Pragmatic diabetes management in nursing homes: individual care plan.

Although the management of diabetes as a simple entity has been extensively developed, there is a dearth of evidence in elderly, frail patients with multiple comorbidities and polymedication. This population represents a large proportion of the residents of nursing homes (NHs). As a multidisciplinary group of French experts (geriatricians, endocrinologists, diabetologists, and general practitioners) with practical experience in this area, which is growing in magnitude throughout the world, we convened to compile pragmatic, simple advice on the management of elderly, frail diabetic patients.

The clinical variability of maternally inherited diabetes and deafness is associated with the degree of heteroplasmy in blood leukocytes.

Context: Maternally inherited diabetes and deafness (MIDD) is a rare form of diabetes with a matrilineal transmission, sensorineural hearing loss, and macular pattern dystrophy due to an A to G transition at position 3243 of mitochondrial DNA (mtDNA) (m.3243A>G). The phenotypic heterogeneity of MIDD may be the consequence of different levels of mutated mtDNA among mitochondria in a given tissue.

[Sarcoidosis during the treatment of hepatitis C by interferon-alpha and ribavirin: 2 cases].

Introduction: Interferon-alpha (IFN alpha) used to treat chronic hepatitis C can be responsible for some side effects. We report two cases of sarcoidosis which appeared in patients treated with IFN alpha and ribavirin for chronic hepatitis C.

Exegesis: A first patient, treated for 5 months with IFN alpha and ribavirin because of chronic hepatitis C, after the failure of a first treatment with IFN alpha alone, was hospitalized for dyspnea.

Observation and treatment of polycythemia vera. Role of the specialist and of the practitioner.

The respective roles of general practitioners and of consultants, for the care of patients treated for polycythemia vera, deserve to be defined in order to improve the detection of late therapeutic complications. The involvement of the general practitioner in the care of patients can only reinforce his knowledge of a rare disease and his interest in its detection. Three factors can influence the methods of supervision and the respective roles of specialists and general practitioners: the easy access to the reference centre, the evolution of policy of medical Insurance Authorities refunding travelling expenses, the quality of contacts between the specialist and the practitioner in charge.