Pub Date : 2025-01-01DOI: 10.1016/j.revmed.2024.06.014
Magali Le Brun , Dominique Godard , Lila Camps , Quentin Gomes de Pinho , Audrey Benyamine , Brigitte Granel
The term “littératie” is derived from the English word “literacy”, which refers to knowledge and skills in the fields of reading, writing, speech (or other means of communication) and calculation that allow people to be efficient and integrated into society. Health literacy is a recent concept that relies on the ability to find, understand, evaluate and communicate information in ways that promote, maintain and improve the health of the individual in various settings over the course of life. The objectives of this review are first of all to realize an overview on the health literacy of populations in Europe. Then, we propose to study the link between health literacy and health status (risk behaviors, chronic diseases, morbi-mortality, adherence to care and medical monitoring) and to study its medico-economic impact. We also analyzed the association between personalized therapeutic education and health literacy. Finally, we propose a review of the means put in place in the care system to improve the health literacy of the patients we manage.
{"title":"La littératie en santé : définition, outils d’évaluation, état des lieux en Europe, conséquences pour la santé et moyens disponibles pour l’améliorer","authors":"Magali Le Brun , Dominique Godard , Lila Camps , Quentin Gomes de Pinho , Audrey Benyamine , Brigitte Granel","doi":"10.1016/j.revmed.2024.06.014","DOIUrl":"10.1016/j.revmed.2024.06.014","url":null,"abstract":"<div><div>The term “littératie” is derived from the English word “literacy”, which refers to knowledge and skills in the fields of reading, writing, speech (or other means of communication) and calculation that allow people to be efficient and integrated into society. Health literacy is a recent concept that relies on the ability to find, understand, evaluate and communicate information in ways that promote, maintain and improve the health of the individual in various settings over the course of life. The objectives of this review are first of all to realize an overview on the health literacy of populations in Europe. Then, we propose to study the link between health literacy and health status (risk behaviors, chronic diseases, morbi-mortality, adherence to care and medical monitoring) and to study its medico-economic impact. We also analyzed the association between personalized therapeutic education and health literacy. Finally, we propose a review of the means put in place in the care system to improve the health literacy of the patients we manage.</div></div>","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"46 1","pages":"Pages 32-39"},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fever is a cosmopolit zoonosis due to Coxiella burnetii. The diagnosis of chronic Q fever can be really misleading. The growth of this bacterium is difficult and blood cultures are often negatives.
Case presentation
We rapport here the case of a 69-year-old man presenting with an alteration of his general condition and low back pain. He suffered from a well-controlled HIV infection and lower limb arteriopathy treated with a cross-femoral bypass. A computed tomography scan revealed a L3–L4 abscessed spondylodiscitis but multiple blood cultures remained sterile, and the transthoracic echocardiography was normal. PET scan showed a hypermetabolism on L3–L4 vertebrae but also indicated an intense uptake of the cross-femoral bypass. C. burnetii serology was in favour of a chronic Q fever. The management of this chronic Q fever needed a multidisciplinary discussion. Three months after the treatment initiation, C. burnetii serology was reduced by a titer and has stabilized 6 months to a year.
Conclusion
Chronic Q fever and mostly osteoarticular diseases are difficult to diagnose. We have to evoke the diagnosis of osteoarticular chronic Q fever in case of insidious inflammatory syndrome, negatives blood cultures spondylodiscitis especially when associated to endocarditis or vascular infection, and in case of spondylodiscitis with a granulomatous histology without Mycobacterium tuberculosis. Although there are many complementary tests (PET scanner, PCR), serology remains the cornerstone of diagnosis.
{"title":"Fièvre Q chronique. Revue de la littérature à propos d’un cas de spondylodicite à hémocultures négatives","authors":"Florentin Masoch , Yoann Roubertou , Claire Triffault-Fillit , Sibylle Guillou , Marie Meignien , Maël Richard , Isabelle Durieu , Romain Euvrard","doi":"10.1016/j.revmed.2024.09.006","DOIUrl":"10.1016/j.revmed.2024.09.006","url":null,"abstract":"<div><h3>Introduction</h3><div>Fever is a cosmopolit zoonosis due to <em>Coxiella burnetii</em>. The diagnosis of chronic Q fever can be really misleading. The growth of this bacterium is difficult and blood cultures are often negatives.</div></div><div><h3>Case presentation</h3><div>We rapport here the case of a 69-year-old man presenting with an alteration of his general condition and low back pain. He suffered from a well-controlled HIV infection and lower limb arteriopathy treated with a cross-femoral bypass. A computed tomography scan revealed a L3–L4 abscessed spondylodiscitis but multiple blood cultures remained sterile, and the transthoracic echocardiography was normal. PET scan showed a hypermetabolism on L3–L4 vertebrae but also indicated an intense uptake of the cross-femoral bypass. <em>C. burnetii</em> serology was in favour of a chronic Q fever. The management of this chronic Q fever needed a multidisciplinary discussion. Three months after the treatment initiation, <em>C. burnetii</em> serology was reduced by a titer and has stabilized 6<!--> <!-->months to a year.</div></div><div><h3>Conclusion</h3><div>Chronic Q fever and mostly osteoarticular diseases are difficult to diagnose. We have to evoke the diagnosis of osteoarticular chronic Q fever in case of insidious inflammatory syndrome, negatives blood cultures spondylodiscitis especially when associated to endocarditis or vascular infection, and in case of spondylodiscitis with a granulomatous histology without <em>Mycobacterium tuberculosis</em>. Although there are many complementary tests (PET scanner, PCR), serology remains the cornerstone of diagnosis.</div></div>","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"46 1","pages":"Pages 49-54"},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.revmed.2024.10.006
Hubert de Boysson , Valérie Devauchelle-Pensec , Christian Agard , Marc André , Boris Bienvenu , Bernard Bonnotte , Guillermo Carvajal Alegria , Olivier Espitia , Eric Hachulla , Emmanuel Héron , Marc Lambert , Jean-Christophe Lega , Kim H. Ly , Arsène Mekinian , Jacques Morel , Alexis Régent , Christophe Richez , Laurent Sailler , Raphaele Seror , Anne Tournadre , Maxime Samson
Purpose
An updated revision of the 2016 recommendations from the French Study Group for Large Vessel Vasculitis (GEFA) was needed to better delineate the place and management of immunosuppressants or biologics in giant cell arteritis (GCA).
Methods
A panel of 18 physicians, including internists and rheumatologists, constituted the task force of this project and drafted the recommendations. Twelve additional readers were asked to analyse and comment on the recommendations. Two face-to-face virtual meetings were held to discuss and validate the recommendations. Each member voted individually, and a > 85% consensus was required to validate each recommendation.
Results
From the initial 6 questions, 26 recommendations were validated. The following main recommendations were validated. (1) Subcutaneous 162 mg tocilizumab (TCZ) for at least 12 months should be used first when glucocorticoid (GC)-sparing treatment is needed with the objective of discontinuing GCs within the subsequent 6 months. (2) GCA patients who have experienced any of the following conditions must receive TCZ at GCA diagnosis with 6 months of GC therapy: major cardiovascular event, osteoporosis with fracture, psychiatric event with GC use, complicated diabetes mellitus, or any previous > 6 months of GC treatment. (3) In patients in whom GC discontinuation is not possible after 12 months of treatment because of persistent disease activity or in patients in whom GC-related adverse events are unacceptable, TCZ (or alternatively methotrexate) may be proposed.
Conclusions
These recommendations were constructed based on the results of the published literature and the experts’ experiences to standardise therapeutic practices in France. Further updates will likely be necessary following new publications.
{"title":"Use of immunosuppressants and biologics in giant cell arteritis: Recommendations of the French Study Group for Large Vessel Vasculitis (GEFA)","authors":"Hubert de Boysson , Valérie Devauchelle-Pensec , Christian Agard , Marc André , Boris Bienvenu , Bernard Bonnotte , Guillermo Carvajal Alegria , Olivier Espitia , Eric Hachulla , Emmanuel Héron , Marc Lambert , Jean-Christophe Lega , Kim H. Ly , Arsène Mekinian , Jacques Morel , Alexis Régent , Christophe Richez , Laurent Sailler , Raphaele Seror , Anne Tournadre , Maxime Samson","doi":"10.1016/j.revmed.2024.10.006","DOIUrl":"10.1016/j.revmed.2024.10.006","url":null,"abstract":"<div><h3>Purpose</h3><div>An updated revision of the 2016 recommendations from the French Study Group for Large Vessel Vasculitis (GEFA) was needed to better delineate the place and management of immunosuppressants or biologics in giant cell arteritis (GCA).</div></div><div><h3>Methods</h3><div>A panel of 18 physicians, including internists and rheumatologists, constituted the task force of this project and drafted the recommendations. Twelve additional readers were asked to analyse and comment on the recommendations. Two face-to-face virtual meetings were held to discuss and validate the recommendations. Each member voted individually, and a<!--> <!-->><!--> <!-->85% consensus was required to validate each recommendation.</div></div><div><h3>Results</h3><div>From the initial 6 questions, 26 recommendations were validated. The following main recommendations were validated. (1) Subcutaneous 162<!--> <!-->mg tocilizumab (TCZ) for at least 12<!--> <!-->months should be used first when glucocorticoid (GC)-sparing treatment is needed with the objective of discontinuing GCs within the subsequent 6<!--> <!-->months. (2) GCA patients who have experienced any of the following conditions must receive TCZ at GCA diagnosis with 6<!--> <!-->months of GC therapy: major cardiovascular event, osteoporosis with fracture, psychiatric event with GC use, complicated diabetes mellitus, or any previous<!--> <!-->><!--> <!-->6<!--> <!-->months of GC treatment. (3) In patients in whom GC discontinuation is not possible after 12<!--> <!-->months of treatment because of persistent disease activity or in patients in whom GC-related adverse events are unacceptable, TCZ (or alternatively methotrexate) may be proposed.</div></div><div><h3>Conclusions</h3><div>These recommendations were constructed based on the results of the published literature and the experts’ experiences to standardise therapeutic practices in France. Further updates will likely be necessary following new publications.</div></div>","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"46 1","pages":"Pages 4-11"},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.revmed.2025.01.002
{"title":"Relecteurs 2024 pour La revue de médecine interne","authors":"","doi":"10.1016/j.revmed.2025.01.002","DOIUrl":"10.1016/j.revmed.2025.01.002","url":null,"abstract":"","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"46 1","pages":"Page 63"},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143205447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.revmed.2024.11.002
Grégoire Martin de Frémont , Kevin Chevalier , Anaïs Roeser
{"title":"Portrait de Brigitte Ranque, PU-PH et cheffe de service de médecine interne à l’hôpital européen Georges-Pompidou et créatrice du circuit CASPER","authors":"Grégoire Martin de Frémont , Kevin Chevalier , Anaïs Roeser","doi":"10.1016/j.revmed.2024.11.002","DOIUrl":"10.1016/j.revmed.2024.11.002","url":null,"abstract":"","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"46 1","pages":"Pages 59-62"},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143205448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.revmed.2024.08.002
Thomas Escoda , Frédérique Retornaz , Anne Plauzolles , Philippe Halfon
Digestive functional disorders are among the most frequent reasons for medical consultation and a significant source of medical wandering. Therapeutic management of these patients is difficult, particularly due to the absence of specific treatment linked to an incomplete understanding of the pathophysiological mechanisms. In a certain number of these patients, the symptoms are accompanied by a small intestinal bacterial overgrowth (SIBO). This entity, historically identified in specific post-surgical situations, seems finally very common and associated with very diverse pathologies. The diagnosis of SIBO is currently being made more accessible through the development of breathing tests. Therapeutic management, based mainly on antibiotic therapy and diet, remains to date largely empirical because it is based on few studies but the growing interest in SIBO should make it possible to identify effective treatments during robust clinical trials.
{"title":"SIBO, quand un mythe devient réalité","authors":"Thomas Escoda , Frédérique Retornaz , Anne Plauzolles , Philippe Halfon","doi":"10.1016/j.revmed.2024.08.002","DOIUrl":"10.1016/j.revmed.2024.08.002","url":null,"abstract":"<div><div>Digestive functional disorders are among the most frequent reasons for medical consultation and a significant source of medical wandering. Therapeutic management of these patients is difficult, particularly due to the absence of specific treatment linked to an incomplete understanding of the pathophysiological mechanisms. In a certain number of these patients, the symptoms are accompanied by a small intestinal bacterial overgrowth (SIBO). This entity, historically identified in specific post-surgical situations, seems finally very common and associated with very diverse pathologies. The diagnosis of SIBO is currently being made more accessible through the development of breathing tests. Therapeutic management, based mainly on antibiotic therapy and diet, remains to date largely empirical because it is based on few studies but the growing interest in SIBO should make it possible to identify effective treatments during robust clinical trials.</div></div>","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"46 1","pages":"Pages 40-48"},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142142244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Chez les sujets avec insuffisance cardiaque à fraction d’éjection préservée ou légèrement réduite, la finérénone est-elle efficace pour diminuer un composite d’exacerbation d’insuffisance cardiaque et de décès d’origine cardiovasculaire tout en étant sécuritaire, comparativement au placebo ?","authors":"Luc Lanthier , Alexandre Mutchmore , Marc-Émile Plourde , Michel Cauchon","doi":"10.1016/j.revmed.2024.11.007","DOIUrl":"10.1016/j.revmed.2024.11.007","url":null,"abstract":"","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"46 1","pages":"Pages 57-58"},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Une cause inhabituelle de dorsalgie","authors":"Fatima Zohra Benbrahim, Omar El Aoufir, Fatima Zahra Laamrani, Laila Jroundi","doi":"10.1016/j.revmed.2024.09.002","DOIUrl":"10.1016/j.revmed.2024.09.002","url":null,"abstract":"","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"46 1","pages":"Pages 55-56"},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142335326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.revmed.2024.10.011
Hubert de Boysson , Valérie Devauchelle-Pensec , Christian Agard , Marc André , Boris Bienvenu , Bernard Bonnotte , Guillermo Carvajal Alegria , Olivier Espitia , Eric Hachulla , Emmanuel Heron , Marc Lambert , Jean-Christophe Lega , Kim Heang Ly , Arsène Mekinian , Jacques Morel , Alexis Regent , Christophe Richez , Laurent Sailler , Raphaèle Seror , Anne Tournadre , Catherine Vignal
Giant cell arteritis (GCA) is a large-vessel vasculitis that mainly affects women over fifty. GCA usually involves branches from the external carotid arteries, causing symptoms such as headaches, scalp tenderness, and jaw claudication. The most severe complication is ophthalmologic involvement, including acute anterior ischemic optic neuropathy and, less frequently, central retinal artery occlusion with a risk of permanent blindness. Approximately 40% of patients may have involvement of the aorta or its branches, which has a poor prognosis, although this is often asymptomatic at diagnosis. Diagnosis is largely based on imaging techniques such as FDG-PET combined with CT, CT angiography, or MRI angiography of the aorta and its branches. Polymyalgia rheumatica is associated with GCA in 30–50% of cases but may also occur independently. Treatment must be initiated urgently in the presence of ophthalmologic signs or when GCA is strongly suspected to prevent vision loss. The gold standard to confirm the diagnosis is temporal artery biopsy. However, Doppler ultrasound and vascular imaging are also reliable diagnostic techniques. Initially, high doses of corticosteroids like prednisone (40–80 mg per day) are the mainstay of treatment. Tocilizumab can be discussed in combination with prednisone for corticosteroid sparing. Long-term management is essential, including monitoring for disease recurrence and corticosteroid-related side effects. General practitioners play a crucial role in early diagnosis, directing patients to specialized centres, and in managing ongoing treatment in collaboration with specialists. This collaboration is essential to address potential long-term complications such as cardiovascular events. They can occur five to ten years after the diagnosis of GCA even when the disease is no longer active, meaning that vigilant follow-up is required due to the patients’ age and status.
{"title":"French protocol for the diagnosis and management of giant cell arteritis","authors":"Hubert de Boysson , Valérie Devauchelle-Pensec , Christian Agard , Marc André , Boris Bienvenu , Bernard Bonnotte , Guillermo Carvajal Alegria , Olivier Espitia , Eric Hachulla , Emmanuel Heron , Marc Lambert , Jean-Christophe Lega , Kim Heang Ly , Arsène Mekinian , Jacques Morel , Alexis Regent , Christophe Richez , Laurent Sailler , Raphaèle Seror , Anne Tournadre , Catherine Vignal","doi":"10.1016/j.revmed.2024.10.011","DOIUrl":"10.1016/j.revmed.2024.10.011","url":null,"abstract":"<div><div>Giant cell arteritis (GCA) is a large-vessel vasculitis that mainly affects women over fifty. GCA usually involves branches from the external carotid arteries, causing symptoms such as headaches, scalp tenderness, and jaw claudication. The most severe complication is ophthalmologic involvement, including acute anterior ischemic optic neuropathy and, less frequently, central retinal artery occlusion with a risk of permanent blindness. Approximately 40% of patients may have involvement of the aorta or its branches, which has a poor prognosis, although this is often asymptomatic at diagnosis. Diagnosis is largely based on imaging techniques such as FDG-PET combined with CT, CT angiography, or MRI angiography of the aorta and its branches. Polymyalgia rheumatica is associated with GCA in 30–50% of cases but may also occur independently. Treatment must be initiated urgently in the presence of ophthalmologic signs or when GCA is strongly suspected to prevent vision loss. The gold standard to confirm the diagnosis is temporal artery biopsy. However, Doppler ultrasound and vascular imaging are also reliable diagnostic techniques. Initially, high doses of corticosteroids like prednisone (40–80<!--> <!-->mg per day) are the mainstay of treatment. Tocilizumab can be discussed in combination with prednisone for corticosteroid sparing. Long-term management is essential, including monitoring for disease recurrence and corticosteroid-related side effects. General practitioners play a crucial role in early diagnosis, directing patients to specialized centres, and in managing ongoing treatment in collaboration with specialists. This collaboration is essential to address potential long-term complications such as cardiovascular events. They can occur five to ten years after the diagnosis of GCA even when the disease is no longer active, meaning that vigilant follow-up is required due to the patients’ age and status.</div></div>","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"46 1","pages":"Pages 12-31"},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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