Background: Health care practitioners’ attitudes and beliefs concerning low back pain (LBP) have been reported to influence their patients’ prognosis. No specific information is available concerning Belgian caregivers. Methods: Validated questionnaires were filled in by 98 participants, such as physiotherapists, occupational therapists, and nurses, prior to attending educational programs about LBP. Results: Biomedical attitudes and beliefs are widely prevalent in Belgium, even among participants claiming to understand the guidelines, with median scores on the biomedical and psychosocial scales of the Health Care Providers’ Pain and Impairment Relationship Scale and of the Pain Attitudes and Beliefs Scale for Physiotherapists of 31, 35, and 50, respectively. Discussion: This study highlights the need of continuous education on biopsychosocial management of LBP patients.
This work sought to further clarify the contribution of medical imaging in the follow-up of pacemakers and implantable cardioverter defibrillators. Right after implementing these devices, chest radiography must be performed in order to precisely evaluate the position of the leads and exclude potential complications. These images constitute the basis for early and late surveillance, thereby enabling the detection of anomalies that may explain any clinical symptoms or electric troubles. CT scanner or Doppler ultrasound may assist under certain circumstances.
S. Dupriez 1, A. Ferrant 1, M-Ch. Vekemans 1, B. Brichard 2, L. Michaux 3, T. Connerotte 4, E. Van Den Neste 1, Ch. Vermylen 2, L. Knoops 5, C. Graux 6, F. P. Duhoux 7, C. Lambert 1, X. Poiré 1, H. Antoine-Poirel 8Published in the journal : April 2018Category : Hématologie et Oncologie médicale
Hereditary hematological malignancies syndromes (HHMS) are still underdiagnosed. Yet, it proves essential to correctly identify these disorders in order to select the most appropriate conditioning regimen before transplantation and exclude an inherited mutation in sibling donors, while ensuring personal and familial counseling. We retrospectively reviewed 252 patients from 117 families with a personal or familial history of multiple cancers, including at least one hematological malignancy. A familial mutation was identified in eight families (GATA2, TERT, FANCA, TP53, PTCH1, BRCA1 and ATM), resulting in specific management and familial screening. This study highlights the necessity of early HHMS diagnosis through a close collaboration between hematologists and geneticists. To finish, we present recommendations to better diagnose and manage HHMS on the basis of our observations and the literature.
When confronted with patients suffering from moderate hyperprolactinemia (25-100μg/L) in daily practice, multiple causes should be evoked. If the condition is not associated with suggestive symptoms, it is most often caused by other conditions than a prolactinoma. These mainly include transient hyperprolactinemia that is not confirmed by subsequent hormonal testing, macroprolactinemia that must always be systematically ruled out; antidopaminergic or serotoninergic drugs leading to a sustained rise in prolactin concentrations (mainly neuroleptics and antiemetics), and disconnection hyperprolactinemia associated with other lesions of the hypothalamic-pituitary axis disrupting the dopaminergic inhibitory control on basal prolactin secretion. We have herein reviewed the different causes of hyperprolactinemia. Before embarking the patient on a long-term treatment with dopamine agonists, the diagnostic evaluation should always take into consideration these potential causes, in addition to a possible pituitary incidentaloma.
Orsalia Alexopoulou, Dominique MaiterPublished in the journal : March 2018Category : Endocrinology
Adult growth hormone deficiency (AGHD) is nowadays recognized as a distinct clinical entity and replacement therapy has become a standard practice. The benefits of GH treatment seem to outweigh its potential risks but issues concerning long term efficacy and safety are still a subject of debate. More research is needed in some key areas and it remains essential to monitor patients by means of longitudinal surveillance studies.
Vanessa Preumont, Stéphanie RouhardPublished in the journal : March 2018Category : Diabétologie
The FreeStyle Libre® and Guardian Connect® glucose monitors are currently available in Belgium for patients with Type 1 diabetes and for subjects without residual insulin secretion. The FreeStyle Libre® device was designed to replace the recommended finger-stick glucose monitoring, without any need of calibration. Accuracy is comparable to that pertaining to currently available real-time continuous glucose monitoring. The system can be used in adults, children, and during pregnancy. In randomized trials, its use was reported associated with a reduction in hypoglycemia and, in observational studies, with an improvement in glycated hemoglobin levels. User satisfaction was proven high, with relatively few adverse events. Glucose data can be summarized as ambulatory profile in order to facilitate insulin dose adjustments. Further trials are needed in order to assess the long-term impact on both glycated hemoglobin and quality of life.
Johann Morelle, Nathalie Demoulin, Michel Jadoul, Hubert PiessevauxPublished in the journal : February 2018Category : Nephrology
In 2017, the treatment of severe forms (proteinuric and/or with impaired kidney function) of IgA nephropathy, the most common primary chronic glomerulonephritis, proved to be of particular interest. Several studies highlighted that the risks associated with conventional immunosuppressive therapy, still mainly based on corticosteroids outweighs the potential benefits. A Targeted (enteric)-release corticosteroids constitutes a new therapeutic agent will soon be tested in a Phase 3 study, following encouraging results from Phase 2. Furthermore, several observational studies, conducted in 2017, suggested that the nephrotoxicity due to proton pump inhibitors be more common than hitherto appreciated, though the causal relationship between both must still be firmly demonstrated. In this paper, we discuss the implications from these studies concerning the use of this widely prescribed family drug.
The year 2017 was particularly rich in new developments in the field pertaining to coagulation disorders, be they thrombotic or hemorrhagic. Several studies further confirmed the role of direct oral anticoagulants (DOACs) at reduced dose levels for the secondary prevention of venous thromboembolic disease. These same agents will likely replace low molecular weight heparins (LMWHs) in cancer patients with antecedents of venous thromboembolism. A specific and extensively validated antidote is already available for dabigatran (idarucizumab). While awaiting the validation of specific antidotes for factor Xa anticoagulants, prothrombin complex concentrates (PCCs) have been shown to be effective, even at reduced dose levels, in patients requiring rapid reversibility of anticoagulation induced by an anti-Xa agent. In the hemophilia setting, the development of a bispecific antibody mimicking the action of FVIII (emicizumab), along with the first successes of gene therapy for hemophilia A open revolutionary perspectives as to the management of this rare disease.
Jean-François Baurain, François Duhoux, Astrid De Cuyper, Frank Cornélis, Jean-Pascal Machiels, Thierry PietersPublished in the journal : February 2018Category : Oncologie
2017 was again a great year for oncologists, as the efficacy of new promising drugs and treatment modalities could be confirmed, thus improving the prognosis of our patients. Since we cannot describe all highlights here, we decided to focus on some major advances. Immunotherapy with anti-PD-1/PD-L1 antibodies has become a standard of care in many metastatic patients, with a long-term survival benefit reported for some of them (yet it is too early to talk about cure). However, the administration of these antibodies is associated with a very specific auto-immune toxicity that may have serious or even fatal consequences if not recognized and treated early. Moreover, the range of available targeted therapies is continuously growing, with the advent of new therapeutic classes, such as the CDK 4/6 and PARP inhibitors. Thanks to our better understanding of the mechanisms underlying resistance to targeted therapies, news drugs have been developed (e.g. osimertinib) and have proved able to overcome the resistance observed with the first-generation tyrosine kinase inhibitors in lung cancer. There is also a trend toward decreasing the aggressiveness of chemotherapeutic regimens. All these treatments are available at the King Albert II Cancer Institute, along with new treatments that are currently being investigated and might become the standard of care of tomorrow.
Marie-Christiane Vekemans, Eric Van Den Neste, Sarah BaillyPublished in the journal : February 2018Category : Onco-Hématologie
The landscape of Multiple Myeloma treatments is rapidly evolving, with more and more potent therapeutic options. The most exciting news are probably those regarding a new class of therapies targeting the B-cell maturation antigen (BCMA) via different mechanisms. CAR T-cells as well as antibody-drug conjugates targeting this antigen have yielded very promising results. This next-generation MM treatments will probably lead to a paradigm shift from purely “survival-focused” to “quality of-life-focused”. Biomarkers of minimal residual disease (MRD) and molecular/cytogenetic techniques will undoubtedly be of great help in redefining treatment goals and selecting appropriate treatments. Treating MM in earlier stages will also impact the way we consider this disease today. The management of chronic lymphocytic leukemia has evolved tremendously over the past years, notably due to the efficacy of new oral therapies and the increased consideration of prognostic factors.