid therapy, TSH level increased to 0.01 +/- 0.02 micro IU/ml but is still significantly suppressed. There was significant lowering in their thyroid hormones levels [11.19 + 6.69 pg/ml to 3.l6 + 0.87 pg/ml for T3 and 3.90 +/- 1.62 ng/dl to 1.39 +/- 0.27 ng/dl for T4, p < 0.01]. This mean IGF-I Z-value was significantly lowered [-0.40 +/- 0.90 changed to -0.98 +/- 0.55, p < 0.05] under treatment but the lowered IGFBP-3 Z-value was not significant [-0.53 +/- 0.72 lowered to 0.73 +/- 0.88, p = 0.4]. In clinical cases of hypothyroidism, the mean serum IGF-1 Z value was significantly lower [-1.92 +/- 0.62] than the control group [-1.07 +/- 1.0, p = 0.03]. This difference is not significant in subclinical cases [-1.55 +/- 0.58]. After 3 months therapy in the clinical hypothyroid group, the serum TSH level dropped significantly from 25.94 +/- 22.82 to 16.40 +/- 12. l9micro IU/ml, p < 0.05. The rise of both IGFIZ-values and IGFBP-3 Z values under therapy with thyroxin were not significant [-1.92 +/- 0.62 rose to -1.10 +/- 0.97 for IGFI and -1.50 +/- 0.76 rose to -1.25 +/- 1.51 for IGFBP-3]. In all studied cases as well as in control subjects, serum fT4 and fT3 values were positively correlated [r = 0.627, p < 0.01] and serum TSH levels were inversely correlated [r = 0.312, p < 0.01] with circulating IGF-l concentrations. our data suggest that even subclinical alteration in thyroid functions correlated with IGF-1 concentrations. We have confirmed that IR IGF-I and IGFBP-3 level are low in hypothyroidism and high in hyperthyroidism reflecting a direct relationship between circulating levels of thyroid hormones and IGF-1. Their response to specific therapy suggests their possible use in monitoring the response to treatment in cases of thyroid dysfunction

Caracterización genómica de la cepa cubana de efecto citopático ligero / Genomic characterization of the Cuban strain of light cytopathic effect

Durante la epidemia de neuropatía ocurrida en Cuba en los años 1992/1994 se aislaron del líquido cefalorraquídeo de pacientes agentes virales relacionados antigénicamente con los virus Coxsackie. Para establecer una función de estos virus en la etiopatogenia de la enfermedad se seleccionaron las cepas 47/93 IPK identificada como Coxsackie A9 y la cepa 44/93 IPK de efecto citopático ligero (ECP-L) y se realizó un estudio de sus características antigénicas mediante Western Blot. Se comprobó la relación antigénica entre ambas cepas y se demostró la ausencia de proteínas estructurales en su forma nativa en los agentes de ECP-L. A partir de estos resultados se plantea la posibilidad de que la persistencia sea un mecanismo por el cual estos virus participen en la etiopatogenia de la neuropatía epidémica en Cuba

Proposition d'algorithmes de prise en charge de la tuberculose pour le Programme de Lutte contre la Tuberculose au Cameroun

La facon la plus fiable d'etablir le diagnostic de la tuberculose pulmonaire est de trouver des BK a l'examen microscopique direct d'un frottis de crachat. C'est une erreur majeure de diagnostiquer une tuberculose pulmonaire sur la radiographie et de ne pas examiner l'expectoration. La phase initiale du traitement doit se faire en hospitalisation. Les medicaments doivent etre pris sous la supervision directe d'un personnel de sante. La phase de continuation du traitement doit se faire sous surveillance au centre de sante le plus proche du malade

Deuses da administração: transformando organizações / Gods of management: transforming organizations

Usa quatro deuses da administração para simbolizar os diferentes modos de administrar, que podem ser distinguidos nas organizações. Enfatiza que a administração de organizações não é uma ciência exata, mas é muito mais um processo criativo e político, possuindo muito da cultura e tradição predominantes naquele momento e local. As organizações, como as tribos e famílias, têm as suas próprias maneiras de fazer as coisas, coisas que funcionam para elas e coisas que não funcionam. A interpretação desses aspectos tem que ser correta para ser eficiente. Embora as organizações sejam diferentes, há padrões que podem ser distinguidos, modelos a serem imitados e linhas de conduta que podem ser seguidas. Explica a teoria das culturas e como ela se aplica às organizações

Aleitamento materno e cancer de mama.Estudo caso-controle desenvolvido em Campinas - Sao Paulo. / Breast feeding and breast cancer. Case-control study carried out in Campinas - Sao Paulo

Foi avaliada a relacao entre cancer de mama e aleitamento materno em um estudo caso-controle de 174 mulheres com cancer de mama e 325 controles. As mulheres que amamentaram e aquelas que deram aleitamento exclusivo ate 12 meses, tiveram a metade do risco de apresentar cancer de mama do que as que nunca deram de mamar ou nunca deram aleitamento exclusivo. O risco de cancer de mama foi 0,4 nas mulheres com 1 a 12 meses de amenorreia por lactacao, diminuindo para 0,2 nas mulheres com 13 ou mais meses. Ao controlar pelo numero de ciclos menstruais ovulatorios, observou-se que as associacoes descritas acima desapareceram nas mulheres que haviam tido ate 299 ciclos; mantiveram-se, entretanto, no grupo das mulheres com 300 ou mais ciclos