In general practice, chest pain is a very common clinical complaint. The general practitioner’s decision to refer a patient to hospital is mainly based on chest pain characterization, patient's cardiovascular history, as well as electrocardiographic and hemodynamic changes. Acute coronary syndrome (ACS) remains the main diagnostic challenge. In this case, a coronary angiography must generally be performed, but the delay will depend on the type of ACS. ST-segment elevation myocardial infarction (STEMI) requires rapid transport to the emergency room, given that the time to reperfusion (time span from diagnosis to coronary reperfusion, ideally <60 min) determines the patient’s prognosis. Patients with non-ST segment infarction (NSTE-ACS) should undergo angiography within 24 to 72 hours. Platelet inhibitors (aspirin and P2Y12 receptor inhibitors) are the cornerstone of pharmacological treatment. They are generally administered over 1 year. Beyond initial diagnosis, the general practitioner also plays a crucial role in ensuring continuity of care following hospitalization, since these patients are at high risk of relapse.
When contacted by a patient suffering from acute vertigo or dizziness, the general practitioner needs easy clinical tools enabling him to screen for urgent and life-threatening central vestibular disorders in a timely and reliable manner. Some subjective complaints are red flags that indicate the need for a rapid medical examination before a possible referral to a neurology emergency unit. Using the HINTS tool must be further promoted, given that it proved to be specific and sensitive in detecting central vestibular disorders. After a review of the subjective symptoms and clinical signs that evoke central vestibular disorders, the article presents the most frequent peripheral vestibular disorders.
A mother makes an appointment at her general practitioner’s (GP) clinic for her son who complains about fatigue and has dropped out of school. After a reassuring anamnesis, clinical examination, and blood tests, the process analysis highlights avoidance behavior.
General practice is not a big user of emergency medical services, with less than 10% of phone calls coming from patients’ home. However, it has a key role to play in the proper functioning of the “acute cardiology” and stroke departments through patient education and rapid dialing of the 112 emergency number.
Respiratory, urinary, and cutaneous infections make up a significant proportion of general practice consultations. Few new antibiotics are available on the market and given the increase of multiresistant bacteria, a rational use of antibiotics proves necessary. Rhinopharyngitis, rhinosinusitis, and bronchitis are most often of viral origin, and treatment is therefore symptomatic. Antibiotics are only required in case of suspected bacterial superinfection, in which case treatment duration is 5 days. Among urinary tract infections, a distinction should be made between complicated and uncomplicated infections, while taking into account some specific risk factors. Both can be complicated by severe sepsis. Escherichia coli remains the predominant uropathogen. There is an increase in multiresistant bacteria, even in the community. Asymptomatic bacteriuria (AB) is common, especially among elderly people. Screening and treatment of AB are indicated only in pregnant women and patients undergoing urinary tract instrumentation with a risk of mucosal bleeding. Skin infections, such as impetigo, do not always require systemic antibiotics. This article is aimed at supplementing and updating the data of an article on the rational use of antibiotics in general medicine published in 2015 in the same journal. It additionally includes recent data on the management of pneumonia, pertussis, and skin infections.
Ehlers-Danlos syndrome (EDS) is the most common inherited connective tissue disorder, primarily affecting collagen and estimated to concern 1 or 2% of the general population. A set of new criteria and nosology was published in 2017. The hypermobile EDS (hEDS) subtype is a multi-systemic disease that can affect all organs. Patients suffer from many clinical signs and diversified symptoms.
SGLT-2 inhibitors (gliflozins) are a new therapeutic class for managing Type 2 diabetes, acting by their glucoretic effect. Along with their glycemic action, these agents likewise exhibit cardiovascular and renal benefits.
In clinical practice, it may at times prove difficult to attain the recommended LDL cholesterol levels due to either high initial levels or low drug tolerance. The 2003 discovery of a new protein named PCSK9 (proprotein convertase subtilisin/kexine Type 9), involved in the metabolism of LDL particles, led to the development of several monoclonal antibodies that neutralize this protein (evolocumab from Amgen, alirocumab from Sanofi/REGENERON, and bocozicumab from Pfizer). When combined with statins and ezetimibe, these agents cause a highly significant reduction in LDL cholesterol levels, associated with very good safety profiles and tolerance, along with significant benefits in terms of cardiovascular prevention. Therefore, they constitute an additional therapeutic strategy to help patients reach their LDL cholesterol targets, especially those with severely elevated cholesterol levels, as observed in familial hypercholesterolemia cases.
This article provides ideas to all health professionals willing to advise people with disabilities about their affective, relational, and sexual life. After presenting the Handicap and Sexuality Resource Center (Namur, Belgium), an institution present throughout the Walloon territory, several resources will be explored (evenings with institutions, educational tools, websites, etc.). Nowadays, this issue is more often taken into consideration. However, existing needs are still far from being met..
Sexual repercussions of cancer and its treatments have long been considered of minor importance. However, the sexual dimension of cancer patients has recently been given particular consideration, resulting in an increased scientific interest and the development of international guidelines. In this paper, we detail the main sexual disorders encountered by both male and female cancer patients. Women are mostly affected by dyspareunia and decreased libido, while erectile dysfunction and decreased libido are predominant in men. These disorders may have a major impact on the couple’s life. We also describe the sexual adverse effects induced by the different cancer treatments and provide some advices and nonpharmacological treatments to manage them.