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Zgheib O, Trombert V, Jandus P, Serratrice C. Drug-induced hypersensitivity syndrome with lupus manifestations due to mesalazine in a patient with ulcerative colitis. BMJ Case Rep 2022; 15:e248229. [PMID: 35217557 PMCID: PMC8883224 DOI: 10.1136/bcr-2021-248229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2022] [Indexed: 11/04/2022] Open
Abstract
Mesalazine is often used as first-line therapy for ulcerative colitis. Several reports have pointed to systemic adverse reactions associated with this drug. Most have evoked a drug-induced hypersensitivity syndrome, while some have described lupus syndromes but with limited clinical and varied biological features. A 75-year-old man presented with fever, dyspnoea, chest pain, polyarthralgia, and myalgia, following mesalazine introduction. Clinical symptoms and low-titre positive antihistone antibodies disappeared after mesalazine withdrawal without recourse to steroids. Pericardial effusion and 8F-fluorodeoxyglucose uptake on positron emission tomography/CT scan, and glomerular haematuria and proteinuria also disappeared. Cytokine-lymphocyte transformation tests showed a strong sensitisation pattern with interleukin-5 production. This case advances our knowledge of the mechanism of mesalazine-induced adverse effects, namely via drug-induced hypersensitivity with lupus manifestations, which we are the first to report.
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Affiliation(s)
- Omar Zgheib
- Internal Medicine of the Elderly, Geneva University Hospitals, Geneva, Switzerland
| | - Véronique Trombert
- Internal Medicine of the Elderly, Geneva University Hospitals, Geneva, Switzerland
| | - Peter Jandus
- Immunology and Allergology, Geneva University Hospitals, Geneva, Switzerland
| | - Christine Serratrice
- Internal Medicine of the Elderly, Geneva University Hospitals, Geneva, Switzerland
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Ing Lorenzini K, Wainstein L, Curtin F, Trombert V, Zekry D, Gold G, Piguet V, Desmeules J. Adverse Drug Reactions Due to Opioid Use in Oldest-Old Patients Visiting the Emergency Unit of the Geneva Geriatric Hospital. J Frailty Aging 2022; 11:329-334. [DOI: 10.14283/jfa.2022.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Glangetas A, Hartley MA, Cantais A, Courvoisier DS, Rivollet D, Shama DM, Perez A, Spechbach H, Trombert V, Bourquin S, Jaggi M, Barazzone-Argiroffo C, Gervaix A, Siebert JN. Deep learning diagnostic and risk-stratification pattern detection for COVID-19 in digital lung auscultations: clinical protocol for a case-control and prospective cohort study. BMC Pulm Med 2021; 21:103. [PMID: 33761909 PMCID: PMC7988633 DOI: 10.1186/s12890-021-01467-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/15/2021] [Indexed: 12/15/2022] Open
Abstract
Background Lung auscultation is fundamental to the clinical diagnosis of respiratory disease. However, auscultation is a subjective practice and interpretations vary widely between users. The digitization of auscultation acquisition and interpretation is a particularly promising strategy for diagnosing and monitoring infectious diseases such as Coronavirus-19 disease (COVID-19) where automated analyses could help decentralise care and better inform decision-making in telemedicine. This protocol describes the standardised collection of lung auscultations in COVID-19 triage sites and a deep learning approach to diagnostic and prognostic modelling for future incorporation into an intelligent autonomous stethoscope benchmarked against human expert interpretation. Methods A total of 1000 consecutive, patients aged ≥ 16 years and meeting COVID-19 testing criteria will be recruited at screening sites and amongst inpatients of the internal medicine department at the Geneva University Hospitals, starting from October 2020. COVID-19 is diagnosed by RT-PCR on a nasopharyngeal swab and COVID-positive patients are followed up until outcome (i.e., discharge, hospitalisation, intubation and/or death). At inclusion, demographic and clinical data are collected, such as age, sex, medical history, and signs and symptoms of the current episode. Additionally, lung auscultation will be recorded with a digital stethoscope at 6 thoracic sites in each patient. A deep learning algorithm (DeepBreath) using a Convolutional Neural Network (CNN) and Support Vector Machine classifier will be trained on these audio recordings to derive an automated prediction of diagnostic (COVID positive vs negative) and risk stratification categories (mild to severe). The performance of this model will be compared to a human prediction baseline on a random subset of lung sounds, where blinded physicians are asked to classify the audios into the same categories. Discussion This approach has broad potential to standardise the evaluation of lung auscultation in COVID-19 at various levels of healthcare, especially in the context of decentralised triage and monitoring. Trial registration: PB_2016-00500, SwissEthics. Registered on 6 April 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01467-w.
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Affiliation(s)
- Alban Glangetas
- Division of Paediatric Emergency Medicine, Department of Women, Child and Adolescent, Geneva University Hospitals, 47 Avenue de la Roseraie, 1205, Geneva, Switzerland
| | - Mary-Anne Hartley
- Intelligent Global Health, Machine Learning and Optimization (MLO) Laboratory, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Aymeric Cantais
- Division of Paediatric Emergency Medicine, Department of Women, Child and Adolescent, Geneva University Hospitals, 47 Avenue de la Roseraie, 1205, Geneva, Switzerland
| | | | - David Rivollet
- Essential Tech Centre, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Deeksha M Shama
- Intelligent Global Health, Machine Learning and Optimization (MLO) Laboratory, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | | | - Hervé Spechbach
- Division of Primary Care Medicine, Department of Community Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Véronique Trombert
- Department of Internal Medicine and Rehabilitation, Geneva University Hospitals, Geneva, Switzerland
| | - Stéphane Bourquin
- Department of Micro-Engineering, Geneva School of Engineering, Architecture and Landscape (HEPIA), Geneva, Switzerland
| | - Martin Jaggi
- Intelligent Global Health, Machine Learning and Optimization (MLO) Laboratory, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Constance Barazzone-Argiroffo
- Paediatric Pulmonology Unit, Department of Women, Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - Alain Gervaix
- Division of Paediatric Emergency Medicine, Department of Women, Child and Adolescent, Geneva University Hospitals, 47 Avenue de la Roseraie, 1205, Geneva, Switzerland
| | - Johan N Siebert
- Division of Paediatric Emergency Medicine, Department of Women, Child and Adolescent, Geneva University Hospitals, 47 Avenue de la Roseraie, 1205, Geneva, Switzerland.
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Serratrice C, Mendes A, Herrmann F, Périvier S, Genton L, Fassier T, Di Silvestro K, Trombert V, Roux X, Cuvelier C, Huber P, Jacques MC, Prendki V, Harbarth S, Scheffler M, Graf C, Zekry D. [Issues and challenges related to COVID-19 in acute geriatric care: lessons learned from the Geneva experience]. Rev Med Suisse 2020; 16:2153-2155. [PMID: 33174695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The older patients have been the most affected by the SARS-CoV-2 pandemic. In addition, this infection has been responsible for high mortality rate in this population. In this article we wanted to describe the clinical findings we encountered in older people with COVID-19 and share some of the issues and challenges we faced during the COVID-19 pandemic.
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Affiliation(s)
- Christine Serratrice
- Service de médecine interne de l'âgé, Département de réadaptation et gériatrie, HUG, 1211 Genève 14
| | - Aline Mendes
- Service de gériatrie, Département de réadaptation et gériatrie, HUG, 1211 Genève 14
| | - François Herrmann
- Service de gériatrie, Département de réadaptation et gériatrie, HUG, 1211 Genève 14
| | - Samuel Périvier
- Service de gériatrie, Département de réadaptation et gériatrie, HUG, 1211 Genève 14
| | - Laurence Genton
- Unité de nutrition clinique, Service d'endocrinologie, diabétologie, nutrition et éducation thérapeutique, HUG, 1211 Genève 14
| | - Thomas Fassier
- Service de médecine interne de l'âgé, Département de réadaptation et gériatrie, HUG, 1211 Genève 14
| | - Katharine Di Silvestro
- Service de médecine interne de l'âgé, Département de réadaptation et gériatrie, HUG, 1211 Genève 14
| | - Véronique Trombert
- Service de médecine interne de l'âgé, Département de réadaptation et gériatrie, HUG, 1211 Genève 14
| | - Xavier Roux
- Service de médecine interne de l'âgé, Département de réadaptation et gériatrie, HUG, 1211 Genève 14
| | - Clémence Cuvelier
- Service de médecine interne de l'âgé, Département de réadaptation et gériatrie, HUG, 1211 Genève 14
| | - Philippe Huber
- Service de gériatrie, Département de réadaptation et gériatrie, HUG, 1211 Genève 14
| | - Marie-Claire Jacques
- Service de gériatrie, Département de réadaptation et gériatrie, HUG, 1211 Genève 14
| | - Virginie Prendki
- Service de médecine interne de l'âgé, Département de réadaptation et gériatrie, HUG, 1211 Genève 14
| | - Stephan Harbarth
- Service des maladies infectieuses et de prévention et contrôle des infections, HUG, 1211 Genève 14
| | - Max Scheffler
- Service de radiologie, Département diagnostique, HUG, 1211 Genève 14
| | - Christophe Graf
- Service de médecine interne et réadaptation, Département de réadaptation et gériatrie, HUG, 1211 Genève 14
| | - Dina Zekry
- Service de médecine interne de l'âgé, Département de réadaptation et gériatrie, HUG, 1211 Genève 14
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Mendes A, Serratrice C, Herrmann FR, Genton L, Périvier S, Scheffler M, Fassier T, Huber P, Jacques MC, Prendki V, Roux X, Di Silvestro K, Trombert V, Harbarth S, Gold G, Graf CE, Zekry D. Predictors of In-Hospital Mortality in Older Patients With COVID-19: The COVIDAge Study. J Am Med Dir Assoc 2020; 21:1546-1554.e3. [PMID: 33138936 PMCID: PMC7491997 DOI: 10.1016/j.jamda.2020.09.014] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine predictors of in-hospital mortality related to COVID-19 in older patients. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Patients aged 65 years and older hospitalized for a diagnosis of COVID-19. METHODS Data from hospital admission were collected from the electronic medical records. Logistic regression and Cox proportional hazard models were used to predict mortality, our primary outcome. Variables at hospital admission were categorized according to the following domains: demographics, clinical history, comorbidities, previous treatment, clinical status, vital signs, clinical scales and scores, routine laboratory analysis, and imaging results. RESULTS Of a total of 235 Caucasian patients, 43% were male, with a mean age of 86 ± 6.5 years. Seventy-six patients (32%) died. Nonsurvivors had a shorter number of days from initial symptoms to hospitalization (P = .007) and the length of stay in acute wards than survivors (P < .001). Similarly, they had a higher prevalence of heart failure (P = .044), peripheral artery disease (P = .009), crackles at clinical status (P < .001), respiratory rate (P = .005), oxygen support needs (P < .001), C-reactive protein (P < .001), bilateral and peripheral infiltrates on chest radiographs (P = .001), and a lower prevalence of headache (P = .009). Furthermore, nonsurvivors were more often frail (P < .001), with worse functional status (P < .001), higher comorbidity burden (P < .001), and delirium at admission (P = .007). A multivariable Cox model showed that male sex (HR 4.00, 95% CI 2.08-7.71, P < .001), increased fraction of inspired oxygen (HR 1.06, 95% CI 1.03-1.09, P < .001), and crackles (HR 2.42, 95% CI 1.15-6.06, P = .019) were the best predictors of mortality, while better functional status was protective (HR 0.98, 95% CI 0.97-0.99, P = .001). CONCLUSIONS AND IMPLICATIONS In older patients hospitalized for COVID-19, male sex, crackles, a higher fraction of inspired oxygen, and functionality were independent risk factors of mortality. These routine parameters, and not differences in age, should be used to evaluate prognosis in older patients.
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Affiliation(s)
- Aline Mendes
- Division of Geriatrics, University Hospitals of Geneva, Geneva, Switzerland.
| | - Christine Serratrice
- Divison of Internal Medicine for the aged, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Laurence Genton
- Clinical Nutrition, University Hospitals of Geneva, Geneva, Switzerland
| | - Samuel Périvier
- Division of Geriatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Max Scheffler
- Division of Radiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Thomas Fassier
- Divison of Internal Medicine for the aged, University Hospitals of Geneva, Geneva, Switzerland
| | - Philippe Huber
- Division of Geriatrics, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Virginie Prendki
- Divison of Internal Medicine for the aged, University Hospitals of Geneva, Geneva, Switzerland
| | - Xavier Roux
- Divison of Internal Medicine for the aged, University Hospitals of Geneva, Geneva, Switzerland
| | - Katharine Di Silvestro
- Divison of Internal Medicine for the aged, University Hospitals of Geneva, Geneva, Switzerland
| | - Véronique Trombert
- Divison of Internal Medicine for the aged, University Hospitals of Geneva, Geneva, Switzerland
| | - Stephan Harbarth
- Division of Infectious Diseases and Infection Control Program, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
| | - Gabriel Gold
- Division of Geriatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Christophe E Graf
- Division of Internal Medicine and Rehabilitation, University Hospitals of Geneva, Geneva, Switzerland
| | - Dina Zekry
- Divison of Internal Medicine for the aged, University Hospitals of Geneva, Geneva, Switzerland
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D'Andrea A, Le Peillet D, Fassier T, Prendki V, Trombert V, Reny JL, Roux X. Functional Independence Measure score is associated with mortality in critically ill elderly patients admitted to an intermediate care unit. BMC Geriatr 2020; 20:334. [PMID: 32907534 PMCID: PMC7488031 DOI: 10.1186/s12877-020-01729-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 08/23/2020] [Indexed: 11/11/2022] Open
Abstract
Background Age alone is not a robust predictor of mortality in critically ill elderly patients. Chronic health status and functional status before admission could be better predictors. This study aimed to determine whether functional status, assessed using the Functional Independence Measure (FIM), could be an independent predictor of mortality in a geriatric population admitted to an intermediate care unit (IMCU). Methods A monocentric, retrospective, observational study of all patients aged ≥75 years old admitted to Geneva University Hospitals’ geriatric IMCU between 01.01.2012 and 31.05.2016. The study’s primary outcome metrics were one-year mortality’s associations with a pre-admission FIM score and other relevant prospectively recorded prognostic variables. Results A total of 345 patients were included (56% female, mean age 85 +/− 6.5 years). Mean FIM score was 66 +/− 26. One-year mortality was 57%. Dichotomized low (≤ 63) and high FIM (> 63) scores were associated with one-year mortalities of 68 and 44%, respectively. Logistic regression calculations found an association between pre-admission FIM score and one-year mortality (p < 0.0001), including variables usually associated with mortality (e.g., age, sex, comorbidities, mini-mental health state score, renal function). Multivariate survival analysis showed a significant difference between groups, with a hazard ratio of 0.29 (95% CI: 0.13–0.65) for patients with high FIM scores. Conclusions In the present study, higher functional status, assessed using the FIM tool before admission to an IMCU, was significantly and independently associated with lower one-year mortality. This opens up perspectives on the potential value of FIM for establishing a finer prognosis and better triage of critically ill older patients.
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Affiliation(s)
- A D'Andrea
- Division of anesthesiology, Département of anesthesiology, Hospital Riviera Chablais, Vaud Valais, Rennaz, Switzerland
| | - D Le Peillet
- Divison of Internal Medecine of the Aged, Departement of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - T Fassier
- Divison of Internal Medecine of the Aged, Departement of Rehabilitation and Geriatrics, Geneva University Hospitals & Interprofessionnal Simulation Center, Geneva, Switzerland
| | - V Prendki
- Divison of Internal Medecine of the Aged, Departement of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - V Trombert
- Divison of Internal Medecine of the Aged, Departement of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - J-L Reny
- Divison of Internal Medecine of the Aged, Departement of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - X Roux
- Divison of Internal Medecine of the Aged, Departement of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland.
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Pires Peixoto R, Trombert V, Poncet A, Kizlik J, Gold G, Ehret G, Trombetti A, Reny JL. Feasibility and safety of high-intensity interval training for the rehabilitation of geriatric inpatients (HIITERGY) a pilot randomized study. BMC Geriatr 2020; 20:197. [PMID: 32503465 PMCID: PMC7275527 DOI: 10.1186/s12877-020-01596-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High-intensity interval training (HIIT) has been shown to be more effective than moderate-intensity continuous training (MICT) for the physical rehabilitation. However, data on its suitability for older hospitalized patients is scarce. METHODS Randomized controlled trial in a hospital setting. Inclusion of 100 patients, ≥65 years old, hospitalized for rehabilitation after an acute medical condition, in a two-week rehabilitation program of either four HIIT or three MICT sessions per week. Completion was defined as participation in all but two planned sessions accomplishing ≥50% of each session. We assessed: upper-limb muscle strength (handgrip isometric strength test), lower-limb muscle strength (quadriceps and ankle flexion and extension tests); gait speed and spatio-temporal parameters (instrumented walkway), and exercise capacity (6-min walk test). All adverse events were recorded as safety endpoints. RESULTS An intention-to-treat analysis showed a 44% completion rate for the HIIT group (95% CI, 30-59) and 77% for MICT (95% CI, 55-82). A modified intention-to-treat analysis restricted to patients who participated in ≥1 session showed an 88% completion rate in the HIIT group (95%CI, 69-97) and an 80% completion rate in MICT (95%CI, 65-90). The exercises most frequently undertaken were the pedal exerciser (54%) and the NuStep (32%). There were no significant differences in the various measures. No serious adverse events occurred. CONCLUSION A HIIT rehabilitation program for this population was feasible, safe and had a high adherence rate. TRIAL REGISTRATION NUMBER Clinicatrials.gov ID: NCT02318459. Trial registration date: November 7th, 2014. Retrospectively registered. This study adheres to the CONSORT guidelines.
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Affiliation(s)
- Rita Pires Peixoto
- Division of Internal Medicine for the elderly, Trois-Chêne, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.,Division of Cardiology, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Véronique Trombert
- Division of Internal Medicine for the elderly, Trois-Chêne, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Antoine Poncet
- Division of clinical epidemiology, Geneva University Hospitals and Geneva Faculty of Medicine, Geneva, Switzerland
| | - Jérôme Kizlik
- Division of Internal Medicine for the elderly, Trois-Chêne, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Gabriel Gold
- Division of Internal Medicine for the elderly, Trois-Chêne, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Georg Ehret
- Division of Cardiology, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Andrea Trombetti
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Jean-Luc Reny
- Division of Internal Medicine for the elderly, Trois-Chêne, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. .,Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle Perret Gentil 4, 1211, Geneva, Switzerland.
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Abstract
RATIONALE Gaucher disease (GD) is a rare genetic lysosomal storage disorder inherited in an autosomal recessive pattern. GD is due to the deficiency of a lysosomal enzyme, acid beta-glucosidase (or glucocerebrosidase). Type 1 Gaucher disease (GD1) is characterized by thrombocytopenia, anemia, an enlarged spleen, and liver as well as bone complications (Erlenmeyer flask deformity, osteoporosis, lytic lesions, pathological and vertebral fractures, bone infarcts, and avascular necrosis leading to degenerative arthropathy). The diagnosis is usually made in first decades but is sometimes delayed. Parkinson disease, neoplasia, and immune system abnormalities may be associated with GD1. PATIENT CONCERNS A patient known for hepatosplenomegaly with hyperferritinemia, anemia, and thrombocytopenia was admitted for Lewy body dementia and bullous pemphigoid. DIAGNOSES Type 1 Gaucher disease. INTERVENTION No specific treatment started. OUTCOMES patient died ten months later due to pneumonia. LESSONS To the best of our knowledge, this is the first case of the association between GD1, bullous pemphigoid, and Lewy body dementia. We discuss the central role of alpha-synuclein in these pathologies.
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Affiliation(s)
- Damien Le Peillet
- Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospital of Geneva, Trois-Chêne Hospital, Thônex
| | - Virginie Prendki
- Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospital of Geneva, Trois-Chêne Hospital, Thônex
| | - Véronique Trombert
- Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospital of Geneva, Trois-Chêne Hospital, Thônex
| | | | - Frédéric Assal
- Department of Clinical Neurosciences, University Hospital of Geneva
| | - Jean Luc Reny
- Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospital of Geneva, Trois-Chêne Hospital, Thônex
- School of medicine, University of Geneva, Geneva, Switzerland
| | - Christine Serratrice
- Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospital of Geneva, Trois-Chêne Hospital, Thônex
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Trombert V. [Not Available]. Rev Med Suisse 2018; 14:210-211. [PMID: 29380980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Véronique Trombert
- Département de médecine interne, de réhabilitation et gériatrie, HUG, 1211 Genève 14
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10
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Jedday L, Trombert V, Meyer P, Ehret G, Reny JL, Cuvelier C. [Right heart failure : important forold and young patientsA challenge from the acute to the chronic]. Rev Med Suisse 2017; 13:1952-1956. [PMID: 29120543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The prevalence of the right heart failure (RHF) is poorly known. However, RHF is often a consequence of left heart failure due to an interdependance between both ventricles. RHF should be indentified because of prognostic relevance. RHF is defined by the inability to maintain adequate cardiac output through the lung circulation. It can result from volume overload, pressure overload, or a disorder of systolic function. Adaptive mechanisms such as dilation or hyper-trophy will maintain adequate hemodynamics. Once these mechanisms become insufficient, congestive signs and hemodynamic consequences will appear. Diagnosis is based on echocardiography. The treatment of RHF is similar to left heart failure. In case of acute RHF, treatment depends of the etiology of RHF. Optimization of the volemia is a central objective of therapeutics.
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Affiliation(s)
- Latifa Jedday
- Département de médecine interne, de réhabilitation et de gériatrie, Hôpital Trois-Chêne, 1226 Thônex
| | - Véronique Trombert
- Département de médecine interne, de réhabilitation et de gériatrie, Hôpital Trois-Chêne, 1226 Thônex
| | | | | | - Jean-Luc Reny
- Département de médecine interne, de réhabilitation et de gériatrie, Hôpital Trois-Chêne, 1226 Thônex
| | - Clémence Cuvelier
- Département de médecine interne, de réhabilitation et de gériatrie, Hôpital Trois-Chêne, 1226 Thônex
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Abstract
We report a case of tuberculous granulomatous panniculitis without vasculitis in an 87-year-old female patient with B-cell chronic lymphocytic leukaemia. One month after starting chemotherapy with chlorambucil and prednisone she presented superficial erythematous plaques on the anterior side of the left leg. Three weeks later erythematous painless deep nodules appeared on the left popliteal fossa and on the left thigh. Cutaneous biopsy revealed granulomatous panniculitis without caseation necrosis or vasculitis. Polymerase chain reaction for Mycobacterium tuberculosis revealed positivity in the skin. The final diagnosis was reactivation of latent tuberculosis (TB) induced by deep immunosuppression associated with chemotherapy and haematological disease. Tuberculous granulomatous panniculitis without vasculitis is a rare presentation of cutaneous TB and may be part of the heterogeneous histopathologic spectrum of erythema induratum of Bazin (nodular vasculitis). Our case shows that the diagnosis of cutaneous TB requires the correlation of clinical findings with histopathology and microbiological tests.
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Affiliation(s)
| | | | - Véronique Trombert
- Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva, Switzerland
| | - Jean-Luc Reny
- Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva, Switzerland
| | - Gürkan Kaya
- Department of Dermatology, University Hospital of Geneva, Geneva, Switzerland
| | - Virginie Prendki
- Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva, Switzerland
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12
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Clemente M, Charbonnier F, Trombert V. [Practical problems with ECG in elderly. Case No. 22]. Rev Med Suisse 2013; 9:849. [PMID: 23667975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Marc Clemente
- Hôpital des Trois-Chêne, Ch. Pont-Bochet 3, HUG, 1226 Thônex
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13
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Trombert V, Isaza C. [Case-based practice with ECG in the elderly. Case number 21]. Rev Med Suisse 2013; 9:481. [PMID: 23539816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- V Trombert
- Hôpital des Trois-Chêne, Chemin Pont-Bochet 3, HUG, 1226 Thônex.
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14
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Vuagnat H, Trombert V, Donnat N. [Pressures ulcers, basis of prevention and treatment in the elderly]. Rev Med Suisse 2012; 8:2295-2302. [PMID: 23240244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Pressure sore is a frequent and painful pathology in the elderly. Upon hospitalization, risk assessment and prevention must be systematic. Pressure ulcer treatment will combine prevention principles, local debridement and moisture control. The interdisciplinary interventions of other health professionals (such as occupational therapist, physiotherapist, dieticians) can be crucial. Last but not least: for wound treatment to be a success, the patient must be considered in his globality.
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Affiliation(s)
- H Vuagnat
- Service de réadaptation médicale, Département de réadaptation et médecine palliative, HUG, Hôpial de Loëx, Bernex.
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15
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Sadfi Charbonnier S, Sanchez A, Trombert V. [Practical ECG problems in the elderly. Complete left bundle branch block ]. Rev Med Suisse 2012; 8:1520-1521. [PMID: 22913004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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16
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Isaza C, Trombert V. [Practical ECG problems. Torsade de pointes in an elderly patient]. Rev Med Suisse 2012; 8:1025. [PMID: 22662633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- C Isaza
- Hôpital des Trois-Chêne, Ch. Pont-Bochet 3, HUG, 1226 Thônex
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17
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Trombert V, Samaras N. [Practical problem on ECG in elderly patient. Case #18]. Rev Med Suisse 2011; 7:2312-2313. [PMID: 22400368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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18
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Rieder JP, Trombert V. [Practical ECG problems in the elderly. Case number 17]. Rev Med Suisse 2011; 7:1014-1015. [PMID: 21692315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- J-P Rieder
- Hôpital des Trois-Chêne, 3 chemin Pont-Bochet, HUG, 1226 Thônex.
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Farhoumand AD, Trombert V, Eusebio J. [Practical ECG problems in the elderly patient. Case number 16. Moxifloxacin-associated QT interval prolongation]. Rev Med Suisse 2011; 7:624-625. [PMID: 21510347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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20
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Trombert V, Barro J, Graf C. [An elderly woman with sweating and vomiting without loss of consciousness]. Rev Med Suisse 2010; 6:2039-2040. [PMID: 21137465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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21
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Samaras N, Trombert V. [ECG in an elderly patient: trigeminal rhythm]. Rev Med Suisse 2010; 6:1416-1417. [PMID: 20701019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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22
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Eusébio J, Trombert V. [Wenckebach type atrioventricular block with sinusal bradycardia]. Rev Med Suisse 2009; 5:1080-1081. [PMID: 19526979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- J Eusébio
- Département de réhabilitation et gériatrie, HUG
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23
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Eusébio J, Trombert V. [Electrocardiogram and bundle branch block in an elderly man. Case #12]. Rev Med Suisse 2008; 4:2172-2173. [PMID: 19009848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- J Eusébio
- Hôpital des Trois-Chêne 3, chemin Pont-Bochet HUG, 1226 Thônex
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24
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Rieder JP, Trombert V. [Practical problems of ECG in aged persons. Case No. 11]. Rev Med Suisse 2008; 4:1884-1885. [PMID: 18831411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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25
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Trombert V, Barro J. [Bradycardia due to blocked atrial bigeminy: ECG]. Rev Med Suisse 2008; 4:864-865. [PMID: 18488751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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26
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Dahl Farhoumand A, Trombert V, Eusebio J. [Management problems in the ECG of an elderly person. Case no. 9]. Rev Med Suisse 2008; 4:550-551. [PMID: 18402409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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27
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Trombert V. [How to increase the necropsy rate in hospital?]. Rev Med Suisse 2007; 3:2542-2545. [PMID: 18072603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The autopsy serves to identify the causes of a patient's death. For some years it is undergoing an important decline but nevertheless the post-mortem examination remains one of the basic tools for the assessment of medical care. The aim of this paper is to detect the reasons for the decline of this practice, to review the contribution of autopsy to medicine and to analyze the effects of physicians training at the request of autopsy to boost this practice.
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Affiliation(s)
- V Trombert
- Dr Vronique Trombert Hôpital des Trois-Chêne, HUG, Chemin Pont-Bochet 3, 1226 Thônex.
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Trombert V, Ghedira M. [Practical problems of ECG in the elderly: ventricular tachycardia. Case No. 8]. Rev Med Suisse 2007; 3:2052-2053. [PMID: 17955834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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29
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Trombert V, Graf C. [Preexcitation of the Wolff-Parkinson-White (WPW) type in a 96 year old patient]. Rev Med Suisse 2007; 3:1478-9. [PMID: 17639671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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30
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Trombert V, Graf C. [Practical problems of the ECG in the elderly: ventricular bigeminal rhythm. Case No, 5]. Rev Med Suisse 2006; 2:2824. [PMID: 17225694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- V Trombert
- HUG, Hôpital de gériatrie 3, chemin Pont-Bochet, 1226 Thônex.
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Trombert V, Graf C. [Bradycardia in an elderly woman caused by amiodarone assessed by ECG]. Rev Med Suisse 2006; 2:811-2. [PMID: 16615729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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32
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Trombert V, Graf C. [Practical problems of the ECG in the elderly. Case No. 4]. Rev Med Suisse 2005; 1:2693-4. [PMID: 16355885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- Véronique Trombert
- Hôpitaux universitaires de Genève, Hôpital de gériatrie 3, chemin Pont-Bochet, 1226 Thônex.
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Frangos Lordos E, Trombert V, Kuzmanovic I, Vogt-Ferrier N, Perrenoud JJ. [Drug-induced refractory arterial hypertension]. Rev Med Suisse 2005; 1:2522, 2525-6. [PMID: 16323733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Polymedication is frequent in geriatric everyday practice and often leads to unwanted drug-drug interactions. Physicians must be aware of the potential interaction-induced with intoxications or therapeutic ineffectiveness. The clinical case presented here illustrates the importance of entertaining the possibility of such an interaction every time that the expected therapeutical effect of a substance is not reached. Our patient had refractory arterial hypertension despite taking five different antihypertensive drugs in hospital, while on carbamazepine for a facial neuralgia. This substance induces the cytochrome P450, which catalyse the metabolism of most of the antihypertensives used. After the discontinuation of carbamazepine and on tritherapy, the blood pressure profile has significantly improved.
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Trombert V, Graf C. [ECG case studies]. Rev Med Suisse 2005; 1:1526-7. [PMID: 16025894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- V Trombert
- Hôpitaux universitaires de Genève, Hôpital de gériatrie, 3, chemin Pont-Bochet, 1226 Thônex.
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Trombert V, Graf C. [Electrocardiography in the elderly]. Rev Med Suisse 2005; 1:853. [PMID: 15865360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- V Trombert
- Hôpitaux universitaires de Genève, Hôpital de gériatrie, 3, chemin Pont-Bochet, 1226 Thônex.
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Trombert V, Graf C. [Practical EKG problems in the aged. Case no. 1]. Rev Med Suisse 2005; 1:326-7. [PMID: 15771363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- V Trombert
- Hôpitaux universitaires de Genève, Hôpital de gériatrie, 3, chemin Pont-Bochet, 1226 Thônex.
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Graf C, Nkoulou R, Trombert V, Perrenoud JJ. SAFETY OF TIROFIBAN THERAPY IN VERY OLD PATIENTS WITH ACUTE CORONARY SYNDROME OR NON-Q-WAVE MYOCARDIAL INFARCTION. J Am Geriatr Soc 2005; 53:172-3. [PMID: 15667404 DOI: 10.1111/j.1532-5415.2005.53031_7.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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