New Type 2 diabetes treatments: cardiovascular safety/benefit and neproprotection

Martin Buysschaert, Benoit Buysschaert, Isabelle Paris, José Luis Medina, Michael Bergman, Vanessa Preumont Published in the journal : January 2020 Category : Diabétologie

Diabetic nephropathy is currently the leading cause of chronic end-stage renal disease, along with its clinical consequences. Its prevention implies multidisciplinary management based on strict control of blood glucose from diabetes onset, in addition to blood pressure control, primarily using ACE-I inhibitors or sartans. Recent clinical trials have demonstrated the cardiovascular security/benefits as well as nephroprotective effects of new classes of antihyperglycemic agents (DDP-4 inhibitors, GLP-1 agonists and SGLT-2 inhibitors), in addition to their well-established antihyperglycemic effects.

This paper aims to review the state of the art of diabetes-related cardiovascular and renal complication management.

 

 

 

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Combined utilization of peridural thoracic anesthesia und intravenous lidocain in preventing autonomic hyperreflexia in the peri-operative period

Audrey Foaleng Published in the journal : December 2019 Category : Anesthésie

A 50-year-old man with a complete medullary section at the old C6-C7 level and suspicion of autonomic hyperreflexia (HA) was assumed to benefit from cystectomy with Bricker-type non-continent urinary diversion. In addition to general anesthesia, thoracic epidural analgesia and intravenous lidocaine were used to prevent HA during the operative period, facilitating postoperative rehabilitation. The patient remained stable throughout the procedure, without any major problems postoperatively. Oral feeding was started on Day 3. The article describes the benefits of epidural analgesia and intravenous lidocaine for managing patients at risk for HA.

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Septic shock and pyomyositis in a 1-year-old boy caused by Panton-Valentine leukocidin-secreting Staphylococcus aureus

Julien Charlier (1), Astrid Haenecour (2), Dimitri Van der Linden (3) Published in the journal : December 2019 Category : Pediatrics

Pyomyositis is an acute bacterial infection involving one or multiple striated muscles, potentially leading to abscess formation. Albeit being uncommon, its consequences for the patient can be severe, even fatal. Primarily described in tropical countries, this condition may also occur in temperate regions. Its pathophysiology is still poorly understood. The initiating process could be a minor muscle traumatism followed by bacterial hematogenous colonization of the muscle. Generally, its clinical presentation is insidious and unspecific, its diagnosis being challenging for the clinician. Nevertheless, a rapid diagnosis allows an early antibiotherapy to be established and complications to be prevented. The cornerstone of pyomyositis diagnosis is magnetic resonance imaging (MRI), along with bacterial cultures from biological fluids. The main bacteria involved in this condition is Staphylococcus aureus (SA), while Panton-Valentine leucocidin (PVL) is a toxin secreted by SA. This toxin is reported to be a virulence factor in invasive SA infections, whereas its precise role is still controversial depending on the infection site. We herein present a case of pyomyositis caused by Panton-Valentine leukocidin-secreting SA, with abdominal wall involvement, in a 1-year-old boy from a tropical country who was spending his holiday in Belgium.

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Internal medicine and dermatology

Evelyne Harkemanne (1), Mathieu Ziraldo (1), Camille Francès (2), Marie Baeck (1) Published in the journal : December 2019 Category : Dermatology

We herein report on the “Peau’se dermatologique” meeting held on June 3rd, 2019 in the Cliniques universitaires Saint-Luc, Brussels, and focused on dermatological manifestations of systemic diseases. Professor Camille Francès, member of the Dermatology department at Hôpital Tenon in Paris, presented eight interesting clinical cases of systemic diseases with associated dermatological features.

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Impact of Freestyle Libre flash glucose monitoring system on glycemic control and quality of life

Margarita Goula, Marie Strivay, Vincianne Thielen Published in the journal : December 2019 Category : Diabétologie

The self-monitoring of glucose values is deemed necessary in diabetic patients to achieve a better glycemic control while avoiding hypoglycemias. New technologies have been devel-oped, such as the Freestyle Libre (sFL), a flash glucose monitoring system whose impact on better glycemic control and improved quality of life must still be assessed. This study confirmed the significant rise in the frequency of self-monitored glucose tests performed when using the sFL, in comparison with baseline, thereby resulting in an improvement in glycemic control and various quality of life features. Larger studies are required to elucidate the potential benefits gained by using sFL in blood glucose self-monitoring by diabetic in a larger scale.

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Clinical manifestations of depression in the elderly

François-Xavier Sibille (1), Emilie Verreckt (1), Pierre Philippot (2), Stéphane Agrigoroaei (2), Pierre Gobiet (3), Laurence Mees (1), Marie Masse (1), Didier Schoevaerdts (1) Published in the journal : December 2019 Category : Geriatry

This article provides some insight into the clinical presentation of depression among the elderly, along with some management paths pertaining to this common, morbid, and at times potentially lethal syndrome. Diagnosis may be challenging because of complaints frequently related to ageing, comorbidities, and polypharmacy. Nonetheless, diagnosis should be made as early as possible. As first step, we must emphasize the relevance of spending time with seniors, thereby improving their communication skills. Several methods borrowed from cognitive rehabilitation may be proposed thereafter. This article is a summary of the twentieth annual meeting organized by the geriatric service association of the CHU, UCL Namur, Belgium.

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Health validated information seeking: The CEBAM (Belgian Centre for Evidence-Based Medicine) Digital Library of Health (CDLH)

Thérèse Leroy (1), Michel De Jonghe (1) Published in the journal : November 2019 Category : Médecine Générale

Physicians encounter a wide range of patients and clinical conditions upon their clinical practice. This generates numerous clinical questions for which it may prove difficult to find quickly a reliable answer. A search in the well-known online engine "Dr. Google" is, therefore, often tempting and can at times provide interesting answers. However, are these answers reliable, validated, and of quality? It is not always easy to sort out, and then evaluate the quality of such information. The Belgian Evidence-based Medicine Center (CEBAM) provides access to all Belgian healthcare professionals by means of a virtual library whose slogan is "medical information for clinical practice, with one click". It offers you access to point-of-care tools, such as Dynamedplus, Belgian clinical practice guides, and a host of other resources, as outlined in this article.

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Unrecognized complication of gastric bypass: a rare case of intraabdominal desmoid tumor

Geoffrey Jacqmin (1), Geanina Curca (1), Mikhael Janssen (2), Christophe Boland (3), David Heuker (1) Published in the journal : November 2019 Category : Chirurgie digestive

Desmoid tumors are rare monoclonal myofibroblastic proliferations with varying clinical courses depending on the disease location and extent. Despite being comprised of histologically benign stromal cell proliferations, these growths can, at times, become locally aggressive and have a high rate of local reccurence, even following complete resection. To date, there are no reports of metastases in the literature. Although various risk factors have been described, the etiologies and pathways of these cell growths are not completely understood. Desmoid tumors occur either as sporadic lesions or as part of familial adenomatous polyposis, which is caused by germ line mutations in the adenomatous polyposis coli gene. Due to their different clinical presentations, no standard approach for desmoid tumors has been recommended so far. Herein, we describe the case of a 46-year-old female who had undergone gastric bypass three years earlier, whilst being diagnosed with a mesenteric desmoid tumor that compressed her Roux-en-Y jejunal limb. To our knowledge, this is the first reported case of desmoid tumor in a patient having undergone a Roux-en-Y gastric bypass.

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Mental disease: open door to euthanasia?

Marc Brusselmans Published in the journal : November 2019 Category : Ethics

In 2002, Belgium adopted a law decriminalizing euthanasia in certain situations. One of this law’s particularities is that it opens the physician’s possibility to practice euthanasia following a patient’s request, which can be based on a constant and unbearable psychic suffering, in the context of a serious accidental or pathological affection, even without a fatal outcome in the short-term. However, this law raises serious ethical issues in the field of mental health, both concerning the concept of diagnosis in psychiatry as well as the incurability of mental illness. This may result in dangerous interpretations. The psychiatric function itself appears to be rather destabilized and challenged by the application of this law. Excesses are possible, and an in-depth reflection is thus paramount concerning the need to better protect the rights of the most vulnerable, such as, among others, the mentally ill.

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Dual antiretroviral therapy as initial treatment for people living with HIV-1?

Emilie Dupont (1,2), Jean Cyr Yombi( 2) Published in the journal : November 2019 Category : Maladies infectieuses

Combined antiretroviral therapy (cART) has significantly improved the prognosis and life expectancy of people living with human immunodeficiency virus (PLWHIV). Current international guidelines recommend a triple therapy that conventionally combines two nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) and a third agent that is either a ritonavir- or cobicistat-boosted protease inhibitor (PI), either a non-nucleoside reverse transcriptase inhibitor (NNRTI), or a boosted or unboosted integrase inhibitor (INI). Due to the toxicity of NRTIs, alternative non-NRTI-based therapeutic regimens have been proposed. They initially had limited success compared to the standard triple therapy due to low efficacy, particularly in patients with high viral load and low CD4 cell counts. A new strategy combining lamivudine (3TC) with boosted PI or INI has yielded promising results, suggesting that modern dual therapies will become a reliable first-line treatment option for PLWHIV. Recently, the European AIDS Clinical Society guidelines have recommended dual therapy as the preferred regimen in treatment-naive patients in certain circumstances.

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