ABSTRACT
The diagnosis of cardiac sarcoidosis, particularly in its isolated cardiac form, represents a major challenge due to non-specific symptoms and the limited sensitivity and specificity of basic cardiac investigations. MRI and metabolic PET-CT are important elements in the diagnostic process. Corticosteroids remain the cornerstone for the treatment of the inflammatory phase, in association with biological agents and steroid-sparing therapies. The goal is to limit the progression of fibrosis, which is a source of malignant arrhythmias and heart failure. The indication for implantation of a cardiac defibrillator must be carefully evaluated to reduce the risk of sudden death. Multidisciplinary collaboration is essential for optimal care.
Le diagnostic de sarcoïdose cardiaque, en particulier dans sa forme cardiaque isolée, représente un défi majeur en raison de symptômes aspécifiques et d'une sensibilité et spécificité limitées des explorations cardiologiques de base. L'IRM et le PET-CT métabolique sont devenus des éléments essentiels dans le processus diagnostique. Les corticostéroïdes restent la pierre angulaire du traitement dans la phase inflammatoire, parallèlement aux agents biologiques et aux thérapies d'épargne cortisonique. L'objectif est d'éviter la progression vers la fibrose, source d'arythmies malignes et d'insuffisance cardiaque. L'indication à l'implantation d'un défibrillateur cardiaque doit être soigneusement évaluée afin de réduire le risque de mort subite. Une collaboration multidisciplinaire est essentielle afin d'assurer une prise en charge optimale.
Subject(s)
Heart Failure , Myocarditis , Sarcoidosis , Humans , Positron Emission Tomography Computed Tomography , Heart , Sarcoidosis/diagnosis , Sarcoidosis/therapyABSTRACT
A pregnant woman presented with an asthma attack with a poor clinical evolution, requiring intubation. Medications traditionally used for the treatment of asthma in non-pregnant patients (short-acting beta-2 agonists, short-acting muscarinic antagonists, systemic corticosteroids) are considered safe during pregnancy, except for epinephrine. A systematic obstetrical evaluation is a key component in the evaluation and management of an asthmatic crisis during pregnancy. The use of peak-flow spirometers and arterial blood gas can help to recognize the degree of severity of an acute asthma attack.
Subject(s)
Anti-Asthmatic Agents , Asthma , Humans , Anti-Asthmatic Agents/therapeutic use , Asthma/therapy , Asthma/drug therapy , Adrenal Cortex Hormones/therapeutic use , Drug Therapy, Combination , Administration, InhalationABSTRACT
According to PubMed statistics when writing this review, the year 2022 is expected to mark the first dip in the number of articles published in relation to the Covid-19 pandemic. This review, without any mention to Sars-CoV-2, highlight this transition and addresses many topics in internal medicine: gastroenterology, cardiology, endocrinology, respiratory medicine, infectious diseases and venous access. Each year, the chief residents of the internal medicine ward in Lausanne university hospital (CHUV) in Switzerland meet up to share their readings: here is a selection of ten articles that have caught our attention, summarized and commented for you, which should change our daily practice.
D'après les statistiques PubMed au moment de la rédaction de cette revue, l'année 2022 devrait marquer le premier infléchissement du nombre d'articles publiés en relation avec la pandémie de Covid-19. Cette revue d'articles, sans écho au Sars-CoV-2, souligne cette transition et aborde de nombreux sujets de la médecine interne : gastroentérologie, cardiologie, endocrinologie, pneumologie, infectiologie et accès veineux. Chaque année, les cheffes et chefs de clinique du Service de médecine interne du CHUV se réunissent pour partager leurs lectures : voici une sélection de dix articles ayant retenu notre attention, revus et commentés pour vous, et qui devraient faire évoluer notre pratique quotidienne.
Subject(s)
COVID-19 , Pandemics , Publications , Humans , COVID-19/epidemiology , Hospitals, University , Internal Medicine , Switzerland , PubMed , Publications/statistics & numerical dataABSTRACT
We describe the case of a 62-year-old woman who presented with insidious onset and slowly progressive neurological complaints. This case illustrates the diagnostic challenges clinicians face because the lack of specific symptomatology and numerous complementary exams. The broad differential diagnosis of this disease requires a diagnostic strategy to be developed. Clinical reasoning is based on clinical, biological and radiological information and highlights the importance of an interdisciplinary approach to patient care.
Nous décrivons le cas clinique d'une patiente de 62 ans se présentant avec des symptômes neurologiques d'apparition progressive et lentement évolutifs. Ce cas illustre un défi diagnostique étant donné l'absence de spécificité des symptômes et des divers examens complémentaires à disposition. Le large diagnostic différentiel de cette affection requiert une stratégie diagnostique élaborée. Le raisonnement clinique se fonde sur des informations cliniques, biologiques et radiologiques et nécessite une approche multidisciplinaire pour finalement accéder au diagnostic.
Subject(s)
Meningitis , Diagnosis, Differential , Female , Humans , Meningitis/diagnosis , Meningitis/etiology , Middle AgedABSTRACT
Disordered eating (DE) is known to predominate among girls, and historically studies have focused primarily on them. This cross-sectional study aimed to investigate the characteristics of adolescent and young adult males at risk of DE. Participants (N = 2269; 15-24 years) in a study assessing their lifestyle were divided into two groups based on the SCOFF five-question screening tool: a SCOFF[+] group for participants at risk of disordered eating, and a SCOFF[-] group for everyone else. SCOFF[+] participants were more likely to be overweight and obese; have a lower socio-economic status and non-Swiss parents; experience weight issues; and report a chronic condition, poorer emotional well-being and a less positive attitude towards life. With 10% of males at risk of DE, clinicians should be aware of their specific characteristics, which should be considered red flags. DE is no longer a female-specific issue.
Subject(s)
Feeding and Eating Disorders/psychology , Obesity/epidemiology , Overweight/epidemiology , Prodromal Symptoms , Adolescent , Adolescent Behavior/psychology , Cross-Sectional Studies , Humans , Male , Risk Factors , Switzerland/epidemiology , Young AdultABSTRACT
The effects of nine cell wall-degrading enzymes on the antimicrobial and antioxidant activities of bilberry were studied. Antimicrobial activity was measured using the human pathogens Salmonella enterica sv. Typhimurium and Staphylococcus aureus as test strains. Enzyme treatments liberated phenolics from the cell wall matrix, which clearly increased the antimicrobial activity of berry juices, press cakes, and berry mashes on the basis of plate counts. Antibacterial effects were stronger against Salmonella than against Staphylococcus bacteria. In general, the increase in activity measured as colony-forming units per milliliter was 3-5 logarithmic units against Salmonella and 1-2 units against Staphylococcus bacteria. Increase in antimicrobial activity was observed only in acidic conditions, which is also the natural environment in various berry products, such as juices. The activity profile of the pectinase preparation affected the chemistry of the phenolics due to the presence of deglycosylating activities in some preparations. The difference in phenolic profiles was reflected in the antimicrobial effects. Bilberry mashes treated with Pectinex Ultra SP-L, Pectinex 3 XL, and Pectinex BE XXL were most efficient against Salmonella bacteria, whereas mashes treated with Pectinex Smash, Pectinex BE 3-L, and Biopectinase CCM showed the strongest antimicrobial activity against Staphylococcus bacteria. Due to the liberation of phenolics from the cell wall matrix the antioxidant activity measured as radical scavenging activity was also increased on average about 30% by the enzymatic treatments. The highest increase in phenolic compounds was about 40%. Highest increases in anthocyanins and in antioxidant activity were observed in berry mash treated with Pectinex Smash XXL enzyme, and the lowest increase was observed after treatment with Pectinex BE 3-L. Enzyme-assisted processing is traditionally used to improve berry and fruit juice yields. However, enzymatic treatments also have an impact on the functional properties of the products. The increased liberation of phenolics from the cell wall matrix can prolong the shelf life of berry products by limiting the growth of contaminants during processing or storage. The increased amount of phenolic compounds may also have a positive effect on gut well-being.