Pharmacological treatment of motor symptoms of Parkinson's disease

Eric Mormont Published in the journal : September 2020 Category : Neurology

This article presents the different pharmacological classes and therapeutic strategies employed at the different stages of Parkinson's disease. To date, only symptomatic treatments exist. Levodopa remains the most effective treatment with the best benefit-risk ratio. It is the initial treatment of choice for most patients. In order to delay the onset of motor complications, such as dyskinesia or end-of-dose akinesia, dopamine agonists or monoamine oxidase B inhibitors may be proposed as first-line treatment to young patients with mild disability. Motor fluctuations can be improved by adjusting the levodopa dosing frequency or by adding a dopamine agonist, monoamine oxidase inhibitor, or catechol-O-methyltransferase inhibitor. Disabling dyskinesias can be improved by reducing the levodopa dose or using amantadine. Patients with severe motor complications may benefit from a treatment with Duodopa® or subcutaneous apomorphine.

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What should be taken into account from the 2019 recommendations of the European Atherosclerosis Society and European Society of Cardio-logy concerning dyslipidemia management for preventing atherosclerotic cardiovascular disease?

Olivier S. Descamps, Johan De Sutter, Ann Mertens, Caroline Wallemacq, Michel Langlois, Ann Verhaegen, Ernst Rietzschel, Guy De Backer Published in the journal : September 2020 Category : Internal Medicine

Several members of the Belgian Societies of Atherosclerosis and Cardiology have revisited in the form of 10 questions the main points of the new recommendations of the European Atherosclerosis Society (EAS) and European Society of Cardiology (ESC) concerning dyslipidemia management for preventing atherosclerotic cardiovascular disease (AVD). These new guidelines are underpinned by a number of key concepts, including the certainty that LDL cholesterol is the major cause underlying the development of atherosclerosis, that reducing LDL cholesterol helps diminish cardiovascular risk, that this cardiovascular benefit is the same regardless of how this reduction is met (nutrition, statin, ezetimibe, or PCSK9 inhibitor), and that there is neither a lower limit to this effect nor any danger at all of extremely low LDL cholesterol levels. To effectively put this knowledge into practice, a step-by-step approach is recommended; thereby enabling us to weight the intensity of the preventive approach based on individuals’ overall MCVA risk and their baseline (untreated) LDL-C levels.

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Pathophysiology of NASH: Have new risk factors been identified?

Nicolas Lanthier Published in the journal : September 2020 Category : Hépato-gastroentérologie

Due to the rising prevalence of obesity, non-alcoholic fatty liver disease (NAFLD) has become the leading cause of chronic liver disease worldwide. NAFLD refers to a disease spectrum that encompasses steatosis and non-alcoholic steatohepatitis (NASH). NASH, which is the inflammatory subtype of NAFLD, has a clear potential of progression to fibrosis and cirrhosis, and can be associated with the need for transplantation. Identification of NAFLD and NASH is important in order to prevent disease worsening and to provide adequate tools for counteracting the causal factors. Risk factors associated with NAFLD and NASH include clinical comorbidities such as the metabolic syndrome, which is more relevant than high body mass index. Further recently identified characteristics, such as dietary composition, intestinal dysbiosis, genetic predisposition, altered brown adipose tissue, muscle alterations, circadian clock disruption or environmental chemicals, are presented in this review.

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Human beings are not tomatoes which can grow without soil

Guibert Terlinden Published in the journal : May 2020 Category : Spiritualité

Humans come from the humus, they are kneaded out of it. In the crisis, the fragility and immensity of each individual’s humanity has been unveiled, even by what was painfully lacking. We must preserve our humanity as an invaluable treasure. We must root our future in it, because without soil, our “DNA” denatures and dies.

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Management of patients with COVID-19-related respiratory failure at the intensive care unit

C. Collienne, D. Castanares-Zapatero, M. Apraxine, C. Beauloye, A. Capes, T. Castelein, C. Debaille, M. Dechamps, L. Gérard, P. Hantson, L-M. Jacquet , V. Montiel, S Pierard, J. Pinto Peireira, A. Robert, O. Van Caenegem, A. Wiart, P-F. Laterre, X. Witteb Published in the journal : May 2020 Category : Intensive Care

During the COVID-19 pandemic, many patients have been admitted to intensive care units, thereby highlighting the work of a medical specialty that is often little or poorly known to the public. In these patients, respiratory failure, falling within the definition of acute respiratory distress syndrome, had to be managed using non-invasive and invasive oxygenation and ventilation techniques, and in the most severe cases, using extracorporeal membrane oxygenation. These heavy treatments, combined with complicated mobilization techniques (prone position) and other usual intensive care treatments, had to be delivered simultaneously to a large number of patients with a guarded prognosis, which has put under significant pressure the bedside care teams.

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Social and economic impacts of the response strategy to the coronavirus pandemic in Belgium

Emilie Banse1, Alix Bigot1, Christian De Valkeneer2, Vincent Lorant3, Olivier Luminet1,4, Pablo Nicaise3, Pierre Smith3, Sandy Tubeuf3,5, Amélie Wuillaume6 Published in the journal : May 2020 Category : Société

The implementation of population containment has proven effective to reduce the number of deaths and avoid overrunning hospitals. However, the restrictive measures of containment and distancing have impacted society far beyond health. In this article, we briefly present four research projects in social sciences and humanities that are currently being conducted at the UCLouvain. The first study, focused on health psychology and emotions, has shown the existence of individual barriers to adopting hygiene and distance behaviors. The second research project on mental health explores the consequences of containment on the mental health of Belgians. The third study, in the field of management and organizational sciences, describes the resilience of companies in crisis situations. Finally, the last study deals with law and discusses the importance of collective responsibility and the need for clear rules to enforce freedom-restricting measures.

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(Easing) lockdown measures, a human and societal challenge: focus on the impact of the COVID-19 “infodemic” in French-speaking Belgium

Bernard Hanseeuw, Louise-Amélie Cougnon, Alexandre Heeren, Nathan Gurnet, Grégoire Lits Published in the journal : May 2020 Category : Société

Managing the health crisis we are facing goes far beyond managing the coronavirus epidemic. The lockdown measures implemented in response to the virus propagation have resulted in broad medical and societal impacts. In addition to the epidemic, an “infodemic” has been generated and is now spreading. For most individuals, this enormous and incessant flow of true and false information is difficult to manage. Moreover, academic physicians now occupy the media space, a situation they are not familiar with. In an academic effort to draw the attention of the Belgian government and experts to the central role of social sciences and humanities in getting out of the crisis, a neurologist has partnered with media sociologists as well as a psychologist specialized in anxiety disorders to better understand the impact of (mis-)information on people’s behavior, with a particular focus on the differences that exist between the general public and health professionals.

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Chest imaging in COVID-19

Amin Mahsouli, Melissa Grillo, Nadia Amini, Souad Acid, Emmanuel Coche, Benoît Ghaye Published in the journal : May 2020 Category : Radiologie

In December 2019, a new type of coronavirus (SARS-CoV-2) spread from China to all around the world. Chest imaging has emerged as a valuable tool for the workup of COVID-19, notably for triaging symptomatic patients to COVID-19 or non-COVID-19 units in anticipation of the reverse transcription-polymerase chain reaction (RT-PCR) results. The findings observed on computed tomography (CT) in this context are highly sensitive, but they are not specific for this pathology. Chest CT most frequently reveals bilateral multilobar ground-glass opacities with a peripheral or posterior distribution. A correlation has been demonstrated between the radiological extent and evolution of chest findings and the clinical course of the disease. CT lesions may precede the onset of symptoms, which confirms the high sensitivity of this technique. This literature review was aimed at highlighting the usefulness of chest imaging in the diagnosis of COVID-19, which exhibits typical and less typical CT features, as well as radiological severity criteria, and in the triaging of patients.

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The big thread: COVID-19 infection and adolescent anxiety

Emmanuel de Becker Published in the journal : May 2020 Category : Psychiatrie infanto-juvénile

The current crisis is simultaneously disrupting and stabilizing adults, as well as children and adolescents, or maybe even grieving them. Along with the phenomenon’s scale, opinions of all kinds are multiplying, fueling more the feeling of insecurity and consequent anguish. In addition to the largely relayed physical concerns, our aim has been to draw attention to psychic and relational health, while focusing on the youngest society members. After recalling the notion and concept of anxiety disorder, we have proposed several therapeutic axes.

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Psychological interventions in COVID-19 units

Leila Rokbani, Julie Saussez, Pauline Chauvier, Céline Baurain, Nathalie Chatelle, Florence Chanteux, François Hocepied, Kevin Wagemans, Philippe de Timary, Geneviève Cool Published in the journal : May 2020 Category : Psychiatrie

In this article, we sought to describe and analyze the interventions and experiences of a subgroup of psychologists from the psychology department of the Saint-Luc University Hospital, who rapidly stepped in to support care units receiving COVID-19 patients during the COVID-19 pandemic. Besides the setting up of a call center and speech groups aimed at relieving staff members, psychologists collectively and voluntarily decided to immerse themselves into these care units in order to support staff members, patients, and families overwhelmed by the strength of the crisis. Behavioral and psychological alarm signs in care unit staff members and psychologists themselves need to be considered and cared for. At the end of the article, a testimony of the involved psychologists provides an insight into the reality of the crisis.

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