Abdominal pain patterns during COVID-19: an observational study.

Abdominal pain and liver injury have been frequently reported during coronavirus disease-2019 (COVID-19). Our aim was to investigate characteristics of abdominal pain in COVID-19 patients and their association with disease severity and liver injury.Data of all COVID-19 patients hospitalized during the first wave in one hospital were retrieved. Patients admitted exclusively for other pathologies and/or recovered from COVID-19, as well as pregnant women were excluded. Patients whose abdominal pain was related to alternative diagnosis were also excluded.Among the 1026 included patients, 200 (19.5%) exhibited spontaneous abdominal pain and 165 (16.2%) after abdomen palpation. Spontaneous pain was most frequently localized in the epigastric (42.7%) and right upper quadrant (25.5%) regions. Tenderness in the right upper region was associated with severe COVID-19 (hospital mortality and/or admission to intensive/intermediate care unit) with an adjusted odds ratio of 2.81 (95% CI 1.27-6.21, p = 0.010). Patients with history of lower abdomen pain experimented less frequently dyspnea compared to patients with history of upper abdominal pain (25.8 versus 63.0%, p < 0.001). Baseline transaminases elevation was associated with history of pain in epigastric and right upper region and AST elevation was strongly associated with severe COVID-19 with an odds ratio of 16.03 (95% CI 1.95-131.63 p = 0.010).More than one fifth of patients admitted for COVID-19 presented abdominal pain. Those with pain located in the upper abdomen were more at risk of dyspnea, demonstrated more altered transaminases, and presented a higher risk of adverse outcomes.

[Do we have to treat the obese male with testosterone ?] / Faut-il traiter un homme obèse avec de la testostérone ?

Since a decade, we observe an expansion of the use of testosterone against different components of the metabolic syndrome in men. More particularly in the obese man, indications for the prescription of this hormone are not well defined because of the contradictory studies which do not allow the establishment of a clear consensus. This article proposes a diagnostic procedure for the detection of hypogonadism in obese men. It clarifies the indications of use of testosterone in this particular context but also the circumstances in which the specialist should be consulted.

Depuis une décennie, nous observons une expansion de l'utilisation de la testostérone chez l'homme surtout contre les différentes composantes du syndrome métabolique. Plus particulièrement, chez l'homme obèse, il n'existe pas d'indications bien définies pour la prescription de cette hormone en raison des études contradictoires qui ne permettent pas d'établir un consensus clair. Cet article propose une démarche diagnostique pour le dépistage de l'hypogonadisme chez l'homme obèse. Il clarifie les indications d'utilisation de la testostérone dans ce contexte particulier mais aussi les circonstances dans lesquelles le spécialiste devrait être consulté.

[2016 Update in general internal medicine : Good intentions, possible bad outcomes]. / Bonnes intentions, possibles résultats défavorables.

Ideally, our clinical practices and decisions should be based on evidence derived from randomized clinical trials. Yet, we often have to determine the potential side effects (including interactions) of drugs that we prescribed using other level of evidence; clinical trials being obviously not appropriate for such situations. Results from observational studies published in 2016 should be of interest to primary care physicians. In this review, we present six of them. Once the limitations of these non-interventional studies acknowledged, primary care physicians should consider these results and be particularly attentive when prescribing these drugs.

Dans l'idéal, nos pratiques et décisions sont guidées sur la base d'évidences issues d'études cliniques randomisées. Cependant, nous devons fréquemment juger des possibles effets indésirables (y inclus interactions) des médicaments que nous prescrivons sur la base d'autres types d'informations, les essais cliniques n'étant pour des raisons évidentes pas réalisables. Les résultats de plusieurs études observationnelles publiées en 2016 dans ce domaine devraient attirer notre attention. Nous présentons ici six d'entre elles. Une fois les limites inhérentes à ce type d'étude considérées, ces résultats nous invitent à être particulièrement vigilants lors de nos prescriptions.

[Substance abuse : a men's disease ?] / L'abus de substances, une maladie masculine ?

For biological and social reasons, men have to face pressure and incentives towards competivity, performance and risk seeking behaviours. These put them at risk for substance use, abuse and dependence, also in a recreational context, to improve their performances. Men's substance use is therefore significantly higher compared to women (2/3 of the global prevalence). The purpose of this paper is a description of gender differences in substance use and advice to provide state of the art screening and care of male patients. Recommendations for a « men-friendly ¼ consultation include : provide a space where men feel comfortable ; if possible, give the choice between a male or a female practitioner ; use other communication media then language only ; discuss and put in perspective the traditional male image ; and collaborate with the patient.

Pour des raisons biologiques et sociales, les hommes doivent répondre à des attentes de performance, de compétitivité et de prise de risques. Cela les expose à la consommation de substances, abus et dépendances, dans un cadre social, récréatif, ou pour augmenter leur performance. La prévalence de consommation est globalement supérieure chez les hommes (deux hommes pour une femme). Cet article propose une description des différences de genre dans la consommation des principales substances et des conseils pour le dépistage et une prise en charge adaptée. Il s'agit principalement d'un cadre permettant une identification, de favoriser le choix du genre du soignant, de travailler en collaboration de même qu'en utilisant d'autres moyens que la parole. L'image traditionnelle de l'homme sera discutée et nuancée.