La Revue de médecine interne
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Functional somatic disorders (FSD) are common conditions that result in a significant deterioration of the quality of life. Their origin is multifactorial and poorly understood, and their management is often inadequately defined. Medications typically show limited effectiveness, while mind-body approaches play a central role, guided by three key principles: establishing an empathetic, respectful, and sincere doctor-patient relationship; promoting regular and gradual physical activity; and implementing cognitive behavioral therapy (CBT). ⋯ The combination of gradual physical activity and CBT appears to be complementary. Other mind-body approaches such as mindfulness meditation might help although their level of evidence is weaker. Given the prevalence of FSD in the general population, it seems necessary for all physicians to be trained in managing this condition.
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Health anxiety (HA) is a frequent problem (up to 20% of consultants in the context of secondary care) responsible for decreased well-being, disability, somatic and psychiatric complications, which contributes to high healthcare expenditures at the population level. It is likely, if not definitely established, that the prevalence of ACS is increasing, and this can partly be explained by the growing medicalization of society in general, the appetite of Media for health issues, and the uncontrolled use of the Internet (which can lead certain vulnerable subjects to cyberchondria). The pandemic of COVID-19 could have contributed to it, at least by the significant increase in the overall level of psychological distress in the population it has caused, although this has not formally been demonstrated to date. ⋯ Certain intuitive attitudes of doctors, such as reassurance, prove to be iatrogenic for the patient with HA. The management of HA can be facilitated by an acculturation of physicians to cognitive conceptions of anxiety in general and HA in particular. HA is effectively treatable by certain psychotherapy and in the first place cognitive and behavioral therapies (CBT), but the availability of trained therapists and accessible at a lower cost is sorely lacking, particularly in France.
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Primary hyperparathyroidism (PHPT) is the leading cause of hypercalcemia. It is secondary to hypersecretion of parathyroid hormone (PTH) by the parathyroid glands. Today, PHTP is asymptomatic in 80-90% of cases. ⋯ Surgical management of the hyperfunctioning parathyroid gland(s) is the only curative treatment for HPTP. Medical management concerns patients for whom surgery is not indicated, who present a surgical contraindication or who refuse surgery. The diagnosis of HPTP warrants contact with an endocrinologist to ensure its management.
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Review Multicenter Study
The CARMEN-France registry of adult patients with immune thrombocytopenia and autoimmune hemolytic anemia in France.
The CARMEN-France registry is a prospective, multicenter registry in France including adult patients with a new diagnosis of immune thrombocytopenia or of autoimmune immune hemolytic anemia (2402 patients included in December 31, 2023). The recording of clinical, biological and treatment data allows detailed epidemiological and pharmacoepidemiological real-world studies. This review summarizes the CARMEN-France registry protocol, gives examples of studies conducted in the registry, and indicates future directions such as inclusion of patient reported outcomes, linkage with the French national health insurance database and linkage with other registries in Europe.
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The standard hemostasis workup [quick time (QT), and activated partial thrombin time (APTT)] is very commonly prescribed but its interpretation is often difficult for practitioners who are not specialized in hemostasis. Here, we review the principles of the diagnostic approach to these tests. Only a very basic knowledge of the coagulation cascade is necessary to identify which clotting factor tests to prescribe and to interpret the results. ⋯ If a single factor is deficient, we review the different causes of acquired deficiencies and briefly discuss the characteristics of the different congenital defects, which generally require specialized management. Lupus anticoagulant is a common and generally benign cause of prolonged APTT to be aware of, which is not related to a hemorrhagic risk. A good knowledge of the diagnostic approach to abnormal QT or APTT generally allows the resolution of the most common situations.