Showing papers by "Georges Kaltenbach published in 2008"
TL;DR: About two thirds of nutrient-deficiency anemia is associated with iron deficiency and most of those cases are the result of chronic blood loss from gastrointestinal lesions, and the remaining cases are usually associated with vitamin B12.
68 citations
TL;DR: Cobalamin (vitamin B12) deficiency is particularly common in the elderly but is often unrecognized because its clinical manifestations are subtle; however, they are also potentially serious, particularly from a neuropsychiatric and hematological perspective.
Abstract: Cobalamin (vitamin B12) deficiency is particularly common in the elderly (>65 years of age) but is often unrecognized because its clinical manifestations are subtle; however, they are also potentially serious, particularly froma neuropsychiatric and hematological perspective. In the elderly, the main causes of cobalamin deficiency are pernicious anemia and food-cobalamin malabsorption. Food-cobalamin malabsorption syndrome is a disorder characterized by the inability to release cobalamin from food or its binding proteins. This syndrome is usually caused by atrophic gastritis, related or unrelated to Helicobacter pylori infection, and long-term ingestion of antacids and biguanides. Management of cobalamin deficiency with cobalamin injections is currently well documented but new routes of cobalamin administration (oral and nasal) are being studied, especially oral cobalamin therapy for food-cobalamin malabsorption.
20 citations
TL;DR: This review confirms the previously reported efficacy of oral cobalamin treatment in elderly patients and suggests a strategy in terms of the form (hydroxy- or cyanocobalamin), frequency and duration of the treatment.
Abstract: The objective of this review is to evaluate the usefulness of oral cobalamin (vitamin B12) treatment in elderly patients. PubMed was systematically searched for English and French articles published from January 1990 to January 2007. Prospective randomized studies (n=3), a systematic review by the Cochrane group (n=1) and prospective studies in a well defined population (n=5) provide evidence that oral cobalamin therapy may adequately treat cobalamin deficiency in elderly patients. However, the current literature does not suggest a strategy in terms of the form (hydroxy- or cyanocobalamin), frequency and duration of the treatment. This review confirms the previously reported efficacy of oral cobalamin treatment in elderly patients. Oral cobalamin treatment avoids the discomfort, inconvenience and cost of monthly injections.
15 citations
TL;DR: Only 31% of tests showed INR in the target range of 2 to 3, a rate lower than in other cohorts, which confirms the difficulty of controlling InR in anticoagulation therapy of elderly subjects.
Abstract: Summary Objectives The primary aim of this study was to analyze the quality of oral anticoagulation management in the real-life practice of hospital geriatric departments, in the absence of a formal dose-adjustment protocol. The secondary objective was to identify factors associated with international normalized ratios (INR) outside the target range. Methods This prospective study was conducted between November 2004 and August 2005 in our hospital's acute geriatric care and geriatric rehabilitation units. It included 110 subjects older than 65 years, all taking fluindione (target INR range of 2 to 3). Indications for oral anticoagulation were atrial fibrillation, venous thromboembolism, and pulmonary embolism. Patients were eligible for inclusion if they had at least 4 INR measurements, and we assessed a maximum of 20 such measures per patient. Results The study included 74 patients in the acute geriatric unit and 36 subjects in rehabilitation units (mean age: 85 years [65–97 years]), who had 1079 INR tests during the study period (mean per patient: 9.8 (±5.5)). Overall, 333 patients (31%) were in the target range of 2–3, 48% below 2, 21% above 3, and 3.6% above 5. The time interval between INR tests did not vary when INR was below 2, but we noted a nonsignificant trend towards a reduction in the average testing interval when INR was above 3 (p = 0.079). No bleeding or thrombotic complications were reported during the study. Of the 11 predefined variables, only cancer (history or current) was significantly associated with elevated INR. Conclusion This study confirms the difficulty of controlling INR in anticoagulation therapy of elderly subjects. Only 31% of tests showed INR in the target range of 2 to 3, a rate lower than in other cohorts. These results may be explained by the high rate of comorbidities in this very old study population.
14 citations
TL;DR: Nutritional deficiencies cause one third of the cases of anemia in the elderly, and iron, vitamin B12 and folate are the most common deficiencies, and their levels should be tested.
Abstract: Key points Nutritional deficiencies cause one third of the cases of anemia in the elderly.The urgency of anemia management in elderly patients depends on tolerance and repercussions, rather than only on the hemoglobin level.Iron, vitamin B12 and folate are the most common deficiencies, and their levels should be tested.Chronic gastrointestinal bleeding is the principal cause of iron-deficiency anemia.Management is based on supplementation combined with effective etiological treatment.
7 citations
TL;DR: The decline in third-generation cephalosporin susceptibility was accompanied by dwindling values for aminoglycoside susceptibility profiles: from 100% to between 91–92%.
6 citations
TL;DR: The act of sharing and exchanging a number of experiences resulted in the identification of synergies between these experiences on a continuum from "health promotion through physical activity and sports" to "prevention of doping", and professionals were able to develop activities in the aforementioned domains, which until now had remained isolated and marginal.
Abstract: Physical activity and exercise are recognized as one of the determinants of health. This study aims to produce a review of the logical foundations at work that support the identification of a public health problem for this determinant and how to address it through national action. The research is based on cross-analysis of data from semi-directed interviews and data extracted from documents on the development, implementation and follow-up of such actions and programmes. The study shows that fourteen national programmes were created and implemented by seven different agencies. These fourteen activities scored an average of 175 +/- 66.9 out of 300%. Actors and professionals in the field must be given more capacity to be implicated and involved while simultaneously encouraging the strengthening of relationships with their environment, in particular the institutional and organizational settings as well as the community components. In general, the structural and operational aspects of action are those which receive the most investment in such activities. Six main points arose as important: doping considered as a addictive mechanism, acknowledgement of the psychological suffering of professional athletes, youth at high risk of doping, and that the concepts of physical activity and sports should take into account a risk/ benefit analysis and the necessity to first and foremost promote health. The act of sharing and exchanging a number of experiences, at the local and regional level, resulted in the identification of synergies between these experiences on a continuum from "health promotion through physical activity and sports" to "prevention of doping". Within this framework, professionals were able to develop activities in the aforementioned domains, which until now had remained isolated and marginal. Recommendations were made to reinforce and strengthen this dynamic. Other determinants of health and public health priorities could be explored using the same methodology.
5 citations
5 citations
01 Jan 2008
TL;DR: Ces resultats montrent que le PTI semble severe chez le sujet âge, mais il n'existe pas de recommandation specifique pour la prise en charge therapeutique de ces patients.
Abstract: Objectif : Le purpura thrombopenique idiopathique (PTI) est une maladie souvent diagnostiquee chez le sujet âge, mais il n'existe pas de recommandation specifique pour la prise en charge therapeutique de ces patients. Methodes : Etude retrospective de 30 patients âges de plus de 65 ans atteints de PTI, diagnostiques et suivis depuis 1985 aux Hopitaux Universitaires de Strasbourg. Les donnees analysees concernaient la presentation clinique, la reponse a 1 et 6 mois et les effets secondaires a divers traitements. Resultats : L'âge moyen des patients etait de 71 ans (extremes : 65-82); 12 patients avaient plus de 75 ans. Les presentations cliniques initiales etaient variees : 6 patients etaient asymptomatiques (20%), 7 patients presentaient un saignement cutane (23%) et 17 patients au moins un saignement d'un autre site que la peau (57%). Le compte plaquettaire moyen etait de 47 x 10 9 /L (extremes : 1-120). Initialement une reponse a la corticotherapie etait observee chez tous les patients traites (n = 14), mais seulement un tiers de ces patients etaient en remission a 6 mois. Un effet indesirable de la corticotherapie etait note chez tous les patients. Des immunoglobulines polyvalentes intra-veineuses ont ete utilisees chez 3 patients sans succes. Apres splenectomie, tous les patients (n = 6) repondaient, mais a 6 mois aucun n'etait en reponse complete. Une complication post-operatoire etait observee chez 4 patients, dont une fatale suite a un choc septique. Le danazol a ete utilise chez 5 patients, avec une reponse dans 60% des cas. Une elevation des transaminases etait rapportee chez tous ces patients. Trois des 30 patients (10%) sont decedes de leur maladie et/ou de complications iatrogenes. Conclusions : Ces resultats montrent que le PTI semble severe chez le sujet âge. Ils suggerent que l'âge influence les reponses et la survenue d'effets indesirables des therapeutiques conventionnelles. Par ailleurs, ces resultats laissent a penser que le danazol pourrait etre une alternative therapeutique a la splenectomie chez ces patients âges.
1 citations