Publication of november-december 2021

  • Thrombopénie immune : prise en charge
  • Héparines : quelle place en 2022 ?
  • Hypercholestérolémie familiale : diagnostic
  • Syndrome du choc toxique menstruel
  • Médecine et crise environnementale
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Actualités thérapeutiques

Diagnosis of familial hypercholesterolemia index patients and...

Familial hypercholesterolemia is a common, yet often underdiagnosed, genetic disease. Nevertheless, this condition is easily manageable provided that the disease is detected early enough and appropriately treated. Our article presents some diagnostic tools for this condition. In a first patient of an as yet unexplored family, referred to as the index patient, we propose to use the DLCN (Dutch Lipid Clinic Network) score, which should be followed by genetic analysis, depending on the case. Once the diagnosis has been confirmed in this index patient, the disease can easily be identified in other first-degree relatives based on a reference table that has presented in this article. This table provides the threshold values of LDL cholesterol concentrations, according to age and gender, at which the existence of familial hypercholesterolemia in a first-degree relative should be suspected. To this article, we have attached a sample letter that can be addressed to family members, designed to alert them on this disease and facilitate the work-up of their general practitioners.

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Actualités thérapeutiques

Update on the management of primary immune thrombocytopenia in...

In recent years, the management of primary immune thrombocytopenic purpura (ITP) has undergone a profound change, owing to an improved understanding of its pathophysiology, the development of new targeted therapeutic molecules, and the updated guidelines of numerous scientific societies, including the Belgian Hematology Society (BHS). The purpose of this article is to review the diagnostic methods, describe both the modalities and objectives of treatment in 2021, and discuss the new therapeutic options made available to us.

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Actualités thérapeutiques

Anticoagulation: What place for low-molecular weight heparins...

Despite the therapeutic revolution brought about by direct oral anticoagulants (DOACs) over recent years, low-molecular weight heparins (LMWHs) keep on playing a major role in the antithrombotic management of numerous patients, either as alternatives to AODs or as first-line drugs. The indications for the latter include pregnancy, cancer, or venous thrombo-embolic disease prevention. After a brief summary recalling the main characteristics and properties of LMWHs, this article proposes a practical review that is primarily focused on the current indications for LMWHs and their precautions for use. The article also reminds us that not all LMWHs are to be considered as equivalent. This particularly concerns tinzaparin, exhibiting a higher molecular weight and less renal elimination, thus being an agent of choice in the treatment of venous thromboembolic disease, especially within the neoplasia context.

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Orthopedics

Periprosthetic joint infection: general principles for primary...

Prosthetic joint infection (PJI) is a dramatic complication, with devastating and costly consequences for both the patient and healthcare system. Despite the progress made in the past decades, its incidence remains stable at around 0.5 to 2%. With the ageing population, the number of prostheses steadily increases, with consequently an increased number of infections. PJI management is complex and requires a multidisciplinary approach, including surgical treatment and antibiotic administration. A delayed diagnosis likely displays serious consequences for the patient. This article summarizes the general management principles of prosthetic joint infections, mainly designed for primary care physicians.

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Geriatry

Covid-19 related suffering: patients and geriatricians on an...

This article describes the case of two elderly patients suffering from COVID-19 and admitted to a geriatric ward. It refers to the physical but, above all, psychological suffering that affects both the patients and their geriatricians at their bedside. Based on international literature, we analyze the severity of COVID-19 consequences on mental health. Moreover, we also add recommendations to be implemented so as to limit the impact of this long-term suffering.

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Clinical Report

Antenatal management of disorders of sex development

Disorders of sex development (DSD) represent a diagnostic challenge. The complexity and variability of DSD and their psychosocial consequences require multidisciplinary care, including obstetricians, endocrino-pediatricians, clinical geneticists, pediatric urologists, neonatologists, psychologists, as well as child psychiatrists. The clinical case described herein is a genotypic-phenotypic discordance. Indeed, the non-invasive prenatal test argued in favor of a male chromosomal sex, whereas the fetal ultrasound was rather in favor of a female phenotype. The antenatal biological explorations will likely enable us to review both the mechanisms and genes involved in sex determination and sexual differentiation. Currently, a molecular diagnosis is found in only 30-50% of cases pertaining to 46, XY. In the event of an unusual external genitalia appearance, 75% of the reported cases are related to 46, XY, the most commonly encountered being hypospadias. The etiology retained in this foetal case is idiopathic DSD, with normal testicular function and severe intrauterine growth restriction (IUGR). Despite the improved etiological and genetic knowledge of sexual differentiation, the understanding of the underlying physiopathology is still incomplete, and some clinical situations remain unresolved.

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STOPP/START.v2

The tool STOPP / START.v2 allows evaluation of drug treatments prescribed to patients age 65 and older.

 

This tool, designed for all care settings, stimulates thinking and challenging medication taken by patients, especially drugs forcardiovascular and nervous system.

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