Gene therapy in 2017: overview and perspectives

Nathalie Lannoy, Cédric Hermans Published in the journal : January 2017 Category : Thérapie génique

Shortly after the discovery of the different so-called monogenic genes (one gene = one disease), the medical and scientific community became excited by the prospects of development and implementation of clinical trials in gene therapy aimed at correcting failing genetic activity. Following the death of a patient with severe combined X-linked immunodeficiency, widely reported in the scientific community, it was obvious that there was still much progress to be made in the 2000s for recognized gene therapies to be implemented. However, new vectors derived from lentiviruses and adenoviral vectors are currently in development, which promise to be more efficient and safer, with positive outcomes in several clinical trials on hemophilia, adrenoleukodystrophy, Leber's amaurosis, or cancer.

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Management of gestational diabetes in 2016: literature review

N. Pirson, D. Maiter, O. Alexopoulou Published in the journal : December 2016 Category : Endocrinologie et Nutrition

Gestational diabetes refers to first-onset glucose intolerance occurring during pregnancy. The prevalence of this pathology was shown to vary widely, whilst currently increasing worldwide in relation to obesity and diabetes outbreak. The pathophysiology of gestational diabetes is similar to that of Type 2 diabetes, as characterized by increased insulin resistance and subsequent pancreatic beta-cell dysfunction. Even though complications of gestational diabetes are well-known, there is no universal consensus with respect to screening criteria. The cornerstone of treatment is diet, which may be followed by insulin therapy, if necessary. Post-partum follow-up appears essential, considering the high risk of diabetes in the patient's future.

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From 1.0 medicine to 3.0 medicine : the connected patient

J. Melchior, F. Ndianabo Published in the journal : December 2016 Category : Cardiology

Mobile devices, tablets, and smart-phones have become essential tools in today's society, and they are also entering the healthcare field. We are slowly, but surely, approaching the e-medicine domain, inhabited by the e-patient, with all its advantages in terms of accessibility, yet also its complications, along with the need to rethink the current health care system.

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Home transfer after cardiac surgery

E. Navarra Published in the journal : December 2016 Category : Cardiology

The patient's return to his own home following heart surgery constitutes a significant moment in time, reflecting his return to daily normal-life activities. Once the peri-operative phase overcome, and following the period of convalescence, the patient must very abruptly continue to life "without any medical environment". The role of the information provided to the patient during his hospital stay, as well as the cooperation between the physician, cardiologist, and surgeon, are all paramount to facilitate the patient's return to his own home.

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Home transfer after coronary intervention

J. Kefer Published in the journal : December 2016 Category : Cardiology

The general practitioner is commonly faced with patients coming home after having undergone coronary intervention. Given this context, the specific items that must be followed-up include potential vascular complications, administered medications for preventing stent thrombosis (antiplatelet agents), as well as the management of recurrent chest pain. General measures to prevent atherothrombosis should be applied and monitored as well.

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Which coronary revascularization method should be applied to patients aged over 80 years?

Patrick C. Chenu Published in the journal : December 2016 Category : Cardiology

There is only little evidence regarding coronary revascularization carried out in octogenarians. Several randomized studies have been conducted, yet being mostly old and obsoletes. More recent randomized clinical trials that underlie the current recommendations have included either no or only a few patients aged over 80 years, specifically excluding those patients who were frail whilst exhibiting numerous comorbidities. We must thus use our clinical common sense when extrapolating the published findings to older patients at medico-surgical meeting, involving anesthesiologists and intensivists. In all cases, a geriatric assessment should be systematically performed.

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Use of anticoagulants in elderly patients

C. Lambert, C. Hermans Published in the journal : December 2016 Category : Cardiology

The risk of thrombosis increases with age and the elderly are particularly likely to both be given and benefit from anticoagulant therapy. However, the bleeding risk is also higher in this patient population. For these reasons, the risk/benefit ratio must be carefully weighed for this age population, with periodic risk/benefit reassessments required.

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Management of arrhythmias in elderly patients

C. Barbraud Published in the journal : December 2016 Category : Cardiology

Arrhythmias are common in elderly patients, and particularly atrial fibrillation, whose prevalence exceeds 15% in subjects aged over 75 years. In these patients, atrial fibrillation has been shown to be associated with a high risk of thromboembolic events. It is therefore paramount to accurately diagnose atrial fibrillation and promptly initiate anticoagulation therapy that has been shown to reduce mortality, even among frail elderly patients.

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Elderly patients: When should an assessment be made and what should it comprise?

Th. Muller Published in the journal : December 2016 Category : Cardiology

Cardiovascular complaints and symptoms of elderly patients are difficult to interpret, given the patients' decreased physical activity, differing experience of pain, and impaired memory. It is therefore our duty to pay close attention to their complaints in order to provide them with optimal treatment.

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Prevalence and characteristics of cardiac problems of seniors in the third or fourth age

P. Cornette Published in the journal : December 2016 Category : Cardiology

The common cardiovascular patient has now become older and more frail while suffering from multimorbidity. Such disease complexity requires different skills to be deployed by the cardiologist. Patient-centered care appears crucial and relies on a global assessment of patient health including frailty. The therapeutic objectives must be defined according to the patients’ priorities while maximizing their functioning and independence.

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