Think Forward.

GERIATRIE : LA NUTRITION FACE AU VIEILLISSEMENT PHYSIOLOGIQUE DES PERSONNES ÂGÉES - PARTIE 1 3509

«QUAND ON AVANCE EN ÂGE, MIEUX VIVRE C’EST MIEUX SE NOURIR» L’équilibre nutritionnel de la personne âgée (PA) est plus précaire car tributaire de modifications physiologiques et de l’émergence de pathologies. Les personnes âgées ont tendance par ailleurs à diminuer leur apport alimentaire sans que leurs besoins énergétiques ne soient réduits : leurs réserves étant amoindries, tout incident rompt un équilibre déjà précaire et la dénutrition fait son apparition. L'IMPACT DU VIELLISSEMENT PHYSIOLOGIQUE SUR LA NUTRITION Avec l’âge, l’altération des perceptions des odeurs et du goût stimule moins l’appétit : la capacité discriminative s’affaiblit d’où une difficulté à identifier les aliments ; le seuil de détection des 4 saveurs de base augmente (multiplié par 11,6 pour le salé, 7 pour l’amer, 4,3 pour l’acide et 2,7 pour le sucré). Près de 400 médications (anti-inflammatoires, antidiabétiques oraux, inhibiteurs de l’enzyme de conversion…), des carences en zinc ou en vitamine B3, la cirrhose du foie ou la déshydratation perturbent le goût. La malnutrition aggrave ces déficiences, ralentissant ainsi le renouvellement cellulaire indispensable à la régénération des acteurs sensoriels. La perte d’appétit découle aussi d’une sénescence des glandes salivaire. Les aliments n’étant plus correctement imbibés, les molécules porteuses de saveurs appétissantes sont moins actives. De plus, la dégradation dentaire et la prédilection pour des aliments plus liquides diminuent les mouvements masticatoires ce qui va encore réduire cette sécrétion. La sécheresse buccale (xérostomie) est alors fréquente, exacerbée par de nombreux médicaments (diurétiques, benzodiazépines, antihistaminiques…), elle va favoriser les caries dentaires, les mycoses buccales et œsophagiennes, occasionnant des brûlures lors de l’ingestion et, in fine, gênant l’élocution et la déglutition. La muqueuse gastrique, en s’atrophiant, sécrète moins d’acide chlorhydrique, d’où une pullulation bactérienne consommatrice de nutriments (folates) et un retard à l’évacuation gastrique de 2 à 3 fois plus long, qui prolonge la phase d’anorexie post-prandiale. L’accélération plus importante chez la PA du transfert du chyme de la partie supérieure de l’estomac (le fundus) à la partie inférieure (l’antre) avec une distension précoce de cette dernière joue par ailleurs un rôle prépondérant dans le sentiment précoce de satiété. Un peptide, le CCK sérique (cholecystokime -pancreozymine), produit par le duodénum au cours du repas, stimule la sécrétion par le pancréas de la trypsine qui inhibe en retour la sécrétion de CCK. L’insuffisance pancréatique exocrine, liée à l’âge ou aggravée par une dénutrition, lève ce rétrocontrôle, d’où une production accrue de CCK à l’origine elle aussi d’une satiété précoce. La survenue plus fréquente chez la PA d’ulcères et de gastrites chroniques, en liaison avec une incidence plus élevée d’infection par Hélicobacter pylori, renforce encore le risque anorexique. Le vieillissement musculaire et la diminution du capital musculaire (sarcopénie) est un phénomène presque inéluctable qui commence à 40 ans pour l’homme contre 50 ans pour la femme. La perte -de 3 à 8 % tous les dix ans- s’accélère après 60 ans et réduit la musculature à 17% du poids du corps à 70 ans contre 30% à 30 ans. La composition en fibres du muscle se modifie : les fibres de type II, ou fibres blanches, à contraction rapide, mais peu résistantes à la fatigue, s’atrophient ; les fibres de type I ou fibres rouges, à contraction lente, générant peu de force, mais une forte endurance, sont moins affectées et leur densité serait même plus importante. Outre cette réduction de la force musculaire malgré une certaine préservation de l’endurance, le système nerveux contrôle moins bien ces contractions. Plusieurs facteurs génétiques, médicamenteux, nutritionnels ainsi que l’augmentation des cytokines (état inflammatoire provenant de l’accroissement de la masse grasse) conditionnent l’apparition de cette sarcopénie. Les hormones sexuelles joueraient aussi un rôle dans le contrôle de l’appétit au cours du vieillissement. La diminution des taux circulants de testostérone observée au moment de l’andropause induirait la perte d’appétit chez l’homme âgé et précipiterait le développement de la sarcopénie. À l’inverse, la réduction de sécrétion des œstrogènes à la ménopause protégerait les femmes de cette perte. Les répercussions de la sarcopénie sont considérables : risques infectieux par baisse des réserves protéiques nécessaires aux défenses immunitaires, chutes et fractures éventuelles compromettant l’autonomie de la PA… Un moindre volume musculaire expose aussi la PA aux troubles de la thermorégulation, la baisse de l’intensité du frissonnement qui en découle rendant la PA plus démunie face à l’exposition au froid. Dr MOUSSAYER KHADIJA الدكتورة خديجة موسيار Spécialiste en médecine interne et en Gériatrie en libéral à Casablanca. Présidente de l’Alliance Maladies Rares Maroc (AMRM) et de l’association marocaine des maladies auto-immunes et systémiques (AMMAIS), Vice-présidente du Groupe de l’Auto-Immunité Marocain (GEAIM) - REFERENCE MOUSSAYER KHADIJA Doctinews N° 25 Août/Septembre 2010, ACTUALISATION JUIN 2024 - POUR EN SAVOIR PLUS : La plupart des personnes âgees souffrent de maladies chronique le plus souvent d'origine auto-immune Les maladies auto-immunes résultent d’un dysfonctionnement du système immunitaire, censé nous protéger des agressions extérieures, qui va le conduire à s’attaquer à notre propre organisme. Elles constituent un important problème de santé publique du fait de leur poids économique et humain : 3ème cause de morbidité dans le monde après les maladies cardiovasculaires et les cancers, elles touchent en effet près de 10 % de la population mondiale et occupent le deuxième ou le troisième poste du budget de la santé dans beaucoup de pays. Enfin, dernier point méconnu mais pas le moindre, ces maladies concernent les femmes dans plus de 75 % des cas : une femme sur six en est atteinte au cours de sa vie ! Passons donc en revue ce que sont ces pathologies et les actions de l’associations AMMAIS UN PROCESSUS D'AUTODESTRUCTION DE L'ORGANISME Notre système immunitaire est composé notamment de cellules spécialisées comme les lymphocytes et de substances (les anticorps) chargées normalement de nous défendre contre toute attaque extérieure provenant de différents virus, bactéries, champignons et autres produits délétères. Lors d’une maladie auto-immune (MAI) ou à manifestations auto-immunes, des éléments de ce système se trompent d’ennemi et s’en prennent à nos tissus et cellules. Certains anticorps devenus nos adversaires s’appellent alors « auto-anticorps ». Au total, il existe près d’une centaine de ces troubles.
Dr Moussayer khadija Dr Moussayer khadija

Dr Moussayer khadija

Dr MOUSSAYER KHADIJA الدكتورة خديجة موسيار Spécialiste en médecine interne et en Gériatrie en libéral à Casablanca. Présidente de l’Alliance Maladies Rares Maroc (AMRM) et de l’association marocaine des maladies auto-immunes et systémiques (AMMAIS), Vice-présidente du Groupe de l’Auto-Immunité Marocain (GEAIM)


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AFCON 2025: Why Morocco Should Win Its Quarterfinal Against Cameroon... 422

The quarterfinal of the 2025 Africa Cup of Nations between Morocco and Cameroon, scheduled for January 9, 2026, at Prince Moulay Abdellah Stadium in Rabat, promises to be the hottest clash of the quarters. A matchup with the taste of revenge from another AFCON, the 1988 edition. But we're in 2025, and a lot of water has flowed under the bridges since then. As unbeaten hosts, the Atlas Lions display total mastery with 7 goals scored for just 1 conceded on penalty in four matches, outpacing the Indomitable Lions and their 6 goals for 3 conceded. This numerical superiority, fueled by Brahim Díaz's spark, El Kaabi's indomitability, a relentless defensive midfielder, a rugged defense, and home crowd advantage, positions Morocco as the clear favorite in an intense technical-tactical duel. Even if not deemed flawless by some, Morocco's run has been effective despite losing two key pieces: Saïss and, even more, playmaker Azzedine Ounahi. The Atlas Lions topped Group A with 7 points: a clinical 2-0 win over Comoros, an offensive festival 3-0 against Zambia, and a strategically understandable 1-1 draw against Mali, proving rare versatility. In the round of 16, a controlled 1-0 against Tanzania confirmed their solidity, with zero goals conceded in three of their four outings. This iron defense, led by trio Yassine Bounou, Nayef Aguerd, and Mazraoui, backed by tireless El Aynaoui, yielded only once on penalty to Mali. Overall, a +6 goal difference evoking the discipline of a team chasing continental glory at home. And Hakimi was only just returning for the last match played. This time, for the quarters, they'll face a solid but vulnerable Cameroon, marked by the team's youth and disjointed play in many phases so far. However, their margin for improvement is huge, and the metamorphosis and step-up could precisely happen here in the quarterfinal. The Indomitable Lions snatched first place in Group F with 7 points too: a precious 1-0 against Gabon, a hard-fought 1-1 against Côte d'Ivoire, and a laborious 2-1 over Mozambique. The two goals conceded in the group stage already highlighted collective defensive failings. Their quarterfinal qualification with a 2-1 over South Africa in the round of 16 showed character but also flaws: three goals conceded in total, including one from an individual error against the Bafana Bafana. Less sharp up front with only 6 goals, they rely on opportunistic realism, far from Moroccan fluidity. Morocco, meanwhile, benefits from Brahim Díaz, a maestro in the spotlight. He's likely living his golden age in the AFCON: 4 goals in 4 matches, a historic record for a Moroccan in a single finals, including a gem in the 64th against Tanzania. He's clearly responding to his club coach who seems unsure how to harness his genius. The first Lion to score in every consecutive match, the Madrid man excels in tight spaces, with Ayoub El Kaabi (3 goals) as his faithful, cutting lieutenant. Facing a solid Cameroonian defense with imperial but sometimes hesitant André Onana, this individual threat—even if small in stature: 4 shots on target per match on average—could tip a locked scenario, as in the round of 16 where his runs unsettled the Taifa Stars. Overall technical mastery and ball dominance also tilt toward Morocco, who crush the collective stats: 2,184 successful passes, an absolute record, 89% accuracy, and 71% possession against Tanzania—an ocean of control. Achraf Hakimi, back with a bang and an assist, will surely animate a hellish right flank, while El Khanouss, just settling in, dictates the midfield tempo despite Azzedine Ounahi's absence. In contrast, Cameroon lags at 77% accuracy and 43% average possession, struggling in quick transitions with Frank Zambo Anguissa as their sole pivot. This technical asymmetry promises a prolonged siege by the Atlas Lions on the opposing box. With Amrabat as sentinel to handle Anguissa, it's game over. Other facts and assets also favor the Atlas Lions: psychological and historical factors could be decisive. Euphoric hosts, the Moroccans are riding a 23-match unbeaten streak and a fired-up crowd in Rabat, where the atmosphere will echo the 2022 World Cup. The overall head-to-head favors Cameroon with 6 wins, 5 draws, 2 losses in 13 duels, untouchable in AFCON with 2 wins and 1 draw, but the last two clashes tilt to Morocco: a 1-0 in 2019 AFCON qualifiers and a humiliating 4-0 at the 2020 CHAN. This is thus a generational arm-wrestle for sure, but Morocco's freshness with fewer minutes played and perfect adaptation to the climate outweighs the Indomitable Lions' experience. These combined elements forge an ideal scenario for a conquering Morocco chasing a second star, to be decided at the final whistle at Moulay Abdellah complex, Friday around 10 PM. While a surprise elimination is always possible in a tournament as tight as the AFCON, Morocco holds today's strongest statistical signals for victory: ✔ Best overall offensive output ✔ Only one team that scored against them vs. two for Cameroon ✔ Collective mastery of ball and tempo ✔ Two scorers in top form (Díaz and El Kaabi) ✔ Home turf and fan support advantage These elements form an objective basis for arguing a Moroccan success in this quarterfinal.

Venezuela after Maduro: Democratic Transition or New Imbroglio? 434

Whether one agrees with Donald Trump or not, the fall of Nicolás Maduro marks a historic turning point in Venezuelan history and, more broadly, in the history of the region and the world. After more than a decade of authoritarian governance, economic collapse, and mass exile, Maduro's capture appears both as a relief for part of the population and as a shock to the international legal order. The arrest of the president, or the suspect, depending on one's perspective, who was exfiltrated and then indicted in the USA for narcotrafficking and corruption, thus concentrates hopes for political transition and accusations of imperialist interference. Venezuela, despite possessing the world's largest proven oil reserves, has experienced a rapid degradation of its democratic institutions since the beginnings of the Bolivarian Revolution. First under Hugo Chávez, then under Maduro, the country has seen its economy crumble, with recurrent hyperinflation, collapse of the national currency, and widespread impoverishment. From 2014 onward, the crisis turned into a full-blown humanitarian catastrophe: shortages of medicines, collapse of public services, and endemic insecurity. The human dimension of this crisis is equally dramatic: nearly eight million Venezuelans have left the country over the past decade, fleeing hunger, repression, and lack of prospects. Internally, political opponents have been marginalized, judicial independence undermined, and fundamental freedoms curtailed, to the point that many international organizations describe it as an authoritarian regime or hybrid dictatorship. Chavismo has morphed into a corrupt oligarchy, capturing oil rents for the benefit of a politico-military elite and criminal networks, a model far from unique. The Trump administration, back in power with an uncompromising discourse against regimes labeled "socialist" or "narco-states," has gradually hardened its strategy toward Caracas. For several years, Washington has multiplied pressures: heavy economic sanctions targeting the national oil company, financial restrictions, naval blockade, and designation of Maduro's inner circle as a transnational criminal organization. Officially, these measures aimed to choke the regime's resources, particularly oil revenues and narcotrafficking flows. In January 2026, this maximum pressure strategy reaches its peak with an operation of exceptional magnitude. Targeted strikes and a special operation coordinated by the United States Southern Command result in Maduro's capture in his bed, followed by his transfer out of Venezuelan territory. President Trump himself publicly announces that Maduro and his wife have been arrested and will be tried in the USA for narcotrafficking, corruption, and participation in an alleged cartel designated as a terrorist organization. In the aftermath, Trump promises that the United States will guarantee a "safe and orderly" political transition for Venezuela, even going so far as to mention the possibility of "managing" the country until credible elections are organized. This military intervention immediately triggered a cascade of contrasting reactions, revealing deep polarization both domestically and internationally. For its supporters, the operation is a form of liberation: it ends a regime accused of repressing its people, rigging elections, and diverting the country's wealth to politico-mafia networks. Part of the Venezuelan opposition, whether in exile or still on the ground, presents Maduro's capture as a historic opportunity to rebuild democratic institutions and revive a bloodless economy. For its detractors, on the other hand, the U.S. intervention constitutes a flagrant violation of Venezuelan sovereignty and international law, particularly the principle of non-use of force enshrined in the UN Charter. Some Latin American and European governments, as well as UN spokespeople, have denounced a unilateral U.S. operation and warned against a dangerous precedent legitimizing similar actions elsewhere in the world. Even within the Venezuelan opposition, some actors fear that the end of internal authoritarianism might open the door to a lasting external tutelage, further exacerbating the divide between pro- and anti-intervention factions. Beyond moral or legal justifications, the geopolitical and energy dimensions are central to understanding the initiative. Venezuela holds considerable but low-quality oil reserves that actors like China and Russia have sought to secure through long-term agreements, massive loans, and equity stakes. This increased presence of rival powers at the gates of the United States runs counter to the old Monroe Doctrine and fuels, on the American side, the perception of a strategic challenge in what Washington considers its "backyard." From this perspective, the intervention cannot be read solely through the prism of human rights or solidarity with the Venezuelan people. Washington also seeks to regain control of the region, reduce Moscow and Beijing's influence in Latin America amid heightened global rivalry. This ambivalence, between rhetoric of democratic liberation and strategic interests, fuels mistrust, particularly in the Global South. Whatever one's opinion of the U.S. intervention, one point remains central: no lasting political transition can succeed without the full adhesion and active participation of the entire Venezuelan people. The end of the Maduro era opens a window of opportunity to rebuild democratic institutions, restore the rule of law, guarantee freedom of expression, and revive the economy, but this window can close quickly if the transition is led solely by external actors. Recent examples from Iraq, Libya, and Syria confirm this. True liberation will not come solely from the fall of a leader, however authoritarian, nor from the promises of a foreign power, however influential. It will depend on an inclusive political process capable of bringing together a deeply fractured society, preventing score-settling, and avoiding the emergence of a new system of dependency, whether economic, security-related, or diplomatic. It is up to the Venezuelans to define, over the long term, the contours of their future, if possible with international support based on law, cooperation, and respect for their sovereignty. The position of the military also warrants close scrutiny.

Maduro, from Sovereign to American Defendant... or The last night of Raiss Maduro... 621

The scenario is now factual: capture, transfer to New York, indictment for narcoterrorism. A historic precedent. Now it's time for "Debates" or "Opinions." From head of state to cartel leader: the Maduro case, or when power redefines the law. An incumbent president is extracted from his palace: Bombs are dropped in the distance; diversion of attention and paralysis of defense systems; A perfectly mastered and executed scenario. A head of state has been abducted by a foreign army and then paraded in handcuffs before the cameras in New York: the scene recalls the end of Manuel Noriega in 1989. This time, it's not the Panamanian general but the revolutionary Nicolás Maduro, a sort of Bolivarian relic, head of the Venezuelan state since 2013, now officially prosecuted for narcoterrorism by American justice and incarcerated in Brooklyn. The message is crystal clear: when a superpower decides, a president can cease to be a subject of international law to become just another cartel leader. Power will determine both the qualification and the fate: in a different unfolding, Gaddafi and Saddam met different ends but also at the hands of foreign powers. The keystone of this operation is less military than narrative. Washington does not present Maduro as a political enemy, but as the mastermind of a transnational criminal conspiracy, extending the indictment already filed in 2020 before the New York federal court. This simple categorical shift, from political to penal, from sovereign to trafficker, allows it to bypass the contemporary obsession with sovereignty, head-of-state immunity, and the need for a UN multilateral mandate. The image is no longer that of an invasion, but of an "extraterritorial police operation" aimed at protecting American public health, a narrative well-honed since the "war on drugs" in Latin America. It feels like watching a TV series scene: DEA agents and special forces, reading of rights, transfer to a federal detention center, solemn announcement by the prosecutor. In reality, it's a demonstration of strategic power. The arrest of a head of state in his bed, with his security apparatus caught off guard and possibly complicit, signals less a military victory than a systemic humiliation: that of a regime that dreamed of being an anti-imperialist bastion and discovers it cannot protect its own president. The Chavista "tiger" reveals itself to be a paper tiger: strong on slogans, weak in real capacity. Jurists will rightly recall that international law protects the immunity of sitting heads of state, except in very narrowly defined exceptions. But history offers another, less comfortable lesson: from Noriega to the International Criminal Court's warrants against Omar el-Bashir or Vladimir Putin, the boundary between sovereignty and penal responsibility has steadily eroded. Already in 1998, the arrest of Augusto Pinochet in London on the basis of a Spanish warrant inaugurated the era of universal jurisdiction against former leaders. Today, with Maduro, another step is taken: this is no longer a sick ex-dictator on a medical visit, but a sitting president, captured by force and tried abroad for narcoterrorism endangering specifically American citizens. The international reaction underscores the brutality of this epochal shift. A few capitals denounce a "cowboy method" contrary to the UN Charter; others take refuge in cautious verbal indignation, quickly diluted in press releases. But the most striking aspect is elsewhere: many leaders who, just yesterday, posed complacently with Maduro, accepted his decorations, and praised his "Bolivarian courage," suddenly discover they have short memories. The archives are full of these now-embarrassing embraces: they remind us that diplomacy loves grand words, sovereignty, dignity, resistance, as long as they cost nothing. Abdelmadjid Tebboune must today regret his recent insulting remarks toward the powers and others who have explicitly recognized the Moroccanness of the formerly Spanish Sahara. In the Maduro affair, Donald Trump has found his formula: topple a regime without uttering the word "war," capture a president without recognizing him as such. The operation de facto violates the spirit of international law, but it cloaks itself in the language of American criminal law, with its charges, judges, juries, and procedures. In Congress, a few voices raise alarms about the precedent created. However, U.S. political history shows that, when faced with what is defined as a "vital interest", fight against drugs, terrorism, territorial protection—partisan quarrels quickly give way to a reflex of unity. Now, the scene shifts to the New York federal court. Maduro, very wealthy, will be supported by prestigious lawyers, will challenge the legitimacy of the procedure, denounce a political trial, and attempt to turn the courtroom into an anti-imperialist platform. The U.S., for its part, will highlight its fight against a "narco-state" that allegedly flooded their market with cocaine in league with Colombian armed groups and criminal networks. At this stage, it matters little whether judicial truth is fully established: the image of the Venezuelan president in the defendant's cage will weigh more durably than all televised speeches. For part of Latin America and beyond, this arrest elicits real relief: that of seeing a leader accused of authoritarian drift, massive corruption, and collusion with narcotrafficking finally answer before a judge. This sentiment is understandable. But should we stop there? For this episode recalls a disturbing truth: sovereignty, in the current international system, has become conditional. Conditional on the ability to defend oneself, to weave effective alliances, to not cross certain red lines set by others. Conditional, above all, on the narrative that the powerful impose on the rest of the world. The Maduro case must neither make us forget the brutality of his regime, nor mask the precedent it creates. It has provoked the exile of more than 8 million people. That a president suspected of serious crimes be judged, many will applaud it. That a power arrogate to itself the unilateral right to abduct and try him on its soil, without an indisputable international mandate, should worry even its allies. These tools, once created, risk no longer being confined to a single "enemy." Those who reassure themselves today thinking they will never be the target of such practices risk discovering, tomorrow, to their detriment, that the narrative has changed there too. It was the last night of Raiss Maduro...

The Urantia Book 663

The Urantia Book was first published in Chicago in 1955 by the Urantia Foundation. It presents itself as a spiritual revelation delivered by celestial beings through a human intermediary in the early twentieth century—but the details of that process are intentionally left vague. There’s no named prophet, no signature author, and no formal church behind it. Instead, the book’s influence has spread quietly over the decades through small study groups and individuals drawn to its holistic spiritual vision. The text opens with a dense Foreword that tries to build a philosophical framework for what follows, then unfolds through 196 “papers” that move from abstract metaphysics to cosmic history and, finally, to a vivid retelling of Jesus’ life. At its center is the idea of God as the “Universal Father,” the source and sustainer of all reality, surrounded by a co-eternal Trinity and a vast, multidimensional universe that radiates outward from an unmoving spiritual core called Paradise. This universe includes a central realm, seven "superuniverses", and countless local creations, each governed by ranks of spiritual personalities. One of the book’s most distinctive ideas is the “Thought Adjuster”—a fragment of God said to live within each person, quietly shaping conscience and character, and drawing the soul toward eternal life. Spiritual progress, in this view, happens not through ritual or doctrine but through everyday moral choices: kindness, honesty, courage, and faithfulness to truth. While the book accepts biological evolution, it also claims that human civilization and religion have been guided at key moments by celestial administrators. It calls for what it terms a “religion of personal experience”—a faith rooted in direct communion with God, intellectual curiosity, service to others, and practical compassion. The final and longest section retells the life and teachings of Jesus in remarkable detail, from his childhood and early travels to his ministry, crucifixion, and post-resurrection appearances. Here, Jesus is portrayed as the living example of unselfish love and God-centered trust—a model of how divine ideals can be lived in ordinary human life. Usually readers engage with The Urantia Book quietly: through private study, meditation, and informal discussions rather than through any institutional structure. Reception has always been mixed. Admirers are drawn to its vast cosmology, moral vision, and integration of science, theology, and philosophy. Critics point to its unverifiable origins, speculative science, and cultural assumptions that mirror the mid-twentieth century. Today, it remains outside traditional religion and academia, often grouped among modern revelatory or “channeled” texts. Whether approached with faith, doubt, or simple curiosity, The Urantia Book invites readers to imagine a universe where the quest for truth, goodness, and beauty is really one journey toward God—where spiritual growth unfolds quietly within the rhythms of everyday life.