Published in the journal : May 2018 Category : Congrès UCL de Médecine Générale

Infection with the human immunodeficiency virus (HIV) remains a public health concern worldwide. Young adults are the most affected by the pandemic, with 40% of new cases concerning people from the 15-24 year age group, which also is the most sexually active. There are four prevention strategies of HIV infection. One of them is post-exposure prophylaxis (PEP) by the administration of antiretroviral therapy, which can be used in post-coital situation for exposed patients. The probability of HIV transmission depends on the type of exposure, infectivity level of the source, and susceptibility of the exposed person. The risk of acquiring HIV after an exposure incident can be calculated by multiplying the risk that the source person is HIV-positive by the risk of exposure. Prophylaxis is recommended when the risk of transmission is greater than 1/1,000 and must be considered when the risk is between 1/1,000 and 1/10,000. When this risk is below 1/10,000, prophylaxis is not recommended. All cases need to be evaluated on an individual basis. Most recent guidelines recommend two nucleoside reverse transcriptase inhibitors (NRTI) associated with either an integrase inhibitor (INI) or a boosted protease inhibitor (PI/r). The treatment should be initiated as soon as possible after exposure, preferably within 24 h or, at the latest, within 72 h. The treatment duration is 28 days. HIV serology is performed at Day 0, Week 8 and Week 12 using a 4th generation blood test. Counselling on HIV prevention should be provided during the follow-up.

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Treating HIV in 2018: what the general practitioner should know

Jean-Cyr Yombi Published in the journal : May 2018 Category : Congrès UCL de Médecine Générale

Many prevention and treatment efforts have been made since the outbreak of the human immunodeficiency virus (HIV) epidemic. It is estimated that by June 2017, 20.9 million people had access to antiretroviral therapy. Due to the efficacy of new antiretroviral therapies, HIV-infected patients have an almost normal life expectancy. HIV has become a chronic disease requiring long-term treatment, which poses new problems such as comorbidities, the accumulation of antiretroviral treatment toxicities and finally, ageing.

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Bariatric surgery: follow-up in general medicine

Benoit Navez(1), Jean-Paul Thissen (2,3) Published in the journal : May 2018 Category : Congrès UCL de Médecine Générale

The recognition of bariatric surgery as a legitimate component of the treatment of obesity and its comorbidities has led to a clear increase in the number of these procedures. It is essential to know the main principles of postoperative follow-up of these patients so as to ensure success and minimize the risks. Indeed, bariatric surgery imposes a modification of eating behavior and exposes the patient to certain complications and nutritional deficiencies. Their nature depends on the type of surgery, which can be either purely restrictive (sleeve gastrectomy) or mixed, i.e. restrictive and malabsorptive (gastric bypass). While surgical complications most often occur early, nutritional deficiencies commonly appear later. In case of associated comorbidities, the follow-up has to be intensified in order to adapt the drug treatment. Pregnancy can only be considered after stabilization of weight and correction of nutritional deficiencies.

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Cytomegalovirus infection associated with portal vein thrombosis and thrombocytopenia: a case report

Gianfranco Di Prinzio (1), Phung Nguyen Ung (2), Anne-Sophie Valschaerts (2), Olivier Borgniet (2) Published in the journal : April 2018 Category : Internal Medicine

We here present the case of portal vein thrombosis in a patient exhibiting symptoms of cytomegalovirus infection, confirmed by serology and polymerase chain reaction (PCR) and complicated by thrombocytopenia. The literature reveals growing evidence that human CMV likely plays a role in thrombotic disorders. However, only 11 cases of CMV-induced visceral venous thrombosis have been described so far. On the other hand, thrombocytopenia is a well-known complication of CMV infection. The patient was successfully treated using high-dose immunoglobulins by intravenous route

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Biological treatments and dermatology

Caroline Colmant, Pierre-Dominique Ghislain, Marie Baeck, Laurence de Montjoye (1) Published in the journal : April 2018 Category : Dermatology

Light was also shed on biosimilars. Doctor Pierre-Dominique Ghislain shared his clinical experience and provided practical guidelines for using biological treatments in dermatology. Lastly, several unusual indications of biological treatments have been illustrated based on clinical cases from the dermatology department of the Cliniques universitaires Saint-Luc, Brussels, Belgium.

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Rare and serious complications related to granulomatosis with polyangiitis

Published in the journal : April 2018 Category : Internal Medicine

Granulomatosis with polyangiitis is a rare systemic vasculitis with significant morbidity and mortality. The diagnosis is based on the association of clinical signs, such as involvement of upper and lower respiratory tract, as well as of the kidney, along with the presence of specific antibodies (ANCA anti-PR3), and confirmation of histopathological biopsy specimen. Although the current treatment of the disease has resulted in significantly reduced mortality, morbidity remains very high, which is linked to both the disease itself and the undesirable effects of immunosuppressive therapy.

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Linear IgA bullous dermatosis

Antoine Costenoble, Dominique Tennstedt (1) Published in the journal : April 2018 Category : Dermatology

Linear IgA bullous dermatosis is a rare autoimmune bullous disease. It proves to be the most common pediatric bullous dermatosis, affecting mainly children older than 4 years. The histopathological aspect of the lesion is highly suggestive, with direct immunofluorescence (DIF) of the perilesional skin showing intense and homogeneous linear IgA deposits on the basement membrane zone (BMZ). These deposits prove pathognomonic for the condition.

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Hypokalemic periodic paralysis

Elise Osterheld (1), Julien Mergen (1), Marianne Michel (1), Evelyne Heylen (2) Published in the journal : April 2018 Category : Pediatrics

Hypokalemic periodic paralysis is a rare autosomal dominant disorder, caused by a defect in calcium or sodium channels. Common triggers include intense physical activity, high carbohydrate intake, and stress. These paralysis episodes usually resolve within a few hours to a few days.

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Interview : Michael Bergman, MD, FACP NYU School of Medicine

Martin Buysschaert Published in the journal : April 2018 Category : Ama Contacts

Martin Buysschaert : Could you discuss your journey as a student from the USA to Louvain and then your journey back to the USA to practice medicine? Michael Bergman: I was young at the time, about 22 years old before coming to Louvain after completing four years of College.

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History of the youngest medical specialty : nephrology (Part 2 of 4 parts)

Yves Pirson Published in the journal : April 2018 Category : Ama Contacts

During the two centuries running from about 1650 to 1850, two scientific innovations account for key achievements in nephrology : new microscopes, which open the door to extending anatomical knowledge to physical processes, and the emergence of chemistry revealing the composition of stones as well as providing the measurement of albumin and urea levels.

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