La Revue de médecine interne
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By the end of the nineties, new immunomodulatory options impacting on the determinants of many immune-mediated diseases became available. These drugs were also called biologicals. Their use was associated with a significant improvement in the management of the patients and on their clinical evolution over time. ⋯ Viruses mostly involved are respiratory (influenza, RSV, and SARS-CoV2), Varicella-Zoster, hepatitis B, or JC viruses, in particular. The viral risk depends not only on the type of biologicals, but also on the underlying disease, the associated comorbidities, the associated treatments, the epidemiological environment, and the individual and collective immunity. At an individual level, prevention and management of the infectious risk are of utmost importance in the global management of patients on biologicals.
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Review Case Reports
[Chronic Q fever. Literature review and a case report of culture negative spondylodiscitis].
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. ⋯ 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.
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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. ⋯ 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.
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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. ⋯ 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.
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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. ⋯ 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.