La Revue du praticien最新文献

Chronic kidney disease: A GENUINE PUBLIC HEALTH BURDEN. Chronic kidney disease (CKD) is a frequent pathology. It requires regular screening and, once diagnosed, specific follow-up. Complications are serious, as end-stage CKD needs renal replacement therapy, and cardiovascular events are common. Over and above its complications, CKD also impacts the quality of life of patients.

Infectious endocarditis: FROM EPIDEMIOLOGY TO PREVENTION. The incidence of infective endocarditis is estimated between 30 and 80 cases per million inhabitants and per year in the general population in industrialized countries. It is heterogeneous and increases sharply in the presence of certain underlying heart diseases; it exceeds 1% per year in patients with a history of endocarditis. Incidence increases after the age of 60 and Staphylococcus is now the most frequent responsible microorganism. Antibiotic prophylaxis is indicated only in the patients who are at high risk of infective endocarditis and who undergo invasive dental care. The recommendations published in 2023 by the European Society of Cardiology highlig.

Infectious endocarditis: STRATEGY FOR DIAGNOSIS. The diagnosis of infective endocarditis is often difficult because the clinical presentations are very heterogeneous. Epidemiology has evolved with more acute forms, different microorganisms, and an increase in prevalence in patients with cardiac prosthetic or electronic devices. Diagnosis is based on a clinical suspicion, associated with microbiological data and imaging evidence of lesions of the endocardium. Echocardiography plays a key role, but advanced imaging techniques provide additional information. The 2023 European Society of cardiology (ESC) recommendations like those of 2015 confirmed the essential role of multimodal imaging, integrating lesions highlighted by any imaging technique as major criteria. The diagnostic criteria have thus been modified to consider new epidemiological and imaging data. Different diagnostic strategy algorithms are proposed depending on whether the patient has prosthetic material or not. The endocarditis team is the keystone in this diagnostic approach to improve patient management.

Chronic kidney disease: HOW TO BENEFIT FORM COORDINATED CARE? Chronic kidney disease (CKD) is a major goal of public health. At each stage of CKD, from screening to renal replacement therapy, coordinated care at geographic level or population-based may contribute to enhance effectiveness and efficiency. Kidney transplantation, home-dialysis and conservative treatment must be prioritized.

COMPLICATIONS OF INFECTIVE ENDOCARDITIS. The high in-hospital mortality of patients with infective endocarditis (about 20%) is mainly due to its complications. These complications are essentially of cardiac, neurological, and infectious origin. Rapid diagnosis and early antibiotic treatment are of paramount importance and allow drastic reduction of the frequency and severity of such complications. Discussion with all physicians caring for the patients with infective endocarditis in an "endocarditis team" setting is a mandatory step in management optimization and outcome improvement. This "endocarditis team" approach allows faster identification of patients at high risk of acute heart failure and/or cerebral embolism, and selection of those who might benefit from urgent valvular surgery. Factors associated with high embolic risk are the size and mobility of vegetation, mitral valve endocarditis, and infection with Staphylococcus aureus. When neurological complications occur, there is a risk that these may be worsened by the valvular surgery if there is a hemorrhagic component. This risk needs to be careful weighed in a team approach before sending patients to surgery. Persistent sepsis after effective antibiotic treatments prompts to local extension of the disease or to embolic extra cardiac secondary infectious localization.

LONG TERM OXYGEN THERAPY IN CHRONIC RESPIRATORY DISEASES. Survival of severe chronic respiratory failure with chronic obstructive pulmonary disease (COPD) is improved by long-term oxygen therapy. Other benefits exist for COPD and other causes of chronic respiratory failure. The indications for this restrictive (more 15 hours per day) treatment require measurements of arterial blood gases in adults. Several actors are involved: the specialist for the prescription, the service provider for supplying and maintaining the equipment, the patient and his entourage, the referring doctor to ensure that oxygen therapy is well tolerated and used. The referring doctor can prescribe short-term oxygen therapy for transient respiratory failure. The choice of oxygen source depends on the patient's ability to ambulate and the required flow rate. Concentrators are increasingly used, despite limited flow rate with mobile devices. Liquid oxygen makes it possible to deliver high flow rates but is expensive. The main complications of oxygen therapy are the worsening of chronic hypercapnia, burns (especially in active smokers)...