[What's new in internal medicine?].
Brief virologic news included the discovery of the virophage, a unique parasite of the giant mimivirus and the association of HHV-8 infection with a peculiar form of African diabetes. Secondly, this news focused on risk factors for arterial or venous thrombosis and therapy for auto-immune disorders. Only oral estrogen therapy increases the risk of venous thromboembolism in postmenopausal women. Despite significant homocysteine lowering, vitamin supplementation with folic acid, vitamins B6 and B12 did not reduce total cardiovascular events among high-risk patients. Patients with venous thromboembolism have a substantially increased long-term risk of subsequent cardiovascular events while obesity, systemic arterial hypertension, and diabetes are common risk factors for arterial and venous thrombosis. The non fasting ApoB/ApoA1 ratio was superior to any of the cholesterol ratios for estimation of the risk of acute myocardial infection in all ethnic groups. Preventive anticoagulation of in-patients with risk of venous thromboembolism was inadequately prescribed in many hospitals of the world. Subcutaneous administration of methotrexate was more effective than the oral administration at the same dosage in patients suffering from active rheumatoid arthritis. Hydroxychloroquine directly reduces the binding of antiphospholipid antibody-beta2-glycoprotein I complexes to phospholipid bilayers. Anti-IL-5 and anti-IL-6 antibodies were effective for the treatment of respectively hypereosinophilic syndrome and rheumatoid arthritis. The efficacy of proteasome inhibitors and mesenchymal stems cells have been demonstrated in respectively two mouse strains with lupus-like disease and steroid-resistant severe acute graft-versus-host disease. These treatments may be useful for auto-immune disorders if their long term toxicity is acceptable. In conclusion, subcutaneous injections of physiological saline, used as placebo in two different trials, enhanced in vitro activation of immunocompetent cells in healthy individuals.
Francès
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C
Service de Dermatologie-Allergologie, Hôpital Tenon, Paris, France. camille.frances@tnn.aphp.fr
D000818:Animals; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001327:Autoimmune Diseases / Q000150:complications / Q000188:drug therapy*; D001435:Bacteriophages / Q000302:isolation & purification; D015992:Body Mass Index; D048909:Diabetes Complications; D004359:Drug Therapy, Combination; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D017681:Hypereosinophilic Syndrome / Q000188:drug therapy*; D006973:Hypertension / Q000150:complications; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007388:Internal Medicine / Q000639:trends*; D008727:Methotrexate / Q000627:therapeutic use; D056686:Mimiviridae / Q000302:isolation & purification; D009765:Obesity / Q000150:complications; D012307:Risk Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000188:drug therapy
D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents; D006886:Hydroxychloroquine; D008727:Methotrexate