Acute variceal bleeding treatment in patients with portal hypertension combines vasoactive drugs, prophylactic antibiotics, hepatic encephalopathy prophylaxis and upper gastrointestinal endoscopy for variceal treatment (...Acute variceal bleeding treatment in patients with portal hypertension combines vasoactive drugs, prophylactic antibiotics, hepatic encephalopathy prophylaxis and upper gastrointestinal endoscopy for variceal treatment (elastic band ligation and/or tissue adhesive injection), on top of non-specific measures. Failure to control bleeding must lead to salvage TIPS (Transjugular Intrahepatic Portosystemic Shunt) discussion, after esophageal tamponade (balloon or stent).Pre-emptive TIPS within 72h must systematically be considered in high-risk patients to reduce rebleeding and mortality. Pre-emptive TIPS must also be discussed in case of gastric variceal bleeding.Following the acute bleeding episode, secondary prophylaxis combines non-selective betablockers and recurrent endoscopic treatments (except after TIPS). Liver transplantation must be discussed in certain cases of refractory bleeding or early relapse after TIPS implantation.
Admission to the intensive care unit represents a profound psychological ordeal for patients' family members. Far beyond the initial shock related to the severity of the illness, the hospital experience exposes families...Admission to the intensive care unit represents a profound psychological ordeal for patients' family members. Far beyond the initial shock related to the severity of the illness, the hospital experience exposes families to a cumulative burden of stress, including prolonged uncertainty, confrontation with medical technology, physical exhaustion, loneliness, opaque medical language, and a sense of helplessness. Numerous studies show that during the months following an ICU stay, up to 70% of relatives experience symptoms of anxiety, 35% symptoms of depression, and nearly one third symptoms consistent with post-traumatic stress disorder. To name this specific burden, we propose the concept of HILLY (healthcare-associated family mental injury). HILLY does not pathologize families' experiences nor does it assign individual blame; rather, it highlights the often-unintentional role of certain care-delivery and organizational practices in the emergence of an avoidable trauma, which adds to that of critical illness itself. Restricted visiting policies, fragmented or jargon-laden communication, lack of dedicated spaces for listening, and insufficient recognition of the role of relatives all contribute to exacerbating this injury. The COVID-19 pandemic starkly illustrated the consequences of family exclusion, leading to complicated grief and heightened psychological symptoms among both relatives and healthcare professionals. Preventing HILLY requires a systemic approach: acknowledging this injury, training teams in communication skills, integrating family mental health into quality indicators, valuing relational time, and organizing structured follow-up after ICU discharge. Thinking HILLY means broadening the ethical framework of care to include those who accompany patients, and recognizing that caring for a patient also means caring for their family.
Health influencers are increasingly present on social media, with around 150,000 healthcare professionals involved in France. Their stated goal is to democratize medical information, in a context where 61% of internet us...Health influencers are increasingly present on social media, with around 150,000 healthcare professionals involved in France. Their stated goal is to democratize medical information, in a context where 61% of internet users admit to being influenced by this content. In response to this boom, the legal framework has gradually been structured and relaxed. At the same time, ethical regulations remain central. While the principle that medicine cannot be practiced as a business remains firmly established, a notable change has taken place since 2020: doctors can now communicate, provided that the information is accurate, scientifically based, cautious, and devoid of any promotional purpose. The French National Medical Council is exercising increased vigilance and published a charter for responsible content creators in 2025. Physician influencers must therefore reconcile legal and ethical requirements by clearly distinguishing between health information and advertising, ensuring transparency of financial links, and avoiding any commercial incentives. This vigilance could intensify in the future, in the context of European and international discussions on the regulation of online health content.
A recent change in terminology proposed by scientific societies replaces the term NAFLD (non-alcoholic fatty liver disease) with the term MASLD (metabolic dysfunction associated steatotic liver disease). The prevalence o...A recent change in terminology proposed by scientific societies replaces the term NAFLD (non-alcoholic fatty liver disease) with the term MASLD (metabolic dysfunction associated steatotic liver disease). The prevalence of metabolic steatosis in France is 18.2%, higher among at-risk individuals (obese, diabetic, or with elevated transaminases). Among patients with MASLD, approximately 25% have liver inflammation with hepatocyte damage, now referred to as MASH (Metabolic dysfunction Associated Steatohepatitis), replacing the former name NASH (Non Alcoholic Steatohepatitis). MASH is associated with a significant increase in overall mortality, related to the severity of histological lesions, particularly cirrhosis. Cirrhosis develops in 15% to 30% of patients with MASH, usually at an older age than in other chronic liver diseases, due to a slower progression rate of fibrosis. Closely related to metabolic syndrome and insulin resistance, the disease progression involves the liver (progression of fibrosis, development of cirrhosis) but also exposes individuals to a significant risk of extrahepatic complications, such as cardiovascular, metabolic, and neoplastic diseases.
The epidemic of metabolic dysfunction-associated steatotic liver disease (MASLD), amplified by shifting dietary habits and increasing sedentary lifestyles, has elevated metabolic dysfunction-associated steatohepatitis (M...The epidemic of metabolic dysfunction-associated steatotic liver disease (MASLD), amplified by shifting dietary habits and increasing sedentary lifestyles, has elevated metabolic dysfunction-associated steatohepatitis (MASH) to a major public health challenge, burdened by the threat of cirrhosis and hepatocellular carcinoma.In this alarming context, bariatric surgery has progressively established itself as a key therapeutic solution, transforming the prognosis for patients with severe forms of the disease. Its efficacy extends beyond simple weight loss: it improves metabolism, reduces hepatic steatosis, inflammation, and, above all, fibrosis. Recent data confirm its impact on long-term survival, with a significant reduction in cardiovascular morbimortality and an overall improvement in life expectancy.However, this approach remains reserved for carefully selected patients. Its integration into therapeutic algorithms raises crucial questions, particularly with the emergence of new pharmacological therapies or less invasive endoscopic approaches.
Metabolic dysfunction associated steatotic liver disease (MASLD) is a systemic disease affecting the liver. The diagnostic approach consists of the identification of hepatic steatosis, the exclusion of other causes of st...Metabolic dysfunction associated steatotic liver disease (MASLD) is a systemic disease affecting the liver. The diagnostic approach consists of the identification of hepatic steatosis, the exclusion of other causes of steatosis and the evaluation of hepatic fibrosis. Comorbidities (obesity, type 2 diabetes, dyslipidemia, high blood pressure, sleep apnea syndrome, cardiovascular diseases, endocrinopathies) must be evaluated and managed when diagnosis of MASLD is made. Simple tests (FIB-4, liver stiffness) mainly allow to differentiate between steatosis and steatohepatitis to define a simplified follow-up by the general practitioner or a specialized multidisciplinary follow-up. The increasing morbidity and mortality linked to MASLD justifies its screening, confirmation of the diagnosis, evaluation of the severity of the liver disease and monitoring according to the stage of the disease.
Drug treatment of metabolic dysfunction-associated steatotic liver disease (MASLD) is undergoing a revolution. The fight against cardiovascular risk factors, the optimization of the treatment of type 2 diabetes, the scre...Drug treatment of metabolic dysfunction-associated steatotic liver disease (MASLD) is undergoing a revolution. The fight against cardiovascular risk factors, the optimization of the treatment of type 2 diabetes, the screening of common extra-hepatic cancers, personalized dietary measures, therapeutic physical exercise programs and the fight against a sedentary lifestyle remain fundamental to propose to all patients. For patients with metabolic dysfunction-associated steatohepatitis (MASH) and liver fibrosis (F2-F3), resmetirom is the first effective and well-tolerated drug marketed in the USA and Europe. Semaglutide or double or triple incretin receptor/glucagon receptor agonists could constitute the future cornerstone of drug management for patients with MASLD, due to the achievement of very significant weight loss (from 10 to more than 24% of the initial weight). Semaglutide has been shown to reduce cardiovascular and renal events, and has been approved for marketing in the USA, for MASH without cirrhosis. The choice of the best drug combination, the optimal prescription duration and the best drug option in the case of MASH-related cirrhosis remain to be determined.
Therapeutic options for multiple sclerosis (MS) have expanded considerably, allowing for increasingly individualized management. In 2026, disease-modifying therapies include immunomodulators, oral immunosuppressants, and...Therapeutic options for multiple sclerosis (MS) have expanded considerably, allowing for increasingly individualized management. In 2026, disease-modifying therapies include immunomodulators, oral immunosuppressants, and monoclonal antibodies. Therapeutic strategies are tailored to disease course and severity, treatment-related risks, and patient characteristics such as age, pregnancy plans, comorbidities. Intravenous corticosteroid therapy is the standard treatment for flare-ups. Management of symptoms particularly pain, urinary dysfunction, and cognitive impairment, most often relies on a multidisciplinary approach involving both medical and paramedical care. When managing complex situations, seeking the advice of an MS Resource and Competence Center (MS RCC) is particularly helpful.