La Revue du praticien最新文献

Health effects of alcohol: UNTANGLING THE TRUTH FROM THE FALSE! Daily alcohol consumption is associated with an increased risk of death, even at low doses. However, it remains high in France, where a large proportion of the population consumes alcohol in excess of reasonable limits. The most recent data invalidate the idea that a low dose could reduce cardiovascular risk. Santé publique France recommended in 2017 not to exceed the dose of 100 g of pure alcohol per week and not to drink alcohol every day. Harmonizing taxes on different types of alcoholic beverages upwards and indicating on each container: "Do not exceed 10 glasses per week" would be two good public health measures.

YOUNG FEMALE ATHLETES AND HIGH LEVEL SPORT. The impact of intensive sport on the menstrual cycle varies according to the individual and the nutritional balance in relation to energy expenditure; impaired reproductive function with menstrual disturbances is an indicator of the syndrome of relative energy deficiency in sport (REDs). Raising the awareness of the female elite athlete, her sport environment, her family and the health professionals in charge of medical care enables better prevention and avoids harmful consequences on bone metabolism, reduced immunity and cardiovascular risk, among others, and the impact on endurance and resistance performance. The absence of a menstrual cycle, apart from hormonal contraception, is incompatible with the research of sport performance. Similarly, moderate to severe dysmenorrhea, heavy menstrual periods which are a source of iron-deficiency anemia, and premenstrual syndrome which interferes with training, should not be treated as a fatality or taboo subject, but should be managed by appropriate treatment and explained to the athlete to ensure care compliance.

FOR AN INSTITUTIONAL OUTREACH APPROACH IN EMERGENCY MEDICAL SERVICES. The "outreach" approach has become the new paradigm of social action. With the creation of regional health agencies, the decompartmentalization between curative medicine, preventive medicine and medico-social care is accelerating. The political will to transpose social tools to the medical field requires removing the confusion between the logic of "outreach" (of Samusocial) and "outside the walls" (of Samu). Especially since Samu, as interface organizations, are privileged hospital actors for this decompartmentalization. The approach initiated by the pediatric Samu of Paris shows that this transposition is possible, both at the individual and institutional levels.

ENDOMETRIOSIS, PHYSICAL ACTIVITY AND SPORT. Endometriosis is a chronic, inflammatory gynecological disorder that impacts the quality of life of 10% of women of reproductive age with chronic recurrent pain and/or infertility. Management is a challenge both at the diagnostic time because no symptom is specific and at the therapeutic time to limit the symptoms of the disease. Recent studies suggest that physical activity has a beneficial effect on the perception of pain and the quality of life of women, if it is adapted to physical abilities, avoiding high-intensity sports during painful periods. Regular adapted physical activity combining endurance, stretching and flexibility at a light to moderate intensity, should allow a physical and psychological well-being for women with endometriosis in association with medical and/or surgical treatment.

TREATMENT OF INFECTIVE ENDOCARDITIS. Patients with infective endocarditis (IE) are taken care for by multidisciplinary teams. The treatment consists of antibiotic therapy initiated early, adapted to the responsible germ and prolonged, associated with surgical treatment when there is an indication for surgery. A parenteral antibiotic therapy is initiated in hospital for a period of at least two weeks. Depending on evolution of the patients, outpatient antibiotic treatment may be considered, and oral antibiotics may be proposed in stable patients when IE is caused by the most frequent germs. The surgical treatment of IE consists of total excision of the infected tissues and aims to restore the integrity of valvular functions. Conservative surgical treatment is performed, when possible, otherwise valve replacement is the alternative. The recognition of surgical indications (heart failure, uncontrolled infection, and prevention of embolic risk) is essential to improve the prognosis.

SARGASSUM SEAWEED AS SAULTS THE FRENCH WEST INDIES. Since 2011, Martinique and the islands of Guadeloupe have been affected by repeated groundings, culminating in an exceptional wave in 2018. While the sargassum ( Sargassum natans and S. fluitans ) involved in these phenomena are neither toxic nor urticating, indirect toxicity linked to the presence of microorganisms and heavy metals (arsenic, mercury, etc.) in sargassum clusters has been described. Similarly, after a 24 to 48 hours stay on the shore, sargassum algae enter a putrefaction cycle responsible to produce hydrogen sulfide (H2S) and ammonia (NH3). The acute toxicity of these gases is well known. However, very few data are available on the clinical effects of prolonged exposure to low doses of H2S and NH3. Our team has recently described the syndromic features of chronic exposure, supposing for deleterious effects on the cardiovascular, respiratory and neurological systems.