Another look at digital clubbing and hypertrophic osteoarthropathy

S. Degrève, X. Vandemergel Published in the journal : April 2016 Category : Internal Medicine

Digital clubbing was first described by Hippocrates over 2500 years ago. This condition may occur as isolated finding or part of the hypertrophic osteoarthropathy syndrome, characterized by periostitis, arthritis, and at times thickening and edema of the skin surrounding the affected joints. Numerous diseases have been associated with this manifestation. In this article, we have reviewed the etiology, pathophysiology, and various theories aimed at explaining the occurrence of digital clubbing.

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Zika virus: current situation

J.C. Yombi, U.N. Olinga Published in the journal : April 2016 Category : Internal Medicine

In February 2016, the World Health Organization (WHO) declared the Zika virus outbreak a global public health emergency. The epidemic is raging in over 30 countries in the Americas, Pacific Islands, and several other regions around the world. The Zika virus belongs to the Flaviviridae family, which also includes the yellow fever, dengue, chikungunya, Japanese encephalitis, and West Nile viruses. It is transmitted by Aedes mosquitoes, especially Aedes aegypti and Aedes albopictus. Other mosquito species such as Anopheles and Culex are also considered potential Zika virus vectors. Symptoms are usually mild to moderate, including fever, bilateral non-purulent conjunctivitis, rash, and arthralgia.

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Quantitative gait analysis: principles and clinical applications

S. Lobet, C. Hermans , Ch. Detrembleur Published in the journal : April 2016 Category : Physical and Rehabilitation Medicine

Walking is a set of repetitive cyclical movements in the three planes of space. This complex process involves not only the lower-limb joints, but also the entire body. Walking may be impaired by a variety of musculoskeletal disorders of peripheral/central neurological, muscular, or osteoarticular origin, associated with compensatory mechanisms such as limping.

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Short-, medium-, and longterm benefits of a back school program: retrospective study on 394 patients with chronic low back pain

V. De Bolle, L. Barras, P. Jassogne Published in the journal : April 2016 Category : Physical and Rehabilitation Medicine

Chronic low back pain is a common reason for medical consultation, with significant impact on functional and professional status of affected patients. Many treatments are available. One of these, a back school program, is a multidisciplinary approach involving therapeutic education and physical exercise. The variety of potential options to treat chronic low back pain and the difficulty of long-term follow-up were the main reasons leading us to carry out this study. Our back school protocol consists of therapeutic education, along with cognitive-behavioral approach and gradual musclestrengthening exercises. In this article, we have presented our experience with back school and our study results regarding 394 chronic low back pain patients assessed on the short- (end-ofprogram evaluation), medium- (6-month evaluation), and longterm (12-month evaluation). The study's main outcome parameters included the benefits of back school on pain, as well as its impact on quality of life, functional status, and professional status. Our back school protocol yielded significant benefits that were maintained over the mediumand long-term. Furthermore, we observed a high rate of patients returning to work.

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Intranasal drug delivery in emergency medicine

J.-M. Jacques Published in the journal : April 2016 Category : Emergency

Whereas intranasal (IN) drug delivery has been used for many years, this administration route has not gained much interest in Belgium. IN drug delivery is painless, easy, and quick, thus proving attractive in emergency settings, especially in pediatric patients. While achieving an efficacy comparable to that of intravenous administration, the IN route is an interesting new alternative for emergency doctors, who can use it to induce opioid analgesia, reach optimal procedural sedation with midazolam, stop epileptic seizures with benzodiazepines, or antagonize morphine overdosage with naloxone.

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Psoriasis and pregnancy in the era of biologics. Case report of ustekinumab treatment during pregnancy

H. Fierens, M. Baeck Published in the journal : April 2016 Category : Dermatology

We report the case of a successful delivery following exposure to ustekinumab during pregnancy. Though psoriasis is not uncommon in pregnant women, its treatment may prove challenging during pregnancy, especially in severe psoriasis cases. While the disease usually improves during pregnancy, its treatment must often be continued. Besides local treatment, UVB phototherapy remains the treatment of choice in moderate-to-severe psoriasis. In patients requiring a systemic treatment, biologics can be considered. Whereas limited safety results are available from studies, various follow-up registers provide reassuring data. Unexpected exposure to biologics during the first trimester of pregnancy proves unproblematic.

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Generalized granuloma annulare: Is therapeutic abstention indicated?

C. Mignon, D. Tennstedt Published in the journal : April 2016 Category : Dermatology

While granuloma annulare is a benign disease, little is known about its pathophysiology, etiology, and comorbidities. Furthermore, its treatment remains poorly standardized. In this case report, we have reviewed and discussed the literature dealing with granuloma annulare, with a special focus on the advisable evaluations and therapies.

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Renal autotransplantation in the loin pain hematuria syndrome: epilog

J. Ravaux Published in the journal : April 2016 Category : Lettre à l'Editeur

In June 2015, we reported the case of a 29-year-old woman with loin pain hematuria syndrome treated by right renal autotransplantation(1). This was the second renal autotransplantation performed in our hospital. Surgery led to complete remission, with total resolution of pain. Seven months later, the patient reported severe left flank pain, requiring high doses of analgesics, such as gabapentin, tramadol, and oxycodone. Owing to the good results of the first autotransplantation, we performed a left renal autotransplantation in December 2015. The patient was discharged on the 4th postoperative day with normal renal function but persistent microscopic hematuria. She no longer needed analgesics and resumed normal daily activities. This second experience seems to confirm our first observation: the first renal autotransplantation allowed for a complete resolution of pain over a 28-year follow-up. This case further supports the role of renal autotransplantation in the treatment of loin pain hematuria syndrome.

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The electronic medical dictionary of the French National Academy of Medicine

J. Hureau, C-P. Giudicelli, J-L. Michaux Published in the journal : April 2016 Category : Lettre à l'Editeur

The electronic medical dictionary of the French National Academy of Medicine is available in open access on the internet, comprising approximately 60,000 definitions. An established editorial board meets twice a month in order to standardize and approve the modifications to the entries. The dictionary is accessed by at least 65,000 visits per month by people from over 120 countries.

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J.P. Thissen, V. Maindiaux Published in the journal : March 2016 Category : Session Diabétologie et Nutrition

The role of sugars, in particular in the form of soft drinks, in the development of obesity and its metabolic and cardiovascular comorbidities is increasingly recognized. The mechanisms involved are probably multiple, but the energy content, the glycemic load and the liquid consistence play probably a more important role than the fructose content. The present recommendations encourage to limit the amount of added or free sugars to 10% maybe 5% of the daily energy intake. The replacement of sugars with sweeteners may be helpful. On a broader scale, education to a less intensely sweet taste is paramount.

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