Homemade Night Splint

Argentina and influenza A (H1N1) in children

In preparing the article on flu in China, reassuring, I arrived on this publication about influenza in Argentina quite disturbing. This article is not published in the journal but accessible only online , which explains why it eluded me for a few days because I do not spend my life on the net, and it's Christmas.

Despite the Christmas break where everything is wonderful, I must inform you:
The comments of Dr. Gamin are blue.
Preamble
Geography
Argentina is a vast country (more than 5 times that of France) extending over 3700 km from north to south and 1,400 km from east to west

image Wikipedia licensed Creative Commons Attribution 3.0 Unported .

Its population is 40 million.


Its economy is dramatic. The political and economic instability has plunged the Argentine economy in the hell of an unprecedented crisis in 2002. This crisis has led more than 50% of the population below the poverty line. Events were then held, followed by looting stores. The global economic crisis of 2008 led plunge this country that just emerged.

Health System :
Argentina spent in 2005 7% of its GDP on health and social services. For a country in ruins but it is already so vast a country where 15 to 50% of people live below the poverty line, with two successive crises that abruptly change the status of people (loss of income, home ...) may be this does not do everything.

GDP of Argentina in 2005 (Source Wikipedia)

"This may explain that"

Flu thus:

Between May and July 2009, 251 children were hospitalized with influenza. Hospitalization rates were double those of seasonal influenza in 2008. Among children who were hospitalized, 47 (19%) were admitted to ICU, 42 (17%) required ventilation and 13 (5%) died. The overall death rate was 1.1 per 100,000 children, compared to 0.1 per 100,000 children against seasonal flu in 2007. (No pediatric deaths associated with seasonal influenza in 2008.) Most of the deaths were caused by refractory hypoxemia. In infants under 1 year the death rate is 7.6 per 100,000.

This chart shows in A blue, the occurrence of influenza by week, B in green, the age distribution and the existence of infections involved more often in small, C in orange, the severity depending on age (Death = death, ICU = Intensive Care Unit or ICU, Hospital Ward = classic). The graph shows that D small are over-represented. The graph shows E age of deceased children. It is not fully consistent with the following table.

Two small So tables ( click on them to enlarge ) drawn from the section studied, even in English, are worth a thousand words.
worry, medical English is almost as simple as the medical French, which is not always easy I admit (but not worse than the legalese). The proof is that I did "German and Russian," which is hardly useful in medicine, then English, early in my medical studies for the "fun" but it remained industrious, for me too. So I learned a little Japanese that I find much more difficult than English to read and write above. But I digress, let.


The second table shows:
13 deaths in total, occurred in children under 15 years of which 9 were carriers of diseases that are already very severe.
avec10 deaths of small children under 3 years of which 4 had no risk factors (age 1 month, 10 months, 2.2 and 2.5 years). The others were already seriously ill.

What lessons for us in northern hemisphere?

published studies that I have, it appears that:
Small children under 2 years are most at risk for influenza
risk factors already described are the same
severity seems lower in rich countries (as often )

And the vaccination?
We have a vaccine adjuvant for small children, must therefore vaccinate small children, especially if they have a risk factor
Should we lower the age of vaccination for small Infants under 6 months at risk? I do not know if the vaccine is effective, but our scientists are surely aware.
must help poor countries because the flu is most dangerous when the existing situation is bad.

Conclusion:
Influenza is more severe in young children . In Argentina, it has killed.
vaccinate children 6 months to 2 years especially if they are at risk.

See also:
" flu worldwide "
" flu in China "

Medicine is not always funny but this is not his vocation. We're here to heal people and enable them to live in the best health conditions.

; Fritz Roy in the Andes (Photo Wikipedia)

"It truce joyous Christmas, Happy New Year 2010 to all and thank you for reading "


Reference:
Romina libst, MD, Pediatric Hospitalizations Associated with 2009 Pandemic Influenza A (H1N1) in Argentina N Eng J Med 361; 26 December 24, 2009: published on the NEJM website

Keywords: Argentina, vaccine, flu, influenza, child, infant, A (H1N1), severity

Smartbro Canopy Reset

China and Influenza A (H1N1) influenza

China is a big country, China is doing everything great. Great Wall is 6700 km, 6 to 7 m in height and 4-5 m wide. (Photo Wikipedia)

Everything is great, except influenza, a small Chinese and publish things very interesting.

I'd make a very small article about their experience. Comments Dr. Gamin are blue





The article reviews the clinical signs of influenza in 2009. From June to August 2009
61 hospitals from 20 provinces participated in this study.

Here is a small card of these provinces to remember your good geography

Image from article studied













Who has the flu?
To detect febrile patients, the Chinese have installed thermal scanners in all ports and airports for entering China.
late August
56 million passengers were checked and 17,909 with a fever and respiratory or very close subjects had a search in the influenza A (H1N1) by PCR .

4.3% of persons with signs of flu or contacts of 747 persons were positive .
When one hears everywhere in France say that 100% of people who have fever and cough were the "flu, we can only be amazed at the difference. Either the Chinese are bad, but still, they publish their work in a prestigious journal, or the French are "too good" but why do not they publish?

426 people have been studied very accurately. Symptoms are the same as elsewhere (fever, cough, fatigue, rapid onset)

The evolution is favorable, with very few complications.
Incubation is 2 days and healing, which is controlled in addition by the disappearance of nasal virus is obtained in 6 days.
The early prescription of "Tamiflu" shortens a bit of time to develop but Chinese doctors are skeptical about the merits his job because of the risk of emergence of resistance, low efficiency, Benin character of this flu, and price. 6 Mild adverse reactions were observed. That should reassure our makers and reconcile general practitioners and paediatricians who think more like the Chinese (O/15 and presto!)


Conclusion : Great little machine and flu.

see also:
" Flu Worldwide "
" flu Argentina "

It is confirmed that:

" Cough is not the flu and not all "

Reference:
B Cao et al: Clinical Features of the Initial Cases of 2009 Pandemic Influensa 5H1N1 A) Virus in china, New England Journal of Medicine 351; 26, December 24, 2009, p. 2507-2517

Keywords: China, 中国, flu, 瓷器 感, A (H1N1), influenza, signs, Tamiflu,

Letter Recommending New Doctor

siltation Summit

The gulf is now in Copenhagen tangible reality, to the despair turgid citizens. Expensive circus where everyone has paraded for His good cause, considering that the illegitimate planetary neighbor. Not to build anything, including in the sphere of symbolic decisions intentions, the leaders have lost any remnant of attention that their audience was multifaceted and inconsistent.
What people may not realize is normally the political responsibility to do so, even bite on interest n ational respectively. Forgotten the purpose to outline a catalyst in motivating the alternative pathway of crisis. We will remain properly seated in the mud to get by, is persuading that climate disasters befall on distant congeners or very late progeny. Not enough to wipe away a tear, nor motivation to challenge the comforts acquired or sought.
Myopia policy that sounds like an infamous Munich environmental if no burst did emerge in the coming year. Copenhagen would, if confirmed lethargy, the birthplace of a bipolar world dominated by China and the U.S. that only the certainty of capture, exploit and deplete effectively captivate. Round leg Tronches in bowl for the rest.
Faced with what some scientists alarmists fear across the world, the dispersal of nations sounds like an archaism crippling.
The UN is nothing but a League maintained its institutions only by the absence of general war for over sixty years. Survival of circumstances, therefore, nothing more.
A real global governance will not solve anything, the contrary: the risk a civil war between those areas and possessing wanting to possess, would multiply. A bankruptcy decision of Heads of State merged in a single set, will succeed edifying the tragedy of a world people fake, gigantic dumping ground for hatred and vengeful bloodthirsty selfishness. Nothing ... except to take the job!
sickly truce confectioners, in the meantime ...

Images Of Tongue Pimples

No pot to escape

Lyon welcomes me the light for ten years this year. Initially sentimental pretext to join a beautiful human hair, since it is embodied town anchor. At the right size for turning out and that only a draisienne improved take care of my travels. Not a fart carbon dioxide, then! My Copenhagen to me, everyday is the enlightened Lugdunum. Well so what if I'm not talking exotic, like those all happy with their often distant anecdotes to fill a vacuum sucked proximity, a nothing intimate. A furnace accessories such gossip! Contemporary
Heresy is especially not wanting to move. The movement would be there. I admit sometimes, for my family affections, but drool over distant lands. Eat what is within reach, without implying ogle the frantic gesticulation Space ... like a ballet of the useless: the self-satisfaction with the screening systematically elsewhere. Time
necessarily advance relentlessly. Why he superimposed this obsession with mobility? Our journey through time at a rate of every second of every day worth soon seconds and weeks equivalent days in our evolving perception, is the most exotic, the most profound and exciting discoveries. I repais without restraint, and above all without trying to hide by smoky path around a planet invaded by those who believe and noisy visitors turn away from the passing time.
Earth would warm by burping meats on our feet and the wandering of mankind -tourist, curious about everything and especially what it is apparently the most inaccessible. Poetic paradox: fossil energy, the quintessence of inaction in the bowels land allows him to claim as a freedom first, perhaps even before that of thought, freedom to go where he feels like it! Claironnons all this unalterable bias for global trade, especially without thinking about some absurd movements generated. Wrong, not in the direction of change ... By what sophistry
humanity she believed that its temporal evolution, a wellness therefore, passed without any doubt by developments space for everything: bread, his leisure, his work and holidays ... all in this together? Move your carcass and thou shalt be changed, my son!
see the reaction of motorists they are trying to blame: "But I can not help it! "This is indeed the bone, the initial choices of civilization that gradually forces the individual to move undergoing overload by the presence of all other forced
... After the path crosses a loved one waiting for me, a grandmother who has no thoughts of his family to move, but c is the most exhilarating travel, beyond time, space and ... to exhaust yourself. It is now more decoys, Copenhagen, Lyon and around the Earth.

Article published on the website of Le Monde newspaper

Jeff Hardy What Face Paint Does He Use

Worldwide (Auvergne, France, Australia, New Zealand, USA, China, Argentina)

In September 2009, WHO has identified the world 277 607 flu cases confirmed dead with 3205 or 1.03% (a far cry from 30,000 French died in 1968 and 3 million patients present French)

" The New England Journal of Medicine" of November 12, 2009 us several articles on flu 2009: the comments of Dr. boy in blue.

Hang you what is wrong and gay is full of figures, but I am simplifying to the maximum, the two articles about us:




Both articles point to the same risk factors:


Obesity significantly with BMI (= weight / height ²)> 35, which represents more than 90 K for 1.60, or 113 K for 1m80 for 29% of hospitalized patients.
Diabetes for 16% of hospitalized patients.
Severe asthma or chronic lung disease for 33% of hospitalized patients. Congestive heart
for 10% of hospitalized patients. Some had multiple
: 28 % of hospitalized patients had multiple risk factors.
32% of hospitalized patients were previously healthy.


Location American (1) . The study period runs from May 1 to June 9, 2009

13,217 infections and 1082 hospitalizations influenza A H1N1, are identified during this period a little short. "A ladle," we must estimate the number of cases to double or triple remains very low for such a country, or 40,000 flu deaths and 304 .
272 (fourth) patients were studied here :

67 / studied the 272 inpatients were admitted in intensive care units (ICU) . 19 are dead. Among these 272
hospitalized, including 18 pregnant women with asthma 4, 2 diabetes. 6 were admitted in ICU, 2 died, but no details on the added risk factors for these two people.


Situation in Australia and New Zealand: (1)


This article is very interesting because it identifies all types of flu (H1N1, 2009, unspecified HIN1 A seasonal or H3N2) admitted to ICU during the period from 1 June to 31 August (winter there) which represents virtually the entire period of influenza: 856 cases distributed as
H1N1 DC 722 cases 14.3%
Flu unspecified 97 cases DC 13 4%
Seasonal influenza H1N1 or H3N2 DC 16.2% 37 cases

The severity is the same regardless of the virus. A 2009 flu is no more evil than others.

Pregnant women are the number of 66 or 9 times the number expected given the frequency of pregnancies in the population. The article says that this sensitivity of pregnant women is not specific to this virus, but already existed in previous epidemics. He does not change pregnant women.

China (Update 25 December 2009)
A vast country with a nice little flu
Argentina (Last Update December 25, 2009)
flu has been more severe especially in children at risk. This encourages immunizing children under 2 years. Click the link for more detail.

France: (2-3) L

he figures published (December 2009) are quite curious :
2.76 million cases (but what do we put here? "They are doing calculations by brilliant mathematicians from attending doctors' surgeries, When I see the variety of patients in my Cabinet and my own diagnostic difficulties, I am dreamer, but for statisticians who do not see patients, the situation may be simpler. And me with my stupid questions, I am can be a bit cheesy?) with 86 dead or 1 30 000 case . These figures are not comparable with the American situation. The comparison with Australia is also difficult, as there are the numbers of serious cases hospitalized in the ICU.


In Auvergne: as of December 4, 2009 (4)

A serious warning in a child with hospitalization in intensive care unit of a little girl of 9 years in acute respiratory distress syndrome , fortunately favorable evolution, but none died in Pediatrics.




In three months, it will probably be completed:

If one accepts the idea that what happened in the southern hemisphere, could happen, we can say that the epidemic will last for three months with a peak at the 6th and 7th weeks either late December to mid January, and off .
can then return to the mad cow, avian flu as migratory birds are coming back, and perhaps of companies with more diverse topics as health policy, research, the fight against poverty, the water, and the rest. "We're not lying"


"Cough is not influenza, Influenza is not all! "



References 1. New England Journal of Medicine Vol 361 No 20 12 November 2009 (4 articles on the flu)
2." The World "dated November 30, 2009
3." The world "dated December 2, 2009
4." Pediatrics ICU Clermont-Ferrand ", Reference Center for Auvergne (personal communication)

Keywords: A (H1N1), Children, Influenza, pregnancy, pandemic, resuscitation, ICU, USA, Argentina, Australia, New Zeland, France, Auvergne,

Updated: December 25, 2009

Miniature Canoe Blueprint

Influenza A (H1N1): Panic "Vaccine Palace": "the great anything. "


Rien ne va plus for the vaccination of influenza A 2009.
The French are not so docile. As they were reluctant , they were scared of talking only severe cases and deaths. So they rushed into the vaccination centers are overwhelmed. The police had to intervene. The guidelines are changing every day. The vaccine without adjuvant was acclaimed by the French granted up to 9 years old yesterday, today, 2 years, and tomorrow? because stocks are limited.
To accelerate the campaign, we continue to neglect the GPs and pediatricians, but we appeal to the Army.
The objective is to vaccinate 250,000 people per day.

Let's make a quick calculation: With
60 million French , must be 240 days or 8 months , working Saturdays, Sundays, public holidays, Christmas and the Year, and with a single dose. There will therefore be finished next summer. Including a side effect of concern for this vaccine is 100 000 600 complications.

If we do that vaccinia 6 million individuals at risk (Large obese, heart failure, respiratory, immune deficiencies and some others as and when our knowledge), on schedule they would be protected in 24 days with a risk of complications 60.
But who knows people at risk ? CPAM does not have access to diagnostics, she knows that the requirements and diseases supported 100%. His estimate is necessarily approximate. As for the Army, so bright it is, it is not known for his exploits in preventive medicine, this would be!
It is therefore imperative to appeal to general practitioners and pediatricians who know all this and more are preferred by patients. "Why continue to row when you attack the cliff?"

What is the flu in the world?

For USA, a small outbreak in May and June but with 40 000 cases and 400 deaths in extrapolating the cases published in the NEJM. (1), which is a bit risky I grant you. This continues but slows. (2) In

Australia : outbreak in June, July and August, with 67 deaths, 86% were carriers of risk factors. (1) In

France: it is estimated the number of cases to 2.76 million, with 86 dead. (3) is so little that is surprising.
These estimates of 2.76 million cases are unreliable because there are actually all kinds of pathologies.

In pediatrics at my office all day I see children who have:
- Fever 39 ° reduction with or without cough normal examination: not influenza
- Fever 39 ° with angina white (viral): so no flu
- fever with fatigue and recovery "miraculous" in 1-2 days: not influenza
- fever with runny nose, in nursery or school: nasopharyngitis = not influenza.
-fever with a horrible sore throat that may require antibiotics and sometimes vomiting.
I do not quote anyone who cough without fever, gastroenteritis, ear infections and company ...
I almost never prescribe antibiotics, Tamiflu once * for a child 8 years which was really bad (with healing "miraculous" the next day and was arrested Tamiflu *) and no hospitalization.

I feel like I have seen less than 10 "flu" in recent weeks while in January 2009, I had seen close to 200 a week (and month flu 2005 to April 2009) in the article September.

add that for a definitive diagnosis must be taken to the hospital and it costs between 200 € and 300 non-reimbursed, so no voluntary for "use science"!
" civic spirit is lost " ! but the child heals anyway, so ... I note however that

may close classes and even entire school when there are 3 or 4 colds coughing ... " caution is part of valor"

What should happen ?

in Australia: it happened this way: (1)

image "NEJM" from 12/11 / 2009 p.1931





the epidemic began in early June, the peak in July and late August.

currently in France, (2)

image "Le Monde" of 30 / 11 / 2009




It is difficult to know where is the epidemic . Experience of my Cabinet and Australian history, I remember the feeling that one is rather at the beginning and the peak is expected to arrive in late December and mid January. But I do not read (alas) in the mark coffee and I do not handle easily the pendulum. Damage.

Conclusion:

As athletes say, "we must return to basics"
It was wrong and we will not succeed. It's mathematical. The Army and the students will change nothing.
"The ship sways in the storm, reducing the wing, and rectify the course" ..
They must vaccinate people at risk who wish , their doctors know. Benefit from their knowledge.
Let's stop people panic healthy . They vaccinate quietly if they wish.

"86 for 2 Dead, 76 million cases this is sad but very few (1 per 30 000), probably less than road accidents in the same time."


References:
1. New England Journal of Medicine Vol 361 No 20 12 November 2009 (4 articles on the flu)
2. "The World" dated November 30, 2009
3. "The World" dated December 2, 2009

Keywords: A (H1N1), children, flu, pandemic, panic, risk, vaccine, general practitioner, pediatrician

Denise Milani T Streaming

The final session, Eddy Mitchell cover (11/29/2009)

Reciever Upconvert Stereo 5.1

Hello Doctor, I just got the paper. Should my child be vaccinated against the flu?

now, "safety", television and radio help, I am flooded with phone calls " just a little intelligence "

the current flu is not so common. It is neither more nor less nasty than usual flu according to The New England Journal of Medicine from November 12, 2009. Complications are rare and mainly concern the holders of severe chronic diseases.
What is at issue is not the vaccine but the WHO policy, our country and lack of transparency, scam, scam and corruption.

Child or adult? little difference


It is consistent to vaccinate you if you meet one of the following conditions:

Have 6 months to 3 years ( and a risk factor, it does not drag) see flu Argentina
Have a severe heart disease or lung cancer, diabetes (and your doctor knows you well). Have
low immunity (immunodeficiency, long-term oral corticosteroids, chemotherapy?).
Obesity important (major risk factor in the U.S. and Australia)

It is less coherent get vaccinated if you meet one or more of the following conditions:


never vaccinated against seasonal influenza previous years. This is not your thing
Hepatitis B Vaccination unwanted yet more dangerous than the flu,
You smoke: you like the risk because tobacco kills more than all the rest.
You drive fast and avoid transport (Slow down the road kills a lot).
You're not worried because of the flu. (With all that said, there would be enough yet!)
Do not want this vaccine. (All the better that's good, It "Panic in vaccine Palace , there are too many candidates. Where are the vaccines?)
Are you pregnant?: the text is made: it was very difficult because it is very complex. Click here .

"Anyway you are free. This vaccine is not mandatory, probably not dangerous at worst useless, and tell you that whatever you do, you could have done otherwise."

"And if you smoke (especially in the car!), It is more efficient stop smoking , to live well and long, that getting vaccinated against the Flu! "

If you think you have a risk factor and you Not sure what to do, consult your doctor. By telephone, the doctor can stick to generalities. Medicine is difficult enough when you have people in front of you, by telephone, it becomes hazardous. Avoid

This can be very sensitive updated at any time based on evolving knowledge

Last updated on 25 December 2009.

Stretchers In The Beginning

Pregnancy and H1N1 vaccine to do?

We approach is an extremely sensitive subject and complex. Sensitive because it is an unborn baby, because the complex immunological status of pregnant women is still very mysterious. What comes to
a pediatrician in this case?
The gynecologist who sees pregnant women, is it not better placed?
No, e follows your gynecologist pregnancy and is trying to deliver the baby the most wonderful, but immunology is not his cup of tea. The immunologist
? Yes it is very hard, but how will you meet?
The pediatrician is at the crossroads between mother, father, child. It can help you sneak.
Anyway I try, to the best of my ability and my knowledge.

What is the status of a pregnant woman an immunological point of view?
A pregnant woman has received the father's sperm, which, combined with an egg, gave an "egg" which will turn into an adorable baby. Therefore welcomes the mother this fetus, future infant. This is similar to a transplant.
When we make a skin graft if the donor is not compatible, that is rejected in 8-10 days. Off the baby is 9 months tolerated. At 9 months, it seems "rejected" and the delivery takes place.
pregnancy was achieved through a process of immune tolerance during which the mechanisms of graft rejection are put to sleep.
same time the baby is tolerated, many other "things" are accepted: Toxoplasma transmitted not undercooked meats, Candida albicans fungus, which gives the B streptococcus and others.
pregnant woman no longer rejects what is foreign.

is also why it is minimally responsive to vaccines. It is not clear how effective are the vaccines. Although the last ten years, advocates vaccination of pregnant women are still quite ignorant of their effects and 10 years is very short.


How effective vaccines for pregnant women?
To my knowledge, there is no serious study on the effectiveness of vaccines in this situation because it is ethically impossible to recruit pregnant women to study the effect of an injection of vaccine. Of course, in the series "Be modern", some vaccinate pregnant women for two reasons apparently laudable, then protect them and their babies . But this is very recent. How many times have we not seen great trials, brutally interrupted? In time pediatrician, I believe that exceptions linked to an individual situation particularly serious, it takes about 20 years back to accept a new treatment for a product on individual growth, but also physical brain. For vaccines in pregnant women, has mostly been limited to study the case by mistake a vaccine was injected, and the only question that holds the attention then is: how is the baby?
frantic lobbying of private health systems, laboratories and insurance in the USA-probably in Europe, but we talk less - not greatly increased our tranquility. (See reference section of the World)
The only publication that I could find on the database in the NEJM (see below) on a limited study done in Bangladesh in 2008 ( why Bangladesh when everything was so simple in the U.S.? probably because this country has an outstanding medical facilities as well as its legal system, which made everything easier ). 340 pregnant women were vaccinated with reduced flu in mothers (but for doing my own research on small series of Parisians in easy to follow, I wonder how we can effectively monitor 340 women in a country as impoverished as Bangladesh.) And it was a Glaxo vaccine , so a study funded by the laboratory. can therefore eliminate this highly suspicious study. Would I be grumpy or bad language at the moment? I no it's not so good character!

Presumably pregnant women the vaccine is less effective. More when it is a new vaccine, nobody knows anything. What

toxicity of vaccines for mom and baby?
In most cases there is no problem (remember that the incidence of Guillain Barre syndrome during the U.S. influenza vaccination in 1976 was 1 in 56 000 vaccinations). But statistics do not count if it's your baby, especially there is no large series. Will you try saying the Bank? Would you take a risk when you do not know whether the vaccine will protect you?

Abstract:
Pregnant women are slightly more at risk but not more than other flus and what they propose is not rated for a company wide scale. I can not decide for you because there is no right answer.
If you do not know what to do, give you 15 days. In 15 days we have to experience some side effects.

References:


Effectiveness of Maternal Influenza Immunization in Mothers and Infants . New England Journal of Medicine (NJEM) 359 :1555-1564 October 9 2008 NUMBER 15 (this study in Bangladesh Glaxo flu vaccine uses a coincidence no doubt) (NB: access to the full article is available to subscribers)

New England Journal of Medicine Vol 361 No 20 12 November 2009 (4 articles on the flu)

A STEP HEHEAD, Infant Protection Through Maternal Immunization.'s Pediatric Clinic of North America 47 No. 2 April 2000 449-463
The Lobby will not disarm. Interview Wendel Porter Former Director of Communication of a giant U.S. health insurance "Le Monde" dated Tuesday, November 24, 2009 (NB access to the full article is available to subscribers)



"Should we vaccinate pregnant women?" I do not think anyone can answer this question. The mother herself will decide ultimately. A poker player must know, but what does he know of immunology, development of fetuses and the affect of mothers? "

Article may be changed.
Updated November 26, 2006 marked
The next topic talk about the flu in the U.S. and Australia and New Zealand in France, Auvergne because the NEJM (always him) of 12 November published a synthesis of these two countries. I have also used data on pregnant women to shape my opinion. Leave me a little time, it is in English very technical stuffed percentage, and I have my awesome to see young patients in consultation and intaglio and life itself! Good day!

Speech For Work Anniversary

The purpose

While the canvas and the old box febrile media have excited their characters on the hackneyed subject of "horseplay, ugly game" and, in this case, a set of m ... erde, play naughty! I focus on the first application of the Treaty of Lisbon. Yep! much less attractive, but far more fundamental to our collective destiny.
I was a fervent, passionate defender of the stillborn constitutional treaty, as to confuse me with some past affection, but I have always denounced the inconsistency process envisioned by leaders too sure because European: bringing twelve countries BEFORE you change institutions to suit the enlarged EU. This inconsistent cart before the horse has wasted a few years after the effective sovereign choice evolved into a referendum plebiscite failure. First act of a boondoggle orchestrated for nothing: the European elections last June have not confirmed the support of the people for parties who had defended the rejection of the treaty. QED, you could just wait ... The image of José Bové phagocytosed by the truculent Cohn-Bendit completes the demonstration of an opportunistic position instead of an actual ex applicable canonists.
no better on the other side? Close to the thinking: it vegetate in confabulations opaque negotiating shameful that spoiling the original spirit of a lively two-headed incarnation with a new European ideal perspective. Because they are the heads of state and government who vote for President of the European Council and High Representative for foreign affairs, this franchise can take care of all the pretenses, the incredible pressure on the other, so-called low exchange courtesies
... Yes, section 9B of the Lisbon Treaty (I 22 rehash of the late Constitution) only uses the verb "elect" without associating the Democratic triptych, "universal, equal and secret, but it does allow the rulers to divert the minds of the election with voting haggling and compromise, thick? The " majority" which refers to the treaty seems to focus more capacity conchier the first principles of every election that standard calculation.
Without commenting on the profile of Herman Van Rompuy and Baroness Ashton of Upholland, one can simply deplore the denial of absolute democratic basis in the electoral process that led them to their respective positions.
As proposed by Thierry Chopin of the Robert Schuman Foundation (that's a personality missing!), ECT would be beneficial to elect this president and this high representative elected by the parliaments of member states with respect secrecy of a vote not negotiable. That would restore the mouth to a Union that no longer seems have a purpose other than the management of petty interests. The Heads of State and Government finally appear the worst position to decide in conscience, and without being influenced by something other than their beliefs rooted, who should preside over the EU and conduct diplomacy. The cutesy
is what multiple instances of Europe, like a newly Barroso appetizingly in return for five years. No new breath to the Commission. No personality big enough to resist the inertia of the member states.
Meanwhile, I do not know what the crisis is global with his snub-nosed way, in the crosshairs, a set of states insolvent followed by a final implosion of the financial system.
While salopiots overpaid Baball continue to push with their feet, hands, ears, it distracts from a population of shenanigans and drama simmering ...
No Goal exciting, nothing to football: a nihilism effective tomorrow ... or even one! Absurd.

Trailer Permit Ontario

Chupee - Cocoon (cover ukulele, 19/11/09)

Mirena And Copper Taste

Rider lost his life in the spray

The end banquet in 2009, not the trappings of j oyeux feast in the small end insurgent Gaul goscinnyenne-Uderzo. We nibble what you can with the hosts we deserve.
Old bloated faces further cluttering the TV trays so that justice. As the paragon of virtue venerable Chirac combines promotions: a faulty memory on the preposterous to sugarcoat the City of Paris; memories fertile in non-written disclosures, for large parts by a non negro ... His fictional political incompatibility, or even genetics, with the haughty Giscard d'Estaing is the erection Past resentments into a cult of hatred. Suppose that a gulf is needed between the snout poking chiraquien the panties of the Madonna and provocative ways to flirt Giscardian imaginary fashion icon Diana Ségur with ethereal. Calf's head has never held a dinette for flower girl!
side mug, the Pasqua post a grumpy since Justice has dared to condemn the farm, the bar in series to pad ill frequented. The former gunslinger Place Beauvau threat, f ustige, tramples. Having not been a term deposit Statement of the award, he was able to deploy his artillery in the media, splitting a "you have a good look! "To evacuate the main charge. Exactly so! A mere glance would have sufficed if the offense was fishy mouth in France. Until conviction, his posture was the move-it-is-nothing to see! Since the court decision, volte-face: all the others in high places, knew too! The discrepancy is systematic ... the beginning of a degeneration of the nervous system, right?

So do not stay in such contaminating company. A crumbling reprobate, hoary pampered, to balance the momentum literature. Two figures Audiovisual: one that is fragile body betrays and old too soon, the other for eighty spring bloom, cheerful, and without shortness of breath.
Polac Michel answered some questions for a documentary on literary programs on television, Writers on a platter. The face ravaged by a semi-paralytic attack, he was a shadow of Physics, who feared him as no longer control his mind, time mowing his relentless bright faculties. Close your eyes and let yourself be carried by a tone of voice still faithful to the old flamboyance of Library Pocket to Right of reply. Pages television to enjoy without restraint to perpetuate the colossus of the heart and intelligence.
Point physical wreck at Pierre Bellemare. The accumulation of decades ennobles be achieved without the ability to self-mockery. The unclassifiable narrator, host, vendor on cathodic tries to boards showman. Confessions of a passion for drama, he meets this challenge with humility combatant. Always in tension for a project to success, he made a third age of the first moment. The obvious commitment to stretch easily over time, make the stay prégnant an extension of a life well-being of each instant.Qu it is good to finish with enthusiasm, by Toutatis!

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Digestive absorption of water: intestinal physiology applied to the treatment of gastro-enteritis

The human digestive tract is a very complex machinery whose purpose is to allow digestion and absorption of food we eat. It begins with the mouth with teeth that grind food to make them more digestible. Then the food passes into the stomach where they are subjected to acid digestion and enzymatic (as well as enzymes for detergents greedy destroy stains, our enzymes break up food into small pieces), then pass into the small intestine so called because it is not big but is 7 to 8 meters long. This part of the intestine is crucial because this is what happens the absorption of almost everything, water, minerals, proteins, sugars, fats. In this article we will only consider the absorption of water.

To indicate the quantities we will take as a reference adult body surface area = 1.73 m² and a baby 1 year (10 pounds) with a body surface of 0.5 m². flows are indeed proportional to the surface of the skin and not by weight.


Where does the water absorbed by our intestines?

The water we drink and food that contained in food represents only 2 to 3 liters for an adult and a bottle for an infant of 10 kg. Contrary to what one can imagine that our water intestine absorbs or 9 to 10 liters per day for adults and 2.5 to 3 liters for an infant comes primarily from our body . It runs in a loop especially at mealtimes. This is the enterohepatic systemic water!

Liquid (liters) Adults Children 1 year
dietary 2-3   1     
Secrétions  digestives             
estomac                                    1,5                            0,5     
Foie                                           0,5         0.2
Pancreas ; 1 to 1.5 0.4 to 0.7
Small Intestine 3 , 0.5
proximal ;
Total 9 to 10 2.5 to 3

Thus we see that in the Child the flow of water is much more important , since a third of its weight in water is secreted and then reabsorbed immediately within 24 hours. It is understandable that any disturbance inputs (lack of water, vomiting) or losses (vomiting, diarrhea, heat stroke) can lead quickly to a critical situation. Therefore diarrhea in infants is rightly a high risk situation, although fortunately, things change very often.

Whither water?

The water we drink or is contained in foods (milk and its derivatives are mainly composed of water) is present in the stomach. It is modified to have a composition quite close to the plasma that makes up our blood. This is why "pure water" remains longer in the stomach. It mixes with secretions different and requires small amounts in the small intestine.
is the small intestine that is responsible for 90% absorption of the water it receives.
It is here that the absorption process instead. The structure of the small intestine is made crypts and villi, which increase the exchange surface between the bolus and the tissue. Specialized cells in the absorption of nutrients are present in enterocytes that their surface microvilli, which, as the villi tissue, their role is to increase the exchange surface. Thus, we consider that the human gut has a contact surface with the bolus equivalent to the area of two tennis courts (400 m2).

Brush border electron microscopy and scanning and it is this cell structure and the presence of villi in the intestinal tissue which increases the surface exchange

How is the reabsorption of water?

There is an extremely effective mechanism and practically always functional: The coupling between the absorption water, salt and glucose . It is the enterocyte , specializing in digestive cell absorption is responsible for this work.

brush border











Glucose ( G) is the grape sugar. It is abundant in table sugar ( G + F ructose) and in starch which is the component ( G + G + G) ... Starch is found in wheat (pasta), the rice, potatoes, etc ...
Na is sodium found in table salt (Na Cl).
Water is everywhere at the tap, milk, fruit, and all foods

The co-transport glucose-sodium-water:
Water arrives in the intestine of side of light (lumens). She is accompanied by glucose and sodium. At the microvilli of the brush border of carriers are "active" specific glucose and sodium (red) . These transporters use energy. Sodium is sent, with water in the capillaries and throughout our body through "sodium pump" located on the other side of the cell ( green) on the basolateral membrane. This reaction produces the necessary energy.

This mechanism is almost always in full force and effective . He should try to stimulate it in cases of acute diarrhea. That's why we use re-hydration solutions we give often and split to avoid exceeding the capacity the diseased intestine. These solutions were initially developed for the treatment of cholera which is a model of secretory diarrhea.

Vibrio cholera: a bacterium is flagellated which moves in contaminated waters
Photo University Bordeaux

bacillus cholera toxin stimulates the secretion mechanisms. It causes diarrhea profuse 5 to 8 liters a day and occurs in countries where the infra structure does not allow for infusions. In addition, the infusions were trying to compensate for the losses but the diarrhea remained the same. By simply drinking a mixture of water, sugar and salt, we were surprised to see that "those who drank had stool less abundant than those who did not drink" and healed faster . had been stimulated absorption mechanisms.

implications of such knowledge on the treatment of gastro-enteritis:

must therefore stimulate the mechanisms of absorption, which are mostly intact : two principles that we will develop in another chapter : rehydrate and nourish. Since we're on the water, see the side re-hydration: at will, split, often.


past, we used the form of soup, carrot containing up to 4.5% sugar. What was remarkably intelligent. The carrot soup is made with 500 g of carrots per liter of water, which resulted in a solution containing 1 gram of sugar per liter as our plasma and a little salt . In addition, the core bring fibers that chelate bile salts and reduce their power of irritation in the colon that does not like them at all. . Water lightly salted rice , share the same principle as the rice is mostly starch that is converted into glucose. Our grandmothers were very strong!
solutions Oral rehydration (ORS) swept the carrot. You could almost regret but "it is progress! What

the rest is water that is not absorbed by the small intestine?
Good question I almost forgot!
Colon is just after the small intestine in the digestive tract and measures approximately 1.5 meters long. Its role is mainly to store the waste, recover water, maintain water balance, and the absorption of some vitamins such as vitamin K. According to the composition of water varies from plus or minus 5%, the stool can be liquid or molded. But the diarrhea of colonic origin have not plenty of diarrhea small bowel.

NB
This article is just a glimpse of a small portion of bowel function vis-à-vis water. Do NOT attempt to treat your own children in case of acute diarrhea. The hydration status should be evaluated by a doctor. Even if you saw a doctor and you're calmer, get up 2 or 3 times during the night to watch the baby and offer him a drink, without forcing .

We see again the " acute diarrhea or gastroenteritis " . The simple rehydration not enough


Acknowledgements: I thank
Dr. Jehan-François Desjeux pediatrician who taught me everything about diarrhea when he worked with cholera toxin to developing solutions re-hydration. He became Director of Research at INSERM and Professor at the INAM.

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