on 24-Mar-2020 (Tue)

L'examen physique cherche des signes de gravité :

• Syndrome septicémique (fièvre > 39 °C ou hypothermie, frissons) ;
• Choc septique ;
• Perte de poids (à exprimer en pourcentage du poids habituel). Les pertes digestives par diarrhée comportent de l'eau, du sodium (environ 50 mmol/L), du potassium et des bicarbonates. Les vomissements aggravent les pertes et limitent les apports ;
• Déshydratation extracellulaire : soif, oligurie, hypotension artérielle, tachycardie, veines jugulaires plates en position semi-assise, pli cutané, cernes périorbitaires, hypotonie des globes oculaires ;
• Déshydratation globale avec, en plus des signes de déshydratation extracellulaire, des muqueuses sèches (face inférieure de la langue), et parfois des troubles de la vigilance

Un patient ayant une infection par le VIH contrôlée par le traitement antiviral et un taux de lymphocytes CD4 supérieur à 200/mm 3 peut être exploré et traité comme un immunocompétent.

En dessous de 200 CD4/mm³ , l'examen parasitologique doit inclure la recherche par techniques spécifiques de Cryptosporidium et Microsporidium.

En dessous de 100 CD4/mm³ , les colites à CMV sont possibles et peuvent être diagnostiquées par la mesure de la charge virale du CMV dans le sérum et par endoscopie colique sur des biopsies avec recherche également d'inclusions virales

Au-dessus de 75 ans, la mortalité par diarrhée infectieuse n'est pas négligeable, elle est liée :

• Aux accidents de déshydratation pendant la diarrhée
• Aux conséquences à moyen terme d'une hypoperfusion des organes vitaux pendant la phase de déshydratation responsable d'un pic de mortalité survenant 8–10 jours après le début de la diarrhée alors que celle-ci a souvent disparu
• Et enfin aux formes graves de colites à Clostridium difficile (en particulier dues au nouveau variant du germe, plus agressif, endémique dans le continent américain et aujourd'hui en Europe).

Cleave bond of κ casein → sugar tail is soluble but remaining para κ casein still bound to α and β casein

Each isonome controls a short-term memory in each of many agencies. For example, suppose we had just been talking about a certain apple, and then I said, "Please put it in this pail." In this case, you would assume that the word "it" refers to the apple. However, if we had been discussing your left shoe, you would assume "it" referred to that shoe. A word like "it" excites an isonome whose signal has no particular significance by itself, but controls what various agencies do with certain recent memories

"polynemes," are involved with our long-term memories. A poly- neme is a type of K-line; it sends the same, simple signal to many different agencies: each of those agencies must learn, for itself, what to do when it receives that signal. When you hear the word "apple," a certain polyneme is aroused, and the signal from this polyneme will put your Color agency into a state that represents redness. The same signal will set you;. Shape agency into a state that represents roundness, and so forth

consider two different situations. In the first case, I hold up an apple and ask, "What is this?" We've already seen how such a sight could lead to activating polynemes for words like "apple" or "fruit." In the second case, there is no apple on the scene, and I ask instead, "What do we call those round, red, thin-peeled fruits?" Yet this time, too, you end up with an apple thought. Isn't it remarkable that one can "recognize" a thing merely from hearing words? What is there in common to our recognizing things in two such different ways? The answer is that inside the brain, these situations really aren't so different. In neither case is there a real apple in the brain. In both cases, some part of mind must recognize what's happening in certain other parts of mind

It islempting to blame this on the ambiguity of words, but the problem is deeper than that. Thoughts themselv es are ambiguous

Uv ttri, ii-. yo,r'u. managed to express yourself, you're no longer in the state you were before; your thoughts were a-blguous to begin with, and you never dld succeed in expressing them but merely replaced them with other thoughts

We can tolerite the ambiguity of words because we are already so competent at coping with the ambiguity of thoughts