Genetic pancreatitis is a rare cause of chronic pancreatitis (1% of the cases). A genetic origin was suspected as early as 1952 and confirmed in 1996 with the identification of the PRSS1 gene, which predisposes individua...Genetic pancreatitis is a rare cause of chronic pancreatitis (1% of the cases). A genetic origin was suspected as early as 1952 and confirmed in 1996 with the identification of the PRSS1 gene, which predisposes individuals to the disease. Since then, new genes have been identified as potential contributors to chronic pancreatitis, usually interacting with environmental factors (alcohol, tobacco consumption). Diagnosis relies on genetic analysis, particularly in cases of unexplained pancreatitis in young patients or those with a family history of pancreatitis. The management of genetic pancreatitis relays on monitoring for early complications and providing psychological support. Carriers of PRSS1 mutations have an increased risk of pancreatic cancer, warranting screening from the age of 40.
Pain in chronic pancreatitis remains difficult to treat, due to a lack of understanding of the underlying nociceptive process. Therefore, treatments are often based on anatomical changes, although morphological features...Pain in chronic pancreatitis remains difficult to treat, due to a lack of understanding of the underlying nociceptive process. Therefore, treatments are often based on anatomical changes, although morphological features are not correlated with pain intensity and severity. It is well established that the cause of pain in chronic pancreatitis involves multiple mechanisms. Traditional theories focused solely on the role of morphological abnormalities of the pancreas in pain are flawed; there is now clear evidence showing that the resulting pain resembles that observed in neuropathic pain. Therefore, antineuropathic drugs are frequently used to treat pain. Furthermore, other etiologies of nociception, such as inflammation and increased intraductal pressure, may contribute to abdominal pain. Chronic pancreatitis pain is likely the result of a complex interaction between multiple mechanisms, which could explain the success or partial failure of single-modality treatment approaches. There is no single approach that is effective for all individuals; a personalized care is preferred.
The natural history of chronic pancreatitis (CP), aside from pain, is primarily marked by the risk of malnutrition and a poor quality of life. Addressing identifiable causes should be a priority whenever feasible, for in...The natural history of chronic pancreatitis (CP), aside from pain, is primarily marked by the risk of malnutrition and a poor quality of life. Addressing identifiable causes should be a priority whenever feasible, for instance, in cases of alcohol and/or tobacco dependence. The surveillance -including nutritional, anthropometric, biochemical, and bone assessments-should support a stepwise management approach, beginning with a balanced Mediterranean diet and extending to dietary counseling, oral nutritional supplements, and, if necessary, enteral and then parenteral nutrition.Beyond nutritional support, it is essential to evaluate for both exocrine and endocrine pancreatic insufficiency, with pancreatic enzyme replacement therapy considered when appropriate. Close monitoring is also needed for screening of other complications, such as diabetes, local or regional complications, and pancreatic cancer. Lastly, the psychological impact of the disease on the overall well-being must not be underestimated.
The first etiology of chronic pancreatitis is excessive alcohol consumption, which accounts for 46% of causes in the USA. Other include metabolic, genetic, obstructive or autoimmune mechanisms. In 2/3 of cases, several f...The first etiology of chronic pancreatitis is excessive alcohol consumption, which accounts for 46% of causes in the USA. Other include metabolic, genetic, obstructive or autoimmune mechanisms. In 2/3 of cases, several factors are interrelated, and it is essential to investigate the etiology to interrupt, if possible, the natural course of progression to chronic pancreatitis. The initial etiological approach should include detailed questioning, a physical examination, an initial laboratory work-up and cross-sectional imaging (CTscan and MRI). Genetic analysis is indicated if the cause remains uncertain, if the patient has a family history of pancreatic disease, in cases of recurrent pancreatitis or if the patient is young (under 35).
Chronic pancreatitis is characterized by irreversible morphological alterations in exocrine and endocrine tissue, combining inflammation and fibrosis. But the usual lack of histological evidence is a problem with this de...Chronic pancreatitis is characterized by irreversible morphological alterations in exocrine and endocrine tissue, combining inflammation and fibrosis. But the usual lack of histological evidence is a problem with this definition. The presentation of chronic pancreatitis is varied: fortuitous discovery, acute or chronic painful manifestations, diarrhoea due to exocrine pancreatic insufficiency, diabetes. CT and MRI are the 2 key procedures for the CP diagnosis and the differential diagnosis of pancreatic adenocarcinoma and papillary and mucinous intraductal tumors. Endoscopic ultrasound is useful for the diagnosis of early forms and for the differential diagnosis of a pseudotumoral focal form. Once the diagnosis of chronic pancreatitis is confirmed, the patient's management includes an exhaustive work-up to search for the cause (alcohol, tobacco, genetics, autoimmune, radiation, ischemic, etc.) and the evaluation of complications (pain, exocrine pancreatic insufficiency, diabetes, cholestasis, cancer).
The availability of medicines in France is based on obtaining a Marketing Authorization (MA) issued by the European Medicines Agency (EMA). However, this procedure does not cover all medical needs, such as certain rare d...The availability of medicines in France is based on obtaining a Marketing Authorization (MA) issued by the European Medicines Agency (EMA). However, this procedure does not cover all medical needs, such as certain rare diseases or specific clinical forms of certain diseases not covered by the MA wording. In order to better secure these off-label prescriptions, in 2021, the french legislature created two procedures: compassionate access authorization (CAA) issued for a specific patient at the request of a clearly identified practitioner responsible for monitoring the patient; and the compassionate prescribing framework (CPF) which provides a regulatory framework for drugs without marketing authorization in a specific indication for rare, serious, or debilitating diseases after analysis of a scientific file suggesting a favorable risk-benefit ratio. The prescriptions made within these frameworks are monitored according to a temporary use protocol and a data collection system that allows the tolerance of these treatments and, potentially, their effectiveness to be assessed. Examples of drugs that have obtained AACs or CPCs in the field of dermatology are presented.
New lipid-lowering therapies (injectable and oral PCSK9 inhibitors, inclisiran, bempedoic acid) allow more intensive LDL-C reduction, including in statin-intolerant patients.Lipoprotein(a) is emerging as a specific targe...New lipid-lowering therapies (injectable and oral PCSK9 inhibitors, inclisiran, bempedoic acid) allow more intensive LDL-C reduction, including in statin-intolerant patients.Lipoprotein(a) is emerging as a specific target, with ASO/siRNA agents (pelacarsen, olpasiran, lepodisiran) achieving marked reductions while outcome data are pending.Antithrombotic strategies are now tailored to ischemic and bleeding risks, using shortened dual antiplatelet therapy (DAPT), P2Y12 monotherapy and de-escalation approaches. On the inflammatory side, low-dose colchicine offers a simple, low-cost option for selected coronary patients, though recent results are mixed.Remote monitoring, hybrid cardiac rehabilitation and personalized care pathways help to further reduce residual cardiovascular risk.
Life-saving for people with type 1 or insulin-deprived diabetes for other causes, needed for people with type 2 diabetes or diabetes of other origin for which glucose control is not achievable without it, insulin therapy...Life-saving for people with type 1 or insulin-deprived diabetes for other causes, needed for people with type 2 diabetes or diabetes of other origin for which glucose control is not achievable without it, insulin therapy has shown a dramatic evolution during the last 30 years. The multiple-daily insulin injection regimens almost only use fast-acting and long-acting insulin analogues, according to a standard-of-care basal-bolus scheme. The initiation of insulin therapy in type 2 diabetes electively promotes the use of a long-acting insulin analogue. Using premix combinations of a fast-acting analogue and NPH insulin becomes obsolete. The treatment by insulin pumps which uses only fast-acting analogues has shown a major development in type 1 diabetes, amplified during the recent 5 years by the availability of automated insulin delivery systems.
Huynh A, de Gasperi S, Thorin A
… +1 more, Dischamps V
Rev Prat
· 2026 Jan · PMID 41729647
The increase in complaints of sexual violence is slowing down and mainly concerns young women outside their family environment. The increase in complaints of physical violence is stabilizing and, for minors, mainly conce...The increase in complaints of sexual violence is slowing down and mainly concerns young women outside their family environment. The increase in complaints of physical violence is stabilizing and, for minors, mainly concerns intra-family violence. These figures, although dramatic, are a sign that victims are speaking out more freely and that the population is becoming more aware of this issue. This is achieved through education on emotional and relational life in schools (EVARS), as well as sexual health education starting in middle school. The need for this education which has been recognized for nearly a century and was shaped by the Neuwirth Law of 1967 and the Fontanet Circular of 1973, the AIDS epidemic and the circulars of 1996-1998, and then the circular of 2001 requiring ongoing and regular sex education from elementary school to high school. This initiative has been inconclusive due to a lack of resources and has too often been considered solely from a biological and informational point of view. Numerous reports have warned of an increase in violence among young people, exposure to pornography, or prostitution cases among minors, leading to the February 2025 circular: "An ambitious program: educating about emotional life, relationships, and sexuality." The content of this program is structured and has been developed considering societal and medical changes. A complementary role between parents and schools, both in terms of the individual dimension of sexual health and its social context. Going far beyond purely biological issues, its comprehensive, secular, and positive approach is designed to be adapted to each age and level of education and is in line with the development of psychosocial skills. Delivering these sessions requires training and professionalism, which can be provided by external partners from middle school onwards. These experts offer tools for reflection and discussion, tailored to each topic and age group. They work closely with the educational teams at the schools. The implementation of these sessions from the start of the 2025 school year has been a real challenge, both in terms of organizing the sessions and communicating with parents, and adjustments are still being made.