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Gliflozins (sodium-glucose cotransporter type 2 inhibitors or SGLT2is) are the only glucose-lowering agents that have proven their ability to reduce major cardiovascular events, hospitalisations for heart failure and the progression to end-stage kidney disease in at risk patients with type 2 diabetes (T2D). One of the most marked and reproducible effects is the reduction in hospitalisations for heart failure. This protective effect was observed in all large prospective cardiovascular outcome trials, independently of the presence of heart failure at inclusion, and was confirmed in two dedicated trials that specifically targeted patients with heart failure and reduced left ventricular ejection fraction, with or without diabetes DAPA-HF with dapagliflozin and EMPEROR-reduced with empagliflozin. The reduction in hospitalisations for heart failure appeared more marked when baseline renal function was impaired, including when estimated glomerular filtration rate (eGFR) was inferior to 45 ml/min/1.73 m². These favourable results contribute to give a privileged position to SGLT2is in more recent international guidelines produced by diabetologists, cardiologists and nephrologists. According to these guidelines, the prescription of SGLT2is should be extended to patients with an eGFR between 30 and 60 ml/min/1.73 m² as well to non-diabetic patients with heart failure and reduced ejection fraction. For other patients with preserved ejection fraction, one has to wait for further results from ongoing large prospective trials.Previous studies have established a positive correlation between democracy and health. The COVID pandemic seems to be putting democracies in trouble. One option to face this challenge could be to strengthen health promotion, as defined in Ottawa Charter.The different protocols and algorithms for difficult intubation highlight the need for early detection of patients at risk of ventilation and difficult intubation. These protocols allow an adaptation of the management and all conclude that an emergency trans-tracheal approach is necessary in case of impossible intubation. In this context, the prevention of hypoxemia must be a major concern of any anaesthetic management. Indeed, in case of an impossible orotracheal intubation, the occurrence of hypoxemia is directly correlated to the duration of apnea. Classically, preoxygenation maneuvers can significantly increase the duration of apnea without hypoxemia. Furthermore, apneic oxygenation maneuvers may be added in case of impossible ventilation but permeable laryngeal passage. This article reports on a patient with difficult intubation and ventilation criteria who benefitted from preoxygenation associated with apneic oxygenation via high flow nasal cannula.As the prevalence of cancers increases with age, some elderly patients are confronted with multiple tumoural pathologies. The clinical case of a 70-year-old patient with adenocarcinoma of the breast and multiple myeloma complicated by severe renal failure illustrates the complexity of oncogeriatric management. The geriatric assessment makes it possible to detect frailty and provides assistance in the development of a personalized care plan while respecting the quality of life.Recently, brentuximab vedotin (BV) (Adcetris®) obtained the reimbursement in Belgium for the treatment of the primary cutaneous NKT-cell lymphomas mycosis fungoides (MF), large cell anaplastic lymphoma and lymphomatoid papulosis type A. BV is a monoclonal antibody directed against the CD30 expressed on tumoral T cells. The inhibition of this pathway releases the process of apoptosis leading to the cell death of the tumoral cells. BV is reimbursed after the use of another systemic treatment without success and if the number of CD30 positive atypical T-cells is larger than 10 %. BV is administered intravenously every 3 weeks with a dosing of 1,8 mg/kg with a maximum of 16 courses. The response rates exceed 75 %. selleck compound In some instances, interesting treatment responses have been observed with BV in CD30 negative patients. The principal adverse effects are neutropenia and peripheral neuropathy. Two patients are presented with longstanding multi-resistant MF that were successfully treated with BV.Prolonged standing or even sitting position can induce a fall in arterial blood pressure because of gravity that provokes a blood volume sequestration in lower limbs. Such a phenomenon may be associated with orthostatic dizziness or sometimes syncope. We present the image of a continuous monitoring using a Finometer® of systolic blood pressure and heart rate. Crossing legs while in sitting position allows immediate increase of arterial blood pressure. This pathophysiological mechanism explains why numerous people cross legs in sitting position, for instance during a prolonged meeting, in an auditorium or in a movie theater. This common phenomenon has potential diagnostic, therapeutic and prognostic implications.A swimbladder is a special organ present in several orders of Actinopterygians. As a gas-filled cavity it contributes to a reduction in overall density, but on descend from the water surface its contribution as a buoyancy device is very limited because the swimbladder is compressed by increasing hydrostatic pressure. It serves, however, as a very efficient organ for aerial gas exchange. To avoid the loss of oxygen to hypoxic water at the gills many air-breathing fish show a reduced gill surface area. This, in turn, also reduces surface area available for other functions, so that breathing air is connected to a number of physiological adjustments with respect to ion homeostasis, acid-base regulation and nitrogen excretion. Using the swimbladder as a buoyancy structure resulted in the loss of its function as an air-breathing organ and required the development of a gas secreting mechanism. This was achieved via the Root effect and a countercurrent arrangement of the blood supply to the swimbladder. In addition, a detachable air space with separated blood supply was necessary to allow the resorption of gas from the swimbladder. Gas secretion as well as gas resorption are slow phenomena, so that rapid changes in depth cannot instantaneously be compensated by appropriate volume changes. As gas-filled cavities the respiratory swimbladder and the buoyancy device require surfactant. Due to high oxygen partial pressures inside the bladder air-exposed tissues need an effective reactive oxygen species defense system, which is particularly important for a swimbladder at depth.
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