The therapeutic potential of molecular scissors: perspectives of the 2020 Nobel Prize in chemistry

Nathalie Lannoy, Cédric Hermans Published in the journal : November 2020 Category : Prix Nobel

The 2020 Nobel Prize in chemistry was jointly awarded to two geneticists Emmanuelle Charpentier and Jennifer Doudna for their having developed the "Crispr-Cas9 molecular scissors". This real innovation pertaining to the molecular biology field is principally able to easily, quickly, and inexpensively edit the genome of any cell. Its use in all fields of life allows for scientific, medical, agronomic, and industrial applications both for better and worse.

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Anesthesia without opioids: May this be useful in Sub-Saharan countries?

Published in the journal : November 2020 Category : Clinical Report

The systematic use of opioids has made us lose sight of their significant adverse effects, including respiratory distress, hyperalgesia, as well as postoperative nausea and vomiting. Sub-Saharan African countries are currently facing the issue of post-interventional surveillance, with post-operative respiratory problems being rather common. Similarly, these countries experience difficulties in managing pain, nausea, and vomiting. At times, opioid ruptures may occur, which may lead to postponing surgical procedures, in a context where access to surgery is already a obstacle. The opioid-free anesthesia could be an interesting alternative for these countries, especially when using accessible drugs with simple protocols. Therefore, anesthesiologists from these countries should focus their interest on such anesthesia techniques, in the aim to better define their place in their daily practice and share their potential benefits in a limited-resource setting.

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Use and abuse of tissue fillers in the field of urology

Walther Brochier, Greet Swinnen, Peter De Wil, Sam Ward Published in the journal : November 2020 Category : Clinical Report

The injection of tissue fillers for esthetic purposes is considered a decade-old practice. In our urological practice, we are now seeing an increasing number of patients that have purposefully injected such fillers in order to increase penile girth. Nevertheless, particularly when done in non-professional settings or using low-quality products, this may lead to severe complications. These complications are mostly caused by the injections of silicone, which is a non-resorbable filler, unlike hyaluronic acid or autologous fat.

We present herein the case report of a 37-year-old man treated in our department for preputial pain and swelling following silicone self-injections. We then continue with a literature review on the topic.

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Multiple resistance to anti-platelets agents

Silvio Wallemacq1A, Mohamed Ben Yedder1A, Patrick Timmermans1A, Jérémie Gras2A, Vincent Haufroid2B, Benjamin Hennart2C, Cédric Hermans3B Published in the journal : November 2020 Category : Clinical Report

Dual antiplatelet therapy consisting of aspirin in combination with clopidogrel, ticagrelor, or prasugrel is considered the standard of care for preventing stent thrombosis following percutaneous coronary angioplasty. However, adverse cardiovascular events may still occur despite such biotherapy. This can be explained by resistance to antiplatelet agents, with clopidogrel resistance the most widely studied so far. Some cases of resistance to other antiplatelet agents like prasugrel and ticagrelor have recently been reported. While laboratory tests have been developed to assess the degree of platelet inhibition under treatment, their clinical usefulness remains controversial. We herein report the case of a patient with a resistance to different antiplatelet agents.

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Chronic hepatitis C, a disease that is prone to be eradicated owing to your collaboration: perspectives of the 2020 Nobel Prize in medicine

Yves Horsmans Published in the journal : November 2020 Category : Prix Nobel

The 2020 Nobel Prize in medicine was jointly awarded to three experts for their contribution to the discovery of the hepatitis C virus. This discovery has enabled us to better understand the epidemiology of the virus, as well as its mode of contamination and mode of reproduction, which has eventually resulted in the development of direct anti-viral agents. These medications are so powerful that the World Health Organization (WHO) has now included the objective of HCV eradication on their agenda.

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Legal support in the field of handicap: why and how to access?

Anne Ketelaer Published in the journal : November 2020 Category : Droit et handicap

Given that European and national legislation in the field of disability is particularly broad and complex, it is often misunderstood not only by persons with disabilities and their families but also by the general public, schools, public authorities, and politicians, in addition to public and private sector employers.

Moreover, persons with disabilities tend to face great difficulties in enforcing their rights. Inclusion starts with knowledge and respect of their most fundamental rights. This is the reason that has motivated the creation of DHEI, which is a new non-profit organization (NPO) that acts in the disability and inclusion field. As a legal support structure in the field of disability, this NPO seeks to make people with disabilities, their families, and healthcare professionals aware of the existing rights via two main axes: training courses in disability law and frontline legal assistance without cost for people with disabilities and their families. By combining both the human and technical aspects of the law, the DHEI actively works in collaboration with various network partners that share extensive expertise in the field of disability.

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New-onset polyarthritis: usefulness of early remission

Emilie Sapart1*, Stéphanie Dierckx2*, Tatiana Sokolova1, Aleksandra Avramovska1, Laurent Meric de Bellefon3, Adrien Nzeusseu1, Bernard Lauwerys1, Patrick Durez1 Published in the journal : November 2020 Category : Rheumatology

Polyarthritis is a chronic inflammatory disease of immune origin that is characterized by a synovitis that progressively destroys the joints, which is at times associated with extra-articular manifestations.

This heterogenic rheumatic disease group can cause both structural and functional impairments, in addition to a decrease in patients' quality of life.

A better understanding of the disease's pathophysiology has led to the development of new encouraging therapeutic strategies for managing this disease.

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COVID-19: clinical presentation and mortality of the first 50 geriatric patients hospitalized at the Cliniques universitaires Saint-Luc in spring 2020

Cédric Mahiat, Séverine Henrard, Isabelle Gilard, Nicolas Lanthier, Peter Stärkel, Isabelle De Brauwer, Pascale Cornette, Benoit Boland Published in the journal : November 2020 Category : Geriatry

Objectives. Although the majority of COVID-19-related in-hospital deaths were reported in patients over 75 years of age, this population has been scarcely described so far. This study was aimed at describing the clinical presentation and in-hospital mortality rate of these geriatric patients.

Methods. This retrospective cohort studied the first 50 patients that were affected with COVID-19 and admitted to geriatric wards at Cliniques universitaires Saint-Luc.

Results. Before admission, the patients (median age: 88 years) were vulnerable (16%), mildly/moderately frail (32%), and severely/very severely frail (52%) according to the clinical frailty scale, whilst presenting with geriatric syndromes (cognitive impairment in 54%, recurrent falls in 44%, and malnutrition in 40%). In 36% of patients, the initial COVID-19 presentation was atypical, consisting of delirium-related or digestive symptoms. The in-hospital mortality rate was high (52%), while being not associated with the degree of frailty; the patients’ mortality rate was associated upon diagnosis with older age, lower systolic blood pressure, higher serum lactate dehydrogenase levels, and marked lung infiltrates.

Conclusions. Concerning the first geriatric COVID-19-affected patients, the initial symptom was often misleading, and the in-hospital mortality rate was high (52%),whereas the prognosis factors still need to be better defined, particularly as for the impact of clinical frailty.

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Rivaroxaban (Xarelto®): Update on new clinical data and therapeutic perspectives

Cédric Hermans Published in the journal : October 2020 Category : Actualité thérapeutique

Direct oral anticoagulants (AODs), which target coagulation Factors Xa or IIa, represent a major therapeutic innovation. Even if classical anticoagulants, such as vitamin K antagonists (AVK) and low molecular weight heparins, still play a crucial role in preventive or curative treatment, AODs have revolutionized the medical management of thrombotic diseases, concerning both arterial and venous conditions.

In addition to being able to replace conventional anticoagulants in common indications like atrial fibrillation and venous thromboembolic disease, there is a plethora of Xarelto data from recent and original studies, as well as from registries and Phase III sub-analyses, which are currently revolutionizing the modalities and benefits of oral anticoagulation at all stages of life and in a wide spectrum of indications.

This article provides a synthetic and practical review of these data and their therapeutic implications.

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Vogt-Koyanagi-Harada disease in a young man, which was complicated by tuberculosis reactivation and occlusive retinal vasculitis

Zineb Bouterfa, Halil Yildiz, Jean Cyr Yombi, Alexandra Kozyreff Published in the journal : October 2020 Category : Clinical Report

We report the case of a 17-year-old man presenting with bilateral visual loss, panuveitis, exudative retinal detachments, and diffuse choroidal infiltration. The patient also complained of headaches and ear pain. Based on the fundus image analysis, fluoangiography, indocyanine green angiography, and optical coherence tomography, Vogt-Koyagani-Harada disease was diagnosed. The patient received high-dose methylprednisolone along with azathioprine. He responded well to treatment with progressive visual improvement and subretinal fluid disappearance. One month later, his right eye exhibited a sectorial retinal vasculitis with infero-temporal vein branch occlusion and massive sub-retinal hemorrhages. Coagulation screening as well as HIV and syphilis serology were all negative; whereas QuantiFERON was positive. An 18F-FDG PET/CT revealed hypermetabolic mediastinal lymph nodes, and a biopsy confirmed active tuberculosis (TB) infection. Anti-TB quadritherapy was initiated, resulting in cytochrome P450 enzyme induction and lowered steroid treatment efficacy, with consecutive recurrence of choroidal inflammation.

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