Laurent Levecq, Margot D’Affnay, Alice BughinPublished in the journal : October 2022Category : Ophtalmology
The physician’s role is no longer limited to trying to make his patient aware of his physical or cognitive impairment, hoping that he will partially or fully give up on driving. The physician must support the patient and point out that there might be solutions, whether in the form of restrictions or conditions, likely to save him from financial and legal setbacks. In rare cases, it may happen that the dialogue is not possible anymore, the incapacity is proven and puts at risk both the patient and the third parties. In this specific situation, the physician might free himself from medical confidentiality without risk of ethical or criminal penalties, provided progressive and proportional actions.
How are our Belgian hospitals, including the physicians who work in them, being funded? How are these funds calculated and allocated? Herein, the article’s author has presented his book covering this topic. In brief, he has further explained the components of Belgian hospital financing, comparing it to what is done abroad, exposing both its strengths and weaknesses, and discussing the ambitious reform that is being scheduled by Minister Vandenbroucke.
Islet transplantation holds great promise for the treatment of type 1 diabetes (T1DM), as it offers the potential to restore euglycaemia in a reliable manner, protects against hypoglycaemia and glycaemic lability in a way that exogenous insulin administration has thus far been unable to achieve, and is associated with far fewer risks than whole-pancreas transplantation. Moreover, for patients requiring total pancreatectomy for benign disease, isolation of islets from the diseased pancreas with intrahepatic transplantation of autologous islets can prevent or ameliorate postsurgical diabetes and improve quality of life. We, therefore, seek to add this alternative treatment to the therapeutic modalities proposed within our institution.
Obesity surgery or bariatric surgery has significantly grown over recent years. Given that obesity plays a key role in the pathophysiology of type 2 diabetes mellitus, it is no surprise that bariatric surgery, along with its impressive weight loss, has been shown to dramatically improve diabetes mellitus. The observation that numerous diabetic patients remain poorly controlled despite recent advances in drug therapy has been associated with an increased interest in this surgical approach to the treatment of diabetes mellitus. The primary purpose of this review has been to summarize the place of bariatric surgery within the therapeutic arsenal for type 2 diabetes mellitus.
Martin Buysschaert (1), Alberto de Leiva-Hidalgo (2)Published in the journal : September 2022Category : Diabétologie
The aim of this article has been to revisit the history of the discovery of insulin, "officially" attributed to F.G. Banting and Ch. Best. The first administration of their pancreatic extract to humans was performed in January 1922 in Toronto. In reality, history has made these two names sacred, whereas others, in Canada and Europe, have also contributed in a decisive way to this discovery. Given this context, we wish to untangle the skeins by describing the essential role and major impact of other researchers from both Canada (J. Macleod and J.B. Collip) and Europe (M. Gley in France, G. Zuelzer in Germany, and N. Paulescu in France and Romania). This article thus primarily seeks to "render to Caesar what belongs to Caesar".
Inhibitors of the sodium-glucose cotransporter 2 (SGLT2) are dramatically changing the management of heart failure and, especially, chronic kidney disease. Indeed, this class of drugs, which was initially developed to improve glycemia control in Type 2 diabetics, is now widely recommended by global/international guidelines as part of the standard care for both diabetics and non-diabetics presenting with heart failure and/or albuminuric chronic kidney disease. Indeed, large outcome trials have conclusively demonstrated their efficacy and safety, with some undesirable effects that are easily manageable in clinical practice, such as mycotic genital infection. The key challenge for the coming years is to ensure that the broad population of patients susceptible to benefit from SGLT2-i is actually treated by these drugs. In the near future, additional trials may further enlarge the population targeted by this drug class.
The biological work-up of the pituitary gland is primarily aimed to detect an excess or deficit of hormone production. The assay methods for the different tests of this workup have significantly evolved over recent years, both through the automation of immunoassays and development of liquid chromatography-mass spectrometry methods. The clinico-biological relationship plays a fundamental role in the evaluation and optimization of these assays, and in the interpretation of their results, as well.
Following a brief review of pituitary diagnostic imaging and basic magnetic resonance imaging (MRI) semiology, the pitfalls of daily pituitary imaging are further discussed and illustrated. The risk of false positives due to the desire to be highly efficient in detecting micro-lesions, along with the risk of ignoring the complexity of the differential diagnosis of macro-lesions, are the two major pitfalls that should be avoided. Technological progress has generated two recent avenues of improvement, including whole-body MRI at 7 Tesla (7T) and, above all, deep-learning (DL), the promises of which are further discussed on the basis of initial data reported in the literature.
Belgium is facing an outbreak of Monkeypox virus. This illness was until now only endemic in West and Central Africa. Since May 2022, an exponential growth of new cases has been recorded in Europe. The clinical presentation is an influenza-like illness followed by a varioliform rash. Most patients will have mild to moderate symptoms but immunocompromised people, children and pregnant women can develop a severe illness. Mortality is low (3-10%) depending on the viral strain. The virus is transmitted mainly by prolonged skin contact and to a lesser extent by air (droplets). It is essential to implement preventive measures now (rapid screening, isolation of confirmed cases and high-risk contacts, public awareness) in order to contain this outbreak. A live attenuated vaccine (Imvanex®), currently not very available, could be used for post-exposure prophylaxis of contact cases and to a greater extent, for pre-exposure prevention. Antiviral treatments (Brincidofovir and Tecorivimat) will also be available in the near future.
Ramanandafy Herveat 1, Ramily Samison Leophonte 2, Raharinoro Raïssa Haingotiana1, Ratovonjanahary Volatantely 2, Rakotoarisaona Fifaliana Mendrika 2, Sendrasoa Fandresena Arilala 2, Rahantamalala Marie Ida 1, Ramarozatovo Lala Soavina 2, Vololontiana HanPublished in the journal : July 2022Category : Clinical Report
Adult IgA vasculitis or Henoch-Schonlein rheumatoid purpura is a rare clinical entity, which is characterized by tissue deposits of immune complexes containing type A immunoglobulins. A 24-year-old man without any particular history, especially concerning past infections, displayed purpuric petechial and ecchymotic skin lesions, which were infiltrated and vascular in nature, as well as associated with polyarthralgia of the elbows and knees, in addition to spasmodic abdominal pain. The blood analysis revealed a discrete inflammatory syndrome with a C-reactive protein (CRP) level at 37 mg/L, the rest of the workup including hemostasis being unremarkable. The renal assessment showed significant proteinuria at 0.73g/24 hours without renal failure. Skin histology exhibited a lymphocytic vasculitis lesion and perivascular infiltrates consisting of mononuclear cells, without fibrinoid necrosis. The diagnosis of subacute IgA vasculitis was established based on the criteria of the American College of Rheumatology and EULAR/PRINTO/PRES (European League Against Rheumatism/Paediatric Rheumatology INternational Trials Organisation/Paediatric Rheumatology European Society). A cortico-resistance of the skin lesions was noted following 21 days of treatment, which eventually resolved at 1 month.
