Notes

Device associated with Pyrolysis Reaction of Al-Rich Al/PTFE/TiH2 Lively Content.
Hip osteonecrosis. Hip osteonecrosis of the is a relatively common pathology, responsible for pain and functional disability mainly affecting young people. It corresponds to bone necrosis of the femoral head, secondary to ischemic and/or cytotoxic mechanisms. They can be unilateral, bilateral or multifocal, thus testifying to the systemic nature of their origin and the importance of the general factors involved in their occurrence. Many risk factors are to be looked for, such as corticosteroid therapy, alcohol abuse, dyslipidemia or sickle cell anemia. MRI is the examination that allows a positive diagnosis and should be offered in the face of any unexplained pain in the young subject, with a normal X-ray. In advanced forms with a collapse of the joint surface and then secondary arthritis, surgical treatment with arthroplasty is the main possible option. The hip prosthesis provides these patients with a comfortable life; but it is not without risk taking into account the pathology which is usually the cause of osteonecrosis in fact, osteonecrosis of the hip is often associated with serious medical pathologies such as hemoglobinopathies (sickle cell anemia in particular), taking corticosteroids in large doses in connection with organ transplantation or diseases such as lupus erythematosus, autoimmune diseases, hyperlipidemias and excessive alcohol intake. However, there are promising therapeutic advances, such as the use of mesenchymal stem cells, which could in the future improve the poor joint prognosis of aseptic osteonecrosis. These conservative treatments are recommended at a stage without collapse of the articular surface.What recourse in the event of the identification of a precarious subject? People in situation of deprivation have multiple and complex needs. Their healthcare management needs to be global and multidisciplinary, requiring the coordination of various medical and social workers. Identify available structures, their methods of access, is the first step for healthcare professionals who receive a vulnerable person they can be medical, social or associative. The institutional sites allow to identify a part of these structures.Health issues in precarious people. Though if it is not possible to draw a single picture of the health of precarious people, many works on social inequalities in health underline their vulnerability and an increased frequency of a variety health problems. We can cite certain harmful behaviors for health (smoking, consumption of psychoactive substances, insufficient food or, conversely, too rich and not very diversified, sedentary lifestyle, delay in screening and prevention, violence, etc...), for certain diseases (cardiovascular diseases, skin diseases, dental problems, respiratory diseases, mental distress, infectious diseases including tuberculosis and HIV, etc.) and in terms of access to care and prevention. Thus, despite the resources to reduce social inequalities in health in France, the state of health of people in precarious situations continues to deteriorate and should constitute a public health priority for health authorities and for caregivers.Medical specific approach of persons in social deprivation. Many social situations interfere with medical care. This consideration is an integral part of the physician mission. The evaluation is based on housing and feeding conditions, financial and job situation, relationship environment, social integration and access to care. The identification of these insecurity areas enables to assess the impact on the health status, to adapt the medical care and to choose reasonable therapeutic targets. The first medical consultation is decisive and sufficient time should be taken. The physician must ensure to create a caring and non-binding environment and must know the suffering caused by the social deprivation. His support position makes the adherence and the continuation of care easier. He can direct the patient towards institutional or associative social assistance organisations, which requires knowledge of local network. These patients, who may be confusing for the practitioners, require patience, perseverance, collaborative work and humanity, essential keys for helping those most in need.Medical responsibility what records should be kept of medical procedures? Quality information is nowadays required to enable patients to understand and accept the treatments proposed to them and to be involved in the choices of the team to which they have entrusted themselves. This is "informed consent". It is up to the doctor to give all the necessary information to the patient during an individual discussion, which he must take care to keep records of. Thus, he will be able to retrace the medical procedures and establish the reality of the information given to his patient. Thus, the doctor must always keep a written record proving and detailing this information, which will allow him to retrace the medical procedures taken and thus establish the veracity of the information given to his patient. However, we must recognize how difficult it is to convey traumatic message, to explain the incomprehensible, to "decode" scientific language, to announce the irreversible. It is therefore imperative, insofar as the duty to provide information will be discussed in each case of liability, to be concerned with proving the content of the information given, in accordance with a demanding but protective deontology for both doctor and patient. This article returns to the essential questions regarding information why inform? Who proves what? How to inform and prove it? ».Chikungunya. Chikungunya is a cosmopolitan arbovirosis transmitted by a mosquito of the genus Aedes. It is characterized by the possible persistence of musculoskeletal symptoms more than three months after infection. After inoculation by an infected mosquito and incubation for three days, the infection is symptomatic in 75-95% of cases. There are three stages. The acute stage is characterized by the sudden onset of high fever associated with incapacitating distal polyarthralgia. Atypical, sometimes severe, manifestations are possible neurological, digestive, cardiac, hepatic, dermatological, hematological, pulmonary and renal. These atypical forms are most often observed at extreme ages and in people with chronic diseases. The post-acute stage (60-80% of cases, from the fourth week to the end of the third month) is characterized by persistent and polymorphic musculoskeletal manifestations. During the chronic stage (50% of cases from the fourth month onwards) two entities can be distinguished chronic inflammatory rheumatism and musculoskeletal disorders. Management is symptomatic. It is based on a precise semiological analysis, attentive listening to the patient and a multidisciplinary approach.West nile virus infection an emerging arbovirosis in france and europe. West Nile virus is a mosquito-borne flavivirus, transmitted to humans by mosquitoes of the genus Culex, from an avian reservoir. Humans are accidental hosts and there is no report of human-to-human transmission, except via blood transfusion or organ transplantation. In 2018, Europe experienced the largest outbreak of West Nile virus infection ever. In France, 27 cases were identified including 7 neuro invasive forms. This infection is asymptomatic in most cases but may also manifest as an isolated fever or flu-like syndrome. In about 1% of cases, neuro-invasive forms with meningitis, meningoencephalitis or flaccid paralysis can be observed. There is no specific treatment for this viral infection. Prevention is based on the prevention of mosquito bites, but also on enhanced epidemiological surveillance during the period of circulation of the virus in Europe (from spring to autumn).Zika virus infection what advice in post-epidemic situation? Zika virus transmission is vector-borne, but it can also be sexual. The Zika disease contracted by an adult or child is most often mild but infection of the woman during pregnancy can lead to severe neurological congenital lesions. The Zika virus continues to circulate in many parts of the world. Risk of infection during travel is low but cannot be overlooked. An infected man can be infectious, during sexual intercourse, up to 3 months after contracting the disease. Information of pregnant women and couples with a child project is warranted if at least one of the two trips or has travelled in Zika virus transmission zone. Selleck NVP-TAE684 Laboratory serologic tests can be used to determine if the partners have been infected and to verify, through the investigation of the virus in the semen, that there is no risk of sexual transmission.Dengue fever an emerging infectious disease. Dengue fever is caused by an arbovirus of the family Flaviviridae and the genus Flavivirus, of which there are 4 serotypes (DEN-1, DEN-2, DEN-3, DEN-4). link2 It is transmitted by the bite of a diurnal mosquito of the genus Aedes, mainly A. aegypti and A. albopictus. An increasing cause of acute fever in travellers, it threatens to emerge in temperate regions where competent mosquitoes (Aedes) are established. Dengue fever is characterized by its clinical polymorphism ranging from asymptomatic to severe forms, which are rare in travellers. Its definite diagnosis is based on virological tests selected according to the stage of the disease and the kinetics of the virus. Its treatment is only symptomatic. It is a notifiable disease in mainland France and is subject to a plan to combat its spread and to specific surveillance in the overseas departments. Dengue prevention is based on the application of personal anti-vectorial protection measures among travellers, awareness-raising among health professionals and social mobilization to combat larval gites in endemic regions or regions colonized by Aedes. In France, the tetravalent vaccine Dengvaxia, which is licensed in France, is not recommended for people residing in overseas departments and for travelers to endemic areas.Yellow fever is still a current threat? Yellow fever is a mosquito-borne disease. Africa is the major endemic zone, although there have been epidemics of concern in South America in the last 3 years, especially in Brazil. link3 The virus causes a febrile hepatitis, which can lead to hemorrhagic complications and death. Diagnosis is based on non-specific serological tests. There is no curative treatment. Prevention relies on protection against mosquito bites and on vaccination with a live attenuated vaccine. WHO recommends only one dose of vaccine but data from the literature about life-long protection are divergent on that point, and travel medicine French authorities still recommend a second dose in most at-risk situations.Complications related to tattoo practice. Tattooing can result in a wide variety of complications, whose prevalence and incidence remain still unclear. Hypersensitivity reactions (or allergies) to tattoo pigments are currently the most common complication on a tattoo, however are not predictable. Infections are nowadays directly related to the lack of asepsis and hygiene during the tattooing procedure or during the healing phase. Patients with a known cutaneous disease should be warned of a potential risk of localization of their disease to the tattoo. Patients with chronic conditions and/or impaired immunity should discuss with their physician about the possibility and when to have a tattoo. Laser removal is the gold standard for tattoo removal and include Q-switched, picoseconds and CO2 lasers. However, a complete disappearance of the tattoo is not always possible.
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