Prevention of gastrointestinal (GI) lesions and hemorrhage in patients receiving antithrombotics relies on gastroprotection with proton pump inhibitors (PPIs) in high-risk individuals. During the recent European Days of the French Society of Cardiology 2025 held in Paris
from the Intercommunal Hospital Group Le Raincy Montfermeil
reviewed updated strategies for prescribing PPIs
While 50%-80% of PPI prescriptions are unjustified
particularly for unnecessary nonsteroidal anti-inflammatory drug (NSAID)-related ulcer prophylaxis
PPIs remain underprescribed for patients at risk for bleeding on antithrombotics
particularly direct oral anticoagulants (DOACs)
A Danish study based on a national health data register found that only 40% of the patients treated with dual antiplatelet therapy of GI bleeding did not receive PPIs
PPIs have been demonstrated to be effective in this regard. A meta-analysis showed that PPIs used as gastroprotective treatments are associated with an 80% reduction in the risk for bleeding
“It is now well established that there is a benefit of PPIs in the prophylaxis of digestive lesions and bleeding in these at-risk patients,” Macaigne said
No specific recommendations are available for the prevention of bleeding in patients receiving antithrombotic drugs. However, the European guidelines for chronic coronary syndrome recommend PPIs (Class I
Level A) for high-risk patients receiving aspirin
To gain a clearer picture of risk factors in patients receiving antithrombotics to prevent cardiovascular risk, Macaigne proposed an algorithm based on the European consensus
In patients receiving antiplatelet drugs such as aspirin
PPI treatment is recommended in the following cases:
PPIs are also recommended in the presence of at least two of the following risk factors: Age ≥ 65 years
but “age becomes a major risk factor,” justifying PPI prophylaxis
“Patients over 65 years of age on DOACs must receive prophylactic PPI treatment,” as do patients treated with a combination of antithrombotics
rivaroxaban is associated with the highest risk for GI bleeding
with a fivefold increased risk in placebo-controlled studies
while apixaban has a lower risk than other DOACs (threefold increased risk)
Half-dose PPIs (except omeprazole) should be administered 30 minutes before breakfast for optimal acid suppression
“A single dose of PPI allows a reduction in gastric acidity of approximately 60% for almost 24 hours,” Macaigne noted
omeprazole) may reduce the efficacy of clopidogrel
Since clopidogrel requires CYP450 metabolism to release its active metabolite
Macaigne recommended maintaining a 12-hour gap between clopidogrel (evening dose) and PPIs (morning dose) or switching to rabeprazole
rabeprazole is preferred in case of treatment with clopidogrel
the risk for interaction being lower with this drug
clopidogrel can also be substituted by prasugrel
Although H pylori infection does not increase the risk for digestive bleeding with anticoagulant therapy, eradication improves chronic gastritis and reduces the risk for gastric cancer in patients on PPIs. The 2022 Maastricht VI/Florence Consensus Report recommends screening for H pylori infection in these patients
diagnosis is based on endoscopy and biopsy
whereas asymptomatic patients require a breath test
“The PPI must then be stopped 2 weeks before the test to increase its sensitivity and not take antibiotics during the previous 4 weeks,” Macaigne advised
Tapering PPIs gradually helps avoid symptom flareups
“A sudden interruption of PPIs is accompanied by acid secretion at a rate higher than before the start of treatment,” which induces digestive symptoms
Another side effect of PPIs is hypomagnesemia
especially in patients aged more than 65 years
A serum magnesium test should be performed in these patients and supplementation should be prescribed if necessary
PPIs may also promote digestive infections by acid-sensitive bacteria
and bacterial proliferation in the upper part of the digestive tract
Microscopic colitis-related secretory diarrhea may also occur
“It usually occurs in patients who have started PPI treatment for about 4 months.” Lansoprazole should be considered a potential trigger if secretory diarrhea appears after this treatment period
This story was translated from Medscape’s French edition using several editorial tools
Human editors reviewed this content before publication
Send comments and news tips to news@medscape.net
Since last April, the picorette has been based on avenue de la Résistance in Le Raincy
after many years in a first location in the town
mother of three daughters and solar entrepreneur
who wanted to create a new place to live in the town where she lives
I saw that there was nothing for children," says the former nurse
who left the hospital to set up her own toy store
"like the ones she knew in Paris and Montreuil"
all products are also available for purchase on the boutique's online site
The big plus of this huge toy store is certainly thechildren's play area: in the center of the store
it's a cocoon where you can play with tea sets
or put your baby down on the play mat for a gentle family moment
Or you can put your baby down on the play mat for a gentle family moment
la picorette also offers workshops for children: sophrology
creative workshops and other initations await the little ones every Wednesday
Older children also have the right to their own workshops
parents' café and creative aperitif sessions
the café Beber - located within the boutique with its saffron-yellow tiled floor and blue-painted columns - allows those who wish to warm up over a hot drink (with vegetable or cow's milk) or a cold one
bread with a chocolate bar and other delicacies straight from the bakery next door
the café has quickly become a meeting place for families and local residents alike
"a place where grannies rub shoulders with newborn babies
La Picorette is open every day of the week
If you're looking for a must-visit address in Raincy
This test was conducted as part of a professional invitation
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Coral Springs, Fla. – The 2015 All-American Scholars have been announced by the Women's Golf Coaches Association (WGCA) and Georgia State's Solene Le Coz has earned that recognition
To become a WGCA All-American Scholar a student-athlete golfer must have a cumulative GPA of 3.5 or higher
produced a 4.06 spring GPA to earn President's List status at GSU as she lifted her cumulative GPA to 3.71
France (in metro Paris) is majoring in accounting managerial sciences and had made the Dean's List during the fall semester
Le Coz had three top 25 finishes during her sophomore season
including at the Sun Belt Conference championship
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The scene in the Paris docklands last month could have been anywhere across the Torah world
In the massive former industrial space regenerated to serve the entertainment industry
singers rehearsed and microphones were adjusted for roshei yeshivah
Underway were the last preparations for the signature blend of Torah inspiration and musical extravaganza with which Dirshu marks events like the global siyum of the three-year Mishnah Berurah cycle
Accents apart — and a certain resonance that comes from being only miles from where Baalei HaTosafos such as Rabbeinu Yechiel of Paris lived — the identikit venue could have been anywhere from South Africa to New Jersey
as Mir Rosh Yeshivah Rav Yitzchak Ezrachi finished his keynote address with a signature roar of “Only Torah!” and a cross section of Paris Jews erupted in singing
That’s because a French revolution is underway
A city whose Torah glory was long in the past and had become a mussar byword for decadence
Exhibit A in that metamorphosis is Dirshu itself
Like ubiquitous consumer brands that signal a country’s socio-economic status
the presence of hundreds of shiurim from the ground-breaking Torah organization is a sure sign that today’s French Jewish community is changing rapidly
The traditional Jews and fine Parisian living of yesteryear are still there
but these have been joined by multiple yeshivos and kollelim
As the community moves east and west from the inner-city neighborhoods to the suburbs
a parallel process of spiritual upgrade is taking place as well
the almost half-million-strong community lives in fear
as the specter of terror attacks sends masses stampeding for the exit
the country’s Jewish community is evolving to cope with the security realities
and a quiet Torah revolution is well underway
a main avenue in Paris’s heavily Jewish 19th arrondissement
the first thing that strikes you is a question
the 300,000 Jews in this city don’t live in a ghetto
they’re spread out thinly across large areas with other populations
That means that as late afternoon gives way to dusk
a visitor starts to look nervously over his shoulder
The idea that you can’t walk around the streets of Paris without a baseball cap is also wrong
yarmulkes are readily visible in this part of the city
I find an older-looking man with a kippah obviously bent on the same mission
“Are you not worried to walk around without a cap?” I ask as we walk
“I am a bit nervous,” he admits in a mixture of French and Ivrit
His destination — a large Moroccan shul — is typical of the French Jewish experience
and guard booth speak of the security that is normal in a community that has suffered recent terror attacks
But inside there are other telling signs of the specific circumstances that had molded today’s French Jewry
Ditto for the collection of Yalkut Yosef from Rav Ovadiah
reverential plaque for Rav Gershon Liebman
“Reb Gershon” survived both Soviet and Nazi forced labor
went on to found yeshivos in Germany and eventually France
where he set up a vast network of Torah institutions
the current French Torah boom is a child of the fearless Novardoker pioneer and others like him
About 15 kilometers east of the 19th — or half an hour in Paris traffic terms — is a window into the ground zero of the latest stage in the country’s Jewish growth
the suburb of Le Raincy is an island of upmarket suburbia in a wider sea of socioeconomic deprivation
It’s also the home to a unique set of Torah institutions
His Merkaz HaTorah campus is an entire ecosystem
catering from nursery age to high school and yeshivah
What stands out is the parallel existence of two different educational approaches: In one building is a yeshivah high school of a type familiar from London or New York
Inside a building that flies the French and European Union flags
are 200 students whose day is divided between Gemara and secular studies
is an institution more familiar from Bnei Brak
Chazon Nachum is a high-level Torah-only yeshivah ketanah
Rav Toledano explains the origins of the twin approach
and was sent by his father to learn first in Schneider’s Yeshiva in London
“In the ’70s and ’80s,” says Rav Yehudah Toledano
“French Jewish life was what was called ‘Consistoire Judaism,’ after the establishment Jewish organization dating from Napoleon’s time
It was a Judaism of synagogues — mostly Ashkenazic — with some shiurim added.”
The waves of North African Jews from traditional backgrounds who arrived from the 1960s onward didn’t feel at home in these shuls and were anyway preoccupied with establishing themselves in the new land of economic promise
It was in that unpromising soil that a handful of pioneers such as Rav Yitzchak Chaikin of Aix-les-Bains (a talmid of the Chofetz Chaim)
Rav Mordechai Rottenberg (known as the “Rouv”) of Paris
“When my father arrived in France in 1967,” explains Rav Yehudah Toledano “he saw that there was no chance of getting local Jews to send their children to a yeshivah
but if there were high-level secular studies
these traditional Jews would send their children.”
Rav Yaakov was able to found a classic yeshivah
we are able to offer different options,” says his son Rav Yehudah Toledano
who took over the institutions when his father passed away in 1996
Today’s French Torah world is built on the first fruits of that struggle decades ago
a great kiruv boom took place under leaders such as former chief rabbi Yosef Sitruk
whose Monday evening lectures could draw 1,000 people,” says Rav Toledano
“Movements like Arachim were successful and introduced Jews to real Gemara learning
and there was an explosion of kosher stores as well as the number of mikvaos.”
As is evident from the gigantic campus of the Chabad elementary school in the 19th district — which educates close to 2,000 children — Lubavitch played a key part in the country’s spiritual progress
There are multiple yeshivos and kollelim in Paris
As a leading figure in France’s Dirshu movement
Rav Toledano points to what the organization’s success means in the context of the community’s evolution
“Dirshu founder Rav Dovid Hofstedter sees France as unique
in that Dirshu has facilitated a sense of community
to allow the different Orthodox communities to feel a sense of belonging to the wider Torah world.”
Somewhere around the 19th’s main thoroughfare
one that sends a chill through the bones because of the association with the deadly attack in 2015 — although it’s only a branch of a Paris-wide chain
and Jews are less safe than across the channel in London
where a large French expat population lives
The slightly threatening feeling of districts like the 19th have persuaded many Jews to up sticks and head to suburbs like Le Raincy
But Rav Toledano explains that educational opportunities are as much a factor as hatred
“The movements to the west of Paris and the Île-de-France in the city’s east are a reaction to anti-Semitism
but also in good part because the baalei teshuvah mentioned above are financially well-off and have gone to live in the more affluent districts of western Paris
“They also want to get closer to Orthodox Jewish schools
That’s why the community around Merkaz HaTorah with nearly 1,000 students has grown in 30 years from about 20 families to nearly 500 families.”
The trend of couples going to learn in Israel and then remaining there acts as a brain drain
But it’s specifically those who move to Israel to flee bigotry in their native country that concern Rav Toledano
“The panic to leave after the terror attacks has finished,” he says
“especially as it’s now clear that moving to Israel can often be disastrous for children
they’re not forced to choose between secular and yeshivah education
he was pessimistic about the future of French Jewry
But now it’s clear that the Orthodox Jewish community is on a growth trajectory
“We’re going to see a growth of Torah learning in Jewish schools
and kollelim with the tradition and warmth that is uniquely French.”
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Depending on where you’re spending Sukkot
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The Paris suburb of Noisy-le-Grand is known for its architecturally unique environment, most notably home to the Espaces d'Abraxas
Similar in concept but much different in style
the Arènes de Picasso or "Picasso's Arenas" is a massive housing complex consisting of 540 residences
designed by Spanish architect Manuel Núñez Yanowsky
The complex is locally nicknamed "camemberts" after its iconic round façades
a pair of circles facing one another across a promenaded square
this post-modernist colossus is supposed to be an abstract representation of an overturned cart
A cluster of cylindrical apartment buildings nod to the city’s vegital past
The unique design of these skyscrapers in a Paris suburb led to them being nicknamed "cloud towers."
an example of Art Deco Streamline Moderne style
was designed to embody the curves of a great ship
architectural experiment designed to increase a resident's longevity
After local authorities changed the design
the building is the best example of Spanish organicist architecture in Madrid
This spaceship-like structure was once a popular roadside restaurant
A medieval shrine set into a towering canyon wall
visit former industrial plants steeped in many years of history - in short
cultural sites and other nuggets that make up France's rich heritage
le programme est mis à jour en fonction des annonces officielles
Heritage Days 2024 at the Château d'Eau de La Courneuve
Heritage Days 2024 at the Diplomatic Archives in La Courneuve
Long live JEP in the 93
The Grand Paris Metropolis is characterised by an enormous demand for social housing
linked to its economic attractiveness and high rents in the private housing sector
Out of the 680,000 applications made for social housing recorded at the end of 2016 in Île-de-France
491,000 targeted a Métropole du Grand Paris municipality as first choice
that is 72% of demands in Île-de-France while the social housing stock within MGP makes up only 67% of its social housing stock
The pressure of demand in the Metropolis amounts to an average of 10 applications made for 1 housing unit allocated
Paris undergoes even more pressure with 16 applications for one allocated housing unit
Other municipalities are also under pressure like Neuilly-sur-Seine
This severe pressure reflects a great demand but equally a low rate of allocated social housing
The pressure weighing upon the social housing stock in the Metropolis is also caused by a low rate of rotation among occupants and a high demand to move to another housing unit: 28% of applicants wish to change their social housing
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Photographer Thibaud Poirier has been making his way across Europe to capture the incredible interiors of churches and temples. In a continuation of his series Sacred Spaces
Poirier explores 15 more modernist places of worship through photographs
he carefully preserves the same composition—a perfectly centered image with the focal point at the front of the pulpit
Thanks to the symmetry of this careful approach to documentation
scrolling through the series allows viewers to make quick comparisons of the aesthetics of each structure
The height of vaults and length of corridors may change
but other qualities tend to remain the same
such as the long rows of pews and the imagery at the pulpit
The series also acts as a celebration of light and structure
The holy atmosphere of these spaces can begin to be understood as the result of a perfectly placed skylight or an impressive arch
While the architectural gestures obviously play a role
Poirier is more poetic when describing the shared qualities of these interiors
“Despite their great stylistic differences,” he explains
“the glue between these churches remains invisible to the human eye yet vibrates within each of us: the emotional state created whilst one is present
The conviction of something larger than us all.”
The series has adapted to the travel restrictions caused by the COVID-19 pandemic
Sacred Spaces II mostly includes photographs from churches in France
built mostly between the 20th and 21st centuries
Poirier will soon add more to the series as restrictions lift
United States Air Force Academy Cadet Chapel
Cathédrale de la Résurrection
France (Corinne Callies et Jean-Marie Duthilleul
Celebrating creativity and promoting a positive culture by spotlighting the best sides of humanity—from the lighthearted and fun to the thought-provoking and enlightening
On August 20, 2018, Dr Basma M’Barek assumed her new role as Head of Oncology at FV Hospital
Dr Basma is highly experienced in radiotherapy
immunotherapy and palliative care and ensures patients benefit from pain relief throughout treatment to recover quickly
Dr Basma is a member of the European Society of Therapeutic Radiation and Oncology (ESTRO)
Dr Basma M’Barek graduated from the University of Tunis El Manar in 2002 and University of Paris VI in France in 2003
She also graduated with a Master in Human Genetics from the University of Medicine and Pharmacy in Tunis
before completing advanced training courses in radiotherapy and oncology
head and neck cancer and new technologies in radiotherapy
Dr Basma has worked in many French hospitals
University Hospital Saint Louis and Le Raincy-Montfermeil Hospital
As a member of FV family, Dr Basma will work with her colleagues to implement the latest advanced treatments to establish FVH’s Oncology Department as the leading oncology centre in Vietnam
providing hope for even more cancer patients
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Tuesday
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The risks of staff shortages and working conditions in maternity wards require urgent measures from the authorities
say a group of perinatal care professionals working in the Ile-de-France region
Published on June 3, 2022, at 7:17 am (Paris), updated on June 3, 2022, at 7:17 am 3 min read Lire en français
At the maternity ward of the Diaconesses hospital
MARTIN BUREAU / AFP Perinatal health care professionals (midwives
childcare assistants and pediatricians) are extremely worried about the risk that staff shortages pose to pregnant women
and after having alerted our supervisors on many occasions over the last few years
as heads of department and members of the management of the maternity units of Ile-de-France
university and non-university maternity units in the public service
wish to raise the alarm on the extremely worrying situation
perinatal care has suffered due to the organization and working conditions imposed by regulating bodies who do not necessarily work in the field
are not recognized as such and the staff must fill the gaps
under the watchful eye of authorities who are aware of the problem but fail to propose any significant measure
the boat is sinking and there are still no concrete plans on the table in an attempt to avoid the shipwreck
The situation is only getting worse and nursing staff are fleeing the poor working conditions
Those who choose to stay see their working conditions change for the worse
Despite our regular alerts to the regional health agency of Ile-de-France and the ministry
they do not seem to truly understand the gravity of the situation and the urgency
You have 75.27% of this article left to read
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L'Avant-Poste defines itself as a committed
Located in a postal building that has been vacant since 2014 in Raincy, L'Avant Poste 's mission is to improve the quality of urban life in the 93 département by offering coworking spaces (with 50 workstations available and 3 meeting rooms)
non-alcoholic drinks à la carte) and snack bar (charcuterie
fresh vegetables...) not forgetting a series of cultural events (conferences
A 350 m² garden can also be discovered on site
In all, 944 m² of the former postal building have been renovated to create L'Avant Poste
To create an environment conducive to work
but also "to anchor entrepreneurship in the region
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The opening of TEFAF 2025 confirmed that the art market is still doing well despite the ongoing global geopolitical challenges
Looking back at the early decades of modernism
we may sense something inevitable about the ascent of Picasso and Matisse
honoring Parisian art dealer Berthe Weill (1865–1951)
constitutes its subject through far-reaching networks of aesthetic trajectories
mirroring her vision for vanguard experimentation and enterprise
Burger King patties and Taco Bell ground meat
eating horse is not unheard of in much of Europe
Trendy Parisian restaurants have had it on their menus for years
while about 500 French horse butchers serve it up as a tastier and healthier alternative to beef
the operator of one such boucherie chevaline in the Paris suburb of Le Raincy
says a loyal clientele has gladly gobbled up his once-galloping prime cuts since his family opened the shop 32 years ago
Do you only sell horse at this butcher shop
We own the boucherie chevaline and keep it separate from the traditional butcher shop we also own
just a few hundred metres away on a different street
The French industry body for horse butchers
has said that there has been a 15 per cent rise in sales of horse meat since the scandal broke
I have heard all of the news about horse meat being used as a substitute for beef
There is a lot of sentimentality about horses
It has always been popular here; I have not noticed much of a change
I think people who grow up eating horse meat carry on eating it all their lives
I eat it and I have raised my children on it
We source our horse meat from two countries: Canada and Belgium
and we have around 300 customers who regularly buy our horse products
The horses themselves are usually about four or five years old
Do you buy the whole animal directly from the farms
but by far the most popular is steak hachée (minced meat)
We sell lots of products from horse meat: sausages
A horse steak right now is about €22 [Dh105] for a kilogram
People say it is a lot like beef but it is not
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‘Robin Hood’ the ever popular hero of the poor originated in English folklore and later featured in literature and still later in cinema has returned with the latest depiction directed by Otto Bathurst
the film depicts how Robin of Loxley [...]
the film depicts how Robin of Loxley (Taron Egerton) a war-hardened Crusader and his Moorish commander (Jamie Foxx) mount an audacious revolt against the corrupt English crown in a thrilling action-adventure packed with gritty battlefield exploits
with Egerton signing on as the lead role that September
the shooting was done from February to may 2017 at different locations in Dubrovnik
The film is now being released at Liberty by Scope Cinemas
Liberty Lite in Colombo and other cinemas around the country
The Sunday Times Sri Lanka