Pharmacologic management of patients with both heart failure and diabetes

Diabetes and heart failure often occur together in patients, with each condition influencing the treatment of the other. Each disease has its own well-documented impact on prognosis, but when they are present in the same patient, the risk of morbidity and mortality increases substantially. Some therapies used in the treatment of diabetes are contraindicated in patients with heart failure, and some therapies for treating heart failure are often mistakenly believed to be contraindicated in patients with diabetes. This article aims to clarify the evidence behind treating these conditions simultaneously and dispel the myths surrounding the pharmacologic management of diabetes in heart failure and vice vers

Les prélèvements microbiologiques ont-ils encore une place dans le diagnostic de pneumopathie acquise sous ventilation mécanique ?

Diagnosis of ventilator-associated pneumonia (VAP) is based on non-specific clinical signs. Several indicators have been tested in order to improve the accuracy of VAP diagnosis. The quantification of clinical parameters by using the clinical pulmonary infection score (CPIS), however, failed to improve the specificity of the diagnosis. This was the same for all the biomarkers tested either in the serum (procalcitonin, C-reactive protein) or in the bronchoalveolar lavage (BAL) fluid [soluble triggering receptor expressed on myeloid cells 1 (sTREM 1), elastin fibers, endotoxin, pro-inflammatory cytokines, Clara cell protein 10]. The microscopic examination of endotracheal samples alone, especially of the BAL fluid, may provide useful information for the detection of infected cells. Thus, microbiology is still needed