The net clinical benefit of antiplatelet agents in the secondary prevention of atherothrombotic cardiovascular events has been widely demonstrated. This recognized efficacy explains the usual reluctance to consider discontinuation such treatment in clinical practice. Discontinuation of antiplatelet therapy should nevertheless be considered in a frequent situation, when an indication for therapeutic anticoagulation arises, as combining two antithrombotic agents significantly increases the risk of bleeding. Current international guidelines recommend discontinuing antiplatelet therapy whenever possible upon initiating therapeutic anticoagulation. Using a clinical case study, this article provides an up-to-date, practical overview of antiplatelet management when introducing therapeutic anticoagulation.
Acute esophageal necrosis, also known as "black esophagus" or Gurvits syndrome, is a rare but severe cause of upper gastrointestinal bleeding. It mainly affects elderly, frail and polymorbid patients, often in the setting of systemic low-flow states or severe metabolic disorders. The clinical presentation is dominated by hematemesis or melena. Diagnosis relies on endoscopy, which reveals circumferential black discoloration of the distal third of the esophagus, stopping at the gastroesophageal junction. Management is primarily symptomatic and etiological, combining hemodynamic stabilization, acid-suppressive therapy and treatment of the underlying cause. Complications, notably perforation, may require surgical intervention.
Through physiological mechanisms and direct interactions, food intake influences the absorption and bioavailability of orally administered medications, with clinical consequences in terms of both efficacy and tolerability. This article provides a practical overview of how commonly prescribed medications should be taken in relation to meals, distinguishing between those that must be administered on an empty stomach, away from meals, or with food. Some medications require strict administration conditions, while others allow greater flexibility. An individualized approach is therefore essential, taking into account the risk of intolerance, to optimize the dosing schedule and promote good therapeutic adherence.
The morbimortality of sepsis and septic shock is high, and their early diagnosis remains difficult for every physician. While it has long been considered primarily a macrocirculatory disorder, research in recent years has brought to light the central place of microcirculation in sepsis. Using clinical signs, for example on the skin, is an effective way to evaluate microcirculation disorder, making it a useful tool for the diagnosis and monitoring of resuscitation during sepsis. Skin mottling can be used as a prognostic tool, enabling the early identification of patients at high risk of complications.
Lower-limb oedema and weight gain remain key components in the assessment of congestion in heart failure and continue to guide clinical decision-making. However, they only imperfectly reflect a complex pathological process involving interactions between the vascular and interstitial compartments, venous capacitance, and lymphatic drainage. Congestion extends beyond simple tissue fluid accumulation or weight gain and includes changes in vascular pressures and volumes that may be dissociated from one another and difficult to detect clinically. This dissociation may lead to diagnostic bias and overinterpretation of visible signs. An integrated approach to congestion therefore appears necessary to improve patient assessment and management.
Acute myeloid leukemia is a malignant blood disorder that requires prompt management. Initial investigations are essential to establish the diagnosis and guide treatment. In patients who are considered "fit" the initial treatment is based on intensive chemotherapy, followed by a consolidation treatment. New drugs have emerged, which are administered in combination to chemotherapy. They allow to better tailor treatment according to the molecular details of the disease.
Autoimmune diseases result from a breakdown of immune tolerance, which can precede clinical manifestations by several years. Screening for antinuclear antibodies (ANA) is commonly performed in patients with nonspecific symptoms suggestive of a systemic autoimmune disease. In the absence of a compatible clinical context, detecting autoantibodies can cause confusion and concern. This article provides an integrated clinicobiological analysis of ANA and extractable nuclear antigen testing, emphasizing the importance of rigorous assay validation and contextualized interpretation to prevent overdiagnosis and unnecessary investigations.
This article provides a brief overview of the pathophysiology of jaundice and bilirubin. When evaluating a patient presenting with jaundice, the initial diagnostic step is based on distinguishing between conjugated and unconjugated hyperbilirubinemia, to differentiate hepatobiliary disorders from prehepatic causes. A structured diagnostic approach is therefore required to guide the differential diagnosis and identify situations requiring prompt management.
