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Stroke-associated pneumonia (SAP) is a common complication in patients with acute ischemic stroke (AIS). This study explored the potential relationship between serum vitamin D levels and SAP. This study recruited 863 consecutive AIS patients. In-hospital SAP was defined as a complication that occurred after stroke, during hospitalization, that was confirmed radiographically. Serum vitamin D levels were measured within 24 hrs of admission and the patients were divided into vitamin D sufficient (>50 nmol/L), insufficient (25-50 nmol/L), and deficient (<25 nmol/L) groups. In this study, 102 (11.8%) patients were diagnosed with SAP. Compared to the patients without SAP, patients with SAP had significantly lower vitamin D levels (P = 0.023). The incidence of SAP was significantly higher in patients with vitamin D deficiency than in those with vitamin D insufficiency or sufficiency (21.2% vs 16.2% & 9.5%, P = 0.006). After adjusting for confounders, vitamin D deficiency and insufficiency were independently associated with SAP (OR = 3.034, 95% CI = 1.207-7.625, P = 0.018; OR = 1.921, 95% CI = 1.204-3.066, P = 0.006, respectively). In multiple-adjusted spline regression, vitamin D levels showed a linear association with the risk of SAP (P < 0.001 for linearity). Reduced vitamin D is a potential risk factor of in-hospital SAP, which can help clinicians identify high-risk SAP patients.

\"In popular memory, Franklin Delano Roosevelt was the quintessential political \"natural.\" Born in 1882 to a wealthy, influential family and blessed with charisma, he seemed destined for high office from birth. Yet for all his gifts, the young Roosevelt nonetheless lacked depth, empathy, and strategic ability. Those qualities, so essential to his success as president, were skills he acquired during his eight-year struggle through illness and recovery. Becoming FDR traces the riveting story of the crucible that forged Roosevelt's political ascent. Soon after contracting polio in 1921, the former vice-presidential candidate was left paralyzed from the waist down at the age of thirty-nine. He spent nearly a decade trying to heal and rehabilitate his body and adapt to the stark new reality of his life. By the time he reemerged on the national stage, his character and his abilities had been transformed. He had become shrewd by necessity, tailoring his speeches to a new medium-radio-that allowed him to reach listeners far beyond his physical presence. Suffering had also taught Roosevelt compassion, cementing his bond with those he once famously called \"the forgotten man.\" Most crucially, he had discovered how to find hope in a seemingly hopeless situation-a genius for inspiration he employed to motivate Americans through the Great Depression and World War II. The polio years were transformative too for Eleanor Roosevelt, whose at-first reluctant appearances as her husband's surrogate sparked a drive to become a force in her own right. Tracing the physical, political, and personal transformation of the iconic president, Becoming FDR is the story of a man who found his strong, true self in the depths of a crushing challenge-and re-emerged with wisdom he would use to inspire the world\"-- Provided by publisher.

Les institutions, destinées a accueillir et a humaniser des situations extrêmes de la subjectivité, sont influencées par des cadres sociaux, politiques et économiques, engendrant des logiques de tri souvent inconscientes. A travers trois exemples cliniques, les auteurs examinent une figure marginalisée des institutions : ces patientes incarnant un « féminin monstrueux », « repoussant », en décalage avec Pidéal du « patient autonome », et de ce fait difficiles a accueillir. Le processus thérapeutique est examiné sous angle d'un arrimage a la recherche, a l'écriture en double et à la groupalité. Le féminin asilaire, Panalyse du statut d'objet passif-jouissant de ces trois figures cliniques et la capacité de la clinicienne à s'ouvrir sans honte sur la communauté des pairs ont été des facteurs déterminants pour contourner pourrissement, exclusion et reproduction du cloaque.

In eight innovative sessions, Henderson, Hanson, and Reynolds provide sage advice, numerous case studies, a wide variety of assessment tools, intructional guidelines, and practical exercises to educate nursing home staff about care of the dying.

We report 3 patients with coronavirus disease who had a decline in respiratory status during their hospital course that responded well to intravenous steroids and interleukin-6 receptor antagonist therapy. These patients later showed development of persistent hypoxia with increased levels of d-dimer levels and were given a diagnosis of pulmonary embolisms.

Profile of fungal species involved in superficial cutaneous mycoses in Lomé (Togo)Introduction.The diagnosis of superficial cutaneous mycosis (SCM) is very frequently evoked during dermatological consultations in tropical zones, but mycological confirmation is very rarely performed routinely. The aim of this study is to describe the profile of fungal species encountered during dermatology consultations in Lomé (Togo), to establish their relative frequencies and, above all, to discuss their responsibility in the lesions observed.Method. This was a descriptive study carried out from February 2020 to March 2022, involving patients presenting lesions suspected of MCS, seen in dermatological consultations. Three dermatological consultation centers, all located in the city of Lomé, served as the setting for case enrollment. Each patient consulted who met the inclusion criteria (i.e. presenting a lesion of SCM and not under antimycotic treatment or having respected an adequate therapeutic window) had a sample taken from the suspected lesion(s). Samples were taken on site and analyzed at the Mycology Laboratory of CHU Sylvanus Olympio for biological confirmation.Results. During the study period, 565 patients were enrolled and sampled, of whom 364 (64.4 %) were women. The median age was 31 years, with interquartile range (IQR) from 22 to 41 years. Direct examination and/or culture were positive in 84.7 % (479/565) of cases. The main fungal species identified were yeasts (63%), including Malassezia sp. (23.8%), other yeasts (39.2%), but also dermatophytes (22.8%), with Trichophyton mentagrophytes as the predominant species (10.8%), and molds (13.1%) including Aspergillus niger and A. fumigatus (3.1% each). Pseudo-dermatophytes were found in only 1% of cases. Fungal associations were also noted in 3.5% of cases. The most frequent associations were C. tropicalis, A. fumigatus and T. mentagrophytes-C. albicans, each found in 0.5% of cases.Conclusion. The spectrum of fungi isolated in suspected cases of SCMs in Lomé is broad, but not all can be held responsible for the lesions observed. This diversity makes it essential to take a mycological sample for accurate identification of the fungus in any suspected case of SCM. Depending on the species isolated, this will enable treatment to be tailored to the patient’s needs.Profil des espèces fongiques isolées lors de consultations dermatologiques à Lomé (Togo)Introduction.Le diagnostic de mycose cutanée superficielle (MCS) est très fréquemment évoqué lors des consultations dermatologiques en zones tropicales, mais la confirmation mycologique y est très peu réalisée en routine. L’objectif de cette étude est de décrire le profil des espèces fongiques rencontrées à l’occasion de consultations de dermatologie à Lomé (Togo), d’en établir leurs fréquences relatives et, surtout, d’en discuter leur responsabilité dans les lésions observées.Méthode. Il s’agit d’une étude descriptive réalisée de février 2020 à mars 2022. Elle a porté sur des patients présentant des lésions suspectes de MCS, reçus en consultation dermatologique dans les trois services de dermatologie de Lomé. Les prélèvements ont été réalisés sur site pour les lésions fortement suspectes de mycoses et analysés au Laboratoire de mycologie du CHU Sylvanus Olympio pour une confirmation biologique.Résultats. Au cours de la période d’étude, 565 patients ont été enrôlés pour prélèvement. Trois cent soixante-quatre (64,4 %) étaient des femmes et l’âge médian était de 31 ans, avec un intervalle interquartile (IIQ) de 22 à 41 ans. L’examen direct et/ou la culture ont été positifs chez 84,7 % (479/565) d’entre eux. Les principales espèces fongiques identifiées étaient des levures du genre Malassezia (23,8 %), d’autres levures (39,2 %), mais également des dermatophytes (22,8 %), avec pour espèce prédominante Trichophyton mentagrophytes(10,8 %), et des moisissures (13,1 %) dont Aspergillus niger et A. fumigatus (3,1 % chacun). Les pseudo-dermatophytes n’ont été retrouvés que dans 1 % des cas. Des cas d’associations de mycètes ont été également notés dans 3,5 % des cas.Conclusion. Le spectre des mycètes isolés dans les suspicions de MCS à Lomé est large, mais tous ne peuvent pas être tenus pour responsables des lésions observées. Cette diversité impose donc la réalisation d’un prélèvement mycologique pour une identification précise du mycète devant toute suspicion de MCS. Selon l’espèce isolée, ceci permettra d’adapter au mieux le traitement.