How to assess the risk of chronizisation in the case of low back pain?

Alexis Lheureux (1), Olivier Nonclercq (2), Jean-Louis Mathias (3), Natalya Korogod (4), Emmanuelle Opsommer (4), Anne Berquin (1 ) Published in the journal : July 2019 Category : Médecine Physique et Réadaptation

Several screening tools have been validated to identify patients at risk of developing chronic low back pain, including the Örebro Musculoskeletal Pain Screening Questionnaire (OMPSQ, long and short versions) and Start Back Screening Tool (SBST). The purpose of this study was to aid the clinicians choose the tool that best suits their needs. A preliminary validation of the French version of the short OMPSQ has demonstrated that the tool’s psychometric properties are comparable to those of the original version. In a literature review, 101 papers were analyzed. Overall, the three questionnaires exhibited moderate predictive properties. The OMPSQ was designed to be a prognostic tool, whereas the SBST was to be a treatment-allocating tool. Knowledge and attitudes of rehabilitation professionals (mostly physiotherapists) from two medium-sized hospitals were also evaluated. Overall, most of the respondents did not know these questionnaires. When provided with the questionnaires, their global attitude was positive, despite several concerns being formulated. In conclusion, valid tools exist for identifying at-risk patients. However, substantial efforts must still be made towards the appropriate education of healthcare professionals.

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Model of co-management in geriatric rehabilitation: a 10-year experience

Julie Paul (1), Amaya Lopez-Sierra (1), Sara Palumbo (2), Pascale Cornette (3), Patricia Dessart (2) Published in the journal : July 2019 Category : Geriatry

Many geriatric patients are discharged from acute hospitalization, exhibiting functional decline. This acute functional decline constitutes a reason for the patient to be considered for an admission to the rehabilitation ward. The inpatient rehabilitation process is particularly challenging for these complex patients. This process requires medical skills to be able manage the medical complications in relation with co-morbidities, along with geriatric skills to be able to cope with various geriatric syndromes (polymedication, denutrition, cognitive disorder, and falls). Finally, some know-how in rehabilitation medicine is also required to be able to supervise a specific rehabilitation process (weight bearing and resistance exercises, dysphagia, incontinence rehabilitation, or orthotics and prosthesis).

A co-management model associating a geriatrician and physical medicine specialists is a possible approach to address this complex issue. In this paper, we further describe this co-management model, along with our particular experience at Valida hospital in this field.

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Future challenges for academic hospitals

Marc Decramer Published in the journal : July 2019 Category : Médecine et société

Despite the sustained discussions and consultations of these recent years about hospital networks and the role of different hospitals, still much ambiguity exists as to the role of academic hospitals. This analysis puts innovation in medicine forward as the primary mission of these hospitals. Academic hospitals currently face a multitude of challenges, such as the lack of financial resources for academic missions and the concentration of complex and rare diseases, to only name the most important ones.

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Sternal osteomyelitis in a 15-month-old child: clinical case and review of clinical, radiological, and therapeutic features

Letizia Vega (1), Jean-Philippe Stalens (2), Jean-Luc Dutrieux (3), Chloé Brunelle (2) Published in the journal : May 2019 Category : Observations cliniques

Osteomyelitis is an infection that affects the bone tissue via hematogenous dissemination, direct post-traumatic or post-surgical inoculation, or a contiguous local infection, such as cellulitis or sinusitis. It is preferentially localized in the metaphyseal region of long bones. Short bones are more rarely affected. Sternal involvement is observed in about 1% of all pediatric osteomyelitis cases. Initial symptoms are often nonspecific, thus resulting in delayed diagnosis. Once the infection is established, symptoms of local inflammation appear. The treatment consists of a targeted antibiotic therapy depending on the child’s age and germs responsible for the infection.

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Hypercalcemia secondary to vitamin D intoxication: clinical vignette and literature review

Adrien De Voeght (1), Eric Godon (1), Alfred Chachati (1), Etienne Cavalier (2), Benoit Buysschaert (1) Published in the journal : May 2019 Category : Observations cliniques

We have reported a case of hypercalcemia with acute renal failure secondary to vitamin D intoxication induced by chronic use of calcitriol. In this article, diagnosis and treatment approaches have been discussed.

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Cardiac toxicity of 5-fluorouracil

Anne-Catherine Claikens, François D’Heygere (1) Published in the journal : May 2019 Category : Observations cliniques

A 53-year-old patient attended the emergency department, on two occasions, because of angina symptoms following the administration of 5-fluorouracil. This treatment was employed in a preoperative neoadjuvant approach in the setting of a recent diagnosis of colorectal cancer (T3N1M0).

Overall, 5-fluorouracil can be associated with cardiac toxicity that manifests itself as pectoral angina, infrequently resulting in irreversible, potentially lethal, cardiac pathologies. While multiple risk factors and action mechanisms have been proposed in the literature, they are still largely unknown among practitioners.

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Giant basal cell carcinoma successfully treated by photodynamic therapy

Muriel Creusot (1), Anne Le Pillouer-Pros (t)2 Published in the journal : May 2019 Category : Observations cliniques

Giant basal cell carcinomas, defined as lesions with a diameter reaching 5cm or more, are rare. They are usually treated by surgery, which can prove mutilating, depending on the size of basal cell carcinoma, or even impossible, depending on the patient’s age or presence of co-morbidities. Since 2003, dynamic phototherapy has become a non-invasive therapeutic alternative for basal cell carcinomas, proven effective. As early as 2010, research revealed the value of intensifying conventional phototherapy sessions with multiple methods, including fractionated CO2 laser, in order to enable trans-epidermal delivery of methyl aminolevulinate (MAL), thereby amplifying the therapeutic response.

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Immunotherapy: successes and prospects

Jean-Francois Baurain Published in the journal : May 2019 Category : ECU-Congrès de médecine générale

Immune checkpoint inhibitors, such as anti-PD1/PD-L1 antibodies, have changed the treatment of several cancers.The survival of cancer patients has drastically improved, with some of them showing complete and durable responses. A number of patients are likely to be cured of their metastatic cancer. This should encourage further research from academic or pharmaceutical teams in an effort to increase the efficacy of modern immunotherapy.

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Monoclonal gammopathy of undetermined significance

Julien Depaus Published in the journal : May 2019 Category : ECU-Congrès de médecine générale

Monoclonal gammopathy of undetermined significance (MGUS) is commonly diagnozed in the general population, particularly the elderly. The condition carries a risk of progression to myeloma or other lymphoproliferative disorders and, thus, warrants regular follow-up. MGUS patients can be risk-stratified based on both the amount and type of the monoclonal protein and light-chain ratio.

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Cardiac stress test: For whom? Why? How?

Agnès Pasquet Published in the journal : May 2019 Category : ECU-Congrès de médecine générale

This article reviews the main indications for stress testing and the different kinds of stress tests that can be performed in patients in the cardiological setting.

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