Medical treatment of chronic heart failure

Agnès Pasquet, Anne Catherine Pouleur Published in the journal : February 2022 Category : Cardiology

During the year 2021, the European Society of Cardiology published new recommendations for the management of patients with chronic heart failure (1). Classically, patients with heart failure have previously been categorized according to the left ventricular ejection fraction (LVEF). Three different groups are currently recognized:

- Patients with reduced LVEF defined as LVEF ≤40%, which is referred to as heart failure with reduced Ejection Fraction).

- Patients with LVEF between 41% and 49%, i.e,. slightly reduced, which is referred to as heart failure with mildly reduced ejection fraction or HFrEF.

- Patients with signs or symptoms of heart failure with structural or functional cardiac abnormalities or elevated natriuretic peptides and an LVEF >50%, which is referred to as heart failure with preserved ejection fraction or HFpEF.

This article has reviewed the principles of pharmacological treatment pertaining to these three groups.

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A rebuilt and revitalized team

Véronique Deneys, Bénédicte Brichard*, Alice Brochier, Julien Cabo, Katherine Carkeek*, Virginie Chapelle, Corentin Deckers, Anabelle Decottignies*, Jean-Philippe Defour*, Antoine Froidure*, Thibaut Gervais, Claudine Guerrieri, Salwa Hamdash, Sarah Peerae Published in the journal : February 2022 Category : Biologie Hématologique

In 2021, a new wind of creativity and dynamism blew through the department owing to the arrival of two new medical staff members. In the special hematology laboratory, the diagnostic protocols in morphology and flow cytometry were reviewed, with the recommendations for the research and interpretation of schistocytes updated accordingly. The search for short telomere syndromes based on the Flow-Fish technique has taken off, with increasingly numerous clinical indications, including pulmonary fibrosis, bone marrow aplasia, and several others. The research outcomes are critical for both optimally managing patients and genetic counseling of families.

High-throughput sequencing (NGS) has been revolutionizing routine medical practice in hemato-oncology for several years now. This targeted sequencing has enabled the search for markers with diagnostic, prognostic, or therapeutic value, thereby opening the way to a more personalized medicine. The hematology molecular biology laboratory has kept on developing this technology. As a result, NGS can now be carried out there for all the hematological-oncological pathologies provided for in the RIZIV-INAMI agreement. Efforts are also being focused on further developing the RNA sequencing technique recommended since 1/1/2022 for two onco-hematological pathologies.

The HLA system plays a central role in human immunity, whereas it also constitutes a major obstacle to organ transplantation. The involvement of anti-HLA antibodies in early and late rejection is currently indisputable. Given this context, the leuko-platelet immunology laboratory implemented a new test for identifying clinically more relevant anti-HLA antibodies in order to facilitate graft allocation.

COVID-19 has not spared the hematological biology department, playing spoilsport at the Blood Bank. Indeed, not only were the transfusion needs of certain Sars-CoV-2-infected patients rather substantial, but the erythrocyte immunology laboratory was confronted with detecting virus-induced anti-erythrocyte autoantibodies, thereby interfering with routine tests while rendering the search for compatible blood at times even more complex.

One of the Transfusion Committee’s objectives in 2021 was to further develop "Patient Blood Management" (PBM) within the various departments at Cliniques universitaires Saint-Luc. The neonatology department was chosen to be the pilot department, with the intention to work on the second PBM pillar, meaning to minimize blood loss by reducing blood sampling in infants. A decision-making flowchart was established and presented to the pediatric medical and nursing teams prior to being implemented.

These different initiatives have been made possible only through the work of the different departmental teams, at all times seeking to fully respect the patient while offering them optimal care.

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Fibroblast Growth Factor 23 is a powerful biomarker of cardiovascular disease

Damien Gruson Published in the journal : February 2022 Category : Biochimie

Cardiovascular diseases are associated with significant morbidity and mortality, markedly impacting healthcare budgets. Biomarkers play an essential role in the diagnosis and prognosis of cardiovascular diseases. Fibroblast Growth Factor 23 is a hormone regulating phospho-calcium metabolism, which is increasingly emerging as a powerful biomarker of cardiovascular risk.

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Semaglutide (Rybelsus®) – first GLP-1 receptor agonist available as oral formulation

Michel P. Hermans Published in the journal : January 2022 Category : Actualité thérapeutique

Oral semaglutide (Rybelsus®) is a new formulation of semaglutide for oral administration of this GLP-1 receptor agonist (GLP1-RA). Oral semaglutide, recently marketed in Belgium, is indicated for the treatment of hyperglycemia in poorly controlled adult Type 2 diabetics (T2DM) (HbA1c >7.5%) while taking metformin, with or without insulin. Phase 3 studies with active comparators or placebo demonstrated oral semaglutide’s sustained efficacy in reducing HbA1c and body weight in diabetic patients that were representative of the natural T2DM history, requiring the progressive stepping-up of glucose-lowering therapies. A prospective cardiovascular outcome trial recently confirmed the safety of this new semaglutide formulation.

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Storm on O negative blood: “collateral damage” of patient blood management?

Véronique Deneys, Louisiane Courcelles, Christine Pirlet, Corentin Streel Published in the journal : January 2022 Category : Immunohématologie

Patient blood management is a multidisciplinary approach that aims to personalize and optimize transfusion. In addition to the obvious benefit to the patient, applying this methodology reduces the overall consumption of blood components. A collateral effect observed is a disproportionate reduction in all blood components according to blood type, with a negligible reduction effect on O-Rh-negative red cell concentrates, thereby unbalancing the supply chain. This could herald a chronic shortage of these products. As a result, is appears essential to rebalance blood component needs and resources by working on three levers of action, which involve reducing demand, reducing waste, and optimizing supply.

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Published in the journal : January 2022 Category : Ama Contacts Read more

What to do about hyperferritinemia?

Géraldine Verstraete Published in the journal : January 2022 Category : Hematology/Oncology

Regularly dosed upon routine biological work-ups, ferritin is revealed increased in a certain proportion of the population. At times, detection of hyperferritinemia leads to exhaustive and useless work-up, often including HFE genotyping. Although hemochromatosis is the most common genetic disease, this condition is not the primary cause of hyperferritinemia. In Western countries, metabolic syndrome and consumption of alcoholic beverages are the first etiologies to be considered. In general, a complete diagnostic approach, including complete medical history, clinical examination, and biology with a complete martial assessment, allows for identifying, without any specialized consultation required.

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Diagnosis of familial hypercholesterolemia index patients and their family members

Olivier Descamps 1, Fabian Demeure ², Caroline Wallemacq3, Ann Mertens 4, Ann Verhaegen 5, Johan De Sutter 6, Michel Langlois 7, Ernst Rietzschel 8. Published in the journal : December 2021 Category : Actualités thérapeutiques

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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Menstrual toxic shock syndrome in a young lady

Diane Elate-Lea1, Florence Dive2, Frédéric Feye3 Published in the journal : December 2021 Category : Emergency

A 20-year-old female patient without comorbidities was admitted to the emergency department in a state of shock. Initially, a diagnosis of septic shock of urinary origin was established. The patient presented with abdominal pain associated with leukocyturia, along with a recent history of untreated cystitis. Admitted to the intensive care unit, the patient reported that she had kept a vaginal tampon for menstruation for over 24 hours during the day preceding her admission to the emergency department, following which the diagnosis of menstrual toxic shock syndrome (mTSS) was made. Antibiotic therapy with intravenous flucloxacillin and clindamycin was initiated.

This case presentation seeks to illustrate the different steps that led to this rare diagnosis, the relevance of a thorough history, as well as the treatment options.

What is already known about the topic?

This condition is a rare, yet possibly fatal disease, affecting women of childbearing age.

What does this article bring up for us?

This article provides a recent literature review, in addition to recalling diagnostic criteria, risk factors, management protocols, and treatment options, as well.

Key Words

Menstrual toxic shock syndrome, Staphylococcus aureus, toxic shock syndrome toxin 1, tampon, menstruation

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Spitzoid lesions – Reminders and novelties in dermoscopy and anatomopathology

Nina Nielens, MD.1, Pascal Van Eeckhout, MD.2, Pauline Richez, MD.3, Liliane Marot, MD.1-2 Published in the journal : December 2021 Category : Peause dermatologique

Spitzoid lesions represent a dermoscopic and anatomopathological challenge. While the spitzoid phenotype is easily recognizable, the differential diagnosis between Spitz nevus, atypical Spitz tumor, and spitzoid melanoma is difficult, requiring the integration of clinical, dermoscopic, histological, and molecular biological criteria.

Three main dermoscopic patterns define the Spitz nevus without asserting its benignity: the starburst pattern, the globular pattern and the vascular pattern. Symmetrical distribution of colors and structures, nodularity, ulcerations, shiny white streak, and age (>/≤ 12 years) must also be taken into account before deciding whether to reassure these patients, monitor the lesions or excise them. Based on these criteria, the International Society of Dermoscopy proposed a management algorithm (Figure 4).

Histologically, the Spitz nevus is composed of multiple epithelioid cells with nucleated nucleoli packed within hyperplastic epidermis. The following criteria must be integrated to enable the histological differential diagnosis between typical or atypical spitzoid tumors, including symmetrical distribution of structures, patient’s age, lesion diameter, infiltration of subcutaneous tissue, ulceration, mitotic index, and presence of genetic alterations.

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