Internal and emergency medicine
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Thirty years ago, chronic conditions such as diabetes, heart disease, and obesity accounted for less than 45% of the global disease burden. Today, they are the leading causes of death and disability worldwide, having surpassed infectious diseases such as HIV/AIDS and malaria. ⋯ More recent research is continuing to define the contribution of other emerging factors to the risk of developing cardiovascular disease, particularly abdominal obesity that is associated with atherogenic dyslipidemia, insulin resistance, chronic inflammation, and prothrombotic state. All these factors constitute the global cardiometabolic risk that plays a significant role in development of cardiovascular disease.
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Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment. The number of indications is increasing and antibodies targeting the CTLA-4 and PD-1/PD-L1 pathways are now also prescribed in adjuvant settings and for metastatic cancer. However, ICIs reactivate autoreactive immune cells as well as tumour-specific T cells, which lead to immune-related adverse events (irAEs) in around 70% of treated patients. ⋯ Some irAEs (especially myocarditis, pneumonitis, and encephalitis) are potentially fatal; in patients with highly suggestive clinical signs, treatment should be initiated before the diagnostic work-up has been completed. When confronted with an unexpected clinical sign, the physician must differentiate rapidly between an irAE, cancer progression, and another (unrelated) cause. The management of irAEs is based on the temporary or permanent discontinuation of the ICI and (for grade ≥ 2 events) the administration of steroids.
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Cardiometabolic risk factors in Tunisia are growing fast. The main risk factor is metabolic syndrome which is a global health issue in both developing and developed countries. ⋯ Hypertension and diabetes are also additional risk factors predicting alarming mortality rates. We propose here a review of the determinants of metabolic syndrome in Tunisia and the overall cardiometabolic risk factors.
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Anaemia is a highly prevalent condition, which negatively impacts on patients' cardiovascular performance and quality of life. Anaemia is mainly caused by disturbances of iron homeostasis. ⋯ Various mechanistic links between iron homeostasis, anaemia, and pulmonary hypertension have been described and current treatment guidelines suggest regular iron status assessment and the implementation of iron supplementation strategies in these patients. The pathophysiology, diagnostic assessment as well as current and future treatment options concerning iron deficiency with or without anaemia in individuals suffering from pulmonary hypertension are discussed within this review.