Due to their anti-inflammatory and analgesic properties, induced by the inhibition of cyclooxygenase, NSAIDs are among the most widely prescribed drugs. In order to improve digestive tolerance, NSAIDs selectively targeting cyclooxygenase 2 or selective COX-2 inhibitors (COXIBS) have been developed. Despite their digestive benefits, these molecules have fallen into disfavour following documentation of an increase in cardiovascular events associated with the use of Rofecoxib. Several recent publications detailed in this article demonstrate, however, that among COXIBS, Celecoxib used in low doses has a favorable cardiovascular safety profile associated with excellent digestive tolerance, suggesting that the role of this molecule should be re-evaluated. This article reviews the advantages, modalities and precautions of Celecoxib use. Key Words NSAIDs, COXIBS, cardiovascular risk, Gastrointestinal haemorrhage, Celecoxib
SGLT-2 inhibitors, when administered to patients with type 2 diabetes, result in an improved glycemic control, which is attributable to the agent’s glucoretic effect, in addition to weight loss and reduced blood pressure. A huge number of controlled studies have demonstrated these effects for empagliflozin (Jardiance®). Moreover, the EMPA-REG OUTCOME TRIAL has also evidenced a clear cardiovascular and renal benefit for Jardiance®. This agent, indeed, reduces the risk of total and cardiovascular mortality respectively by 32% and 38%, and the risk of hospitalization for heart failure by 35%. The risk of nephropathy (incident or deterioration of a preexisting disease) is also reduced by 39%.
The aim of this paper is to propose a state of the art in the field and to discuss the place of Jardiance® in clinical practice, based on scientific data.
Key Words
Type 2 diabetes, empagliflozin, cardiovascular disease, nephropathy, treatment
Obesity and Type 2 diabetes are both associated with low-grade inflammation. Among the possible pathomechanisms, their link to intestinal bacteria is becoming increasingly convincing. Evidence suggests that gut microbiota plays a key role in triggering inflammation and insulin resistance through various mechanisms, such as the translocation of bacteria or bacterial components that induces metabolic endotoxemia. Certain intestinal bacteria may also be either deleterious or beneficial to glucose homeostasis. Among these, the specific role of Akkermansia muciniphila is currently being investigated.
Key Words
Obesity, diabetes, gut microbiota, Akkermansia muciniphila, inflammation
The non-traumatic shoulder physical examinations starts with a specific history followed by an observation of both shoulders at rest and during anterior elevation and abduction movements that must remain symetrical. Thereafter, the patient must be asked to indicate precisely where the pain is located. Active and passive mobilities are evaluated. In case of a major reduction of both passive and active mobility of the shoulder, which is accompanied by severe pain, the occurrence of an adhesive capsulitis should be suspected. The tendons of the rotator cuff must be evaluated with the traditional specific tests. The impigment tests must also take place, as tendon injuries often go along with subacromial impigment. Finally, palpation of the tendon of the rotator cuff as well as motor testing of the muscles of the shoulder including the serratus anterior will end the physical examination of a non-traumatic painful shoulder.
CDK4/6 inhibitors are a new standard of care in the management of metastatic breast cancer patients. In the early setting, the use of genomic tests will better define the patients who will benefit the most from adjuvant chemotherapy.
Breast cancer occurs in 12% of the female population. If in most of the case this affection is sporadic, heredity plays a role in 10-15% of the cases. In certain personal of familial situations, a genetic analysis can be proposed to the patients after genetic counselling. When a germline mutation is found in a family, a predictive genetic testing can be proposed to “at risk” relatives to take preventive measures. General practitioners, caretaker of the familial history, plays an important role in the follow-up and support, as in the information’s transmission in the family.
Alexandre Jacquerie ¹, Elodie Georges¹, Charlotte Van Ende², Gabriela Migali², Benoit Ghaye³, Michel Lambert¹Published in the journal : April 2017Category : Internal Medicine
We report the case of a 43-year-old woman presenting with atypical back pain caused by a tumor-like paraspinal mass. This turned out be a rare presentation of granulomatosis with polyangiitis (GPA) or Wegener's disease.
Key Words
Back pain, tumor-like mass, thoracic spine lesion, GPA
Laurine Sacré (1), Isabelle Tromme (1), Jean-François Baurain (2), Benoit Lengelé (3), Marie Baeck (1)Published in the journal : April 2017Category : Dermatology
We report here on the "PEAU’se dermatologique" meeting, held on January 16, 2016, focusing on melanoma diagnosis and new treatments. Doctor I. Tromme presented her thesis results concerning melanoma detection by means of optical and digital dermoscopy. Professor JF. Baurain provided us with a better understanding of new systemic therapies for metastatic melanomas. Lastly, Professor B. Lengelé shared with us his experience in electrochemotherapy for managing primary or metastatic cutaneous tumors.
Key Words
Melanoma, optical and digital dermoscopy, targeted therapy, elcetrochemotherapy
Georges de Bilderling (1), Claire Geurten (1), Jean Evrard (1), François Kanen (1), Laurent Houtekie (2), Alain Poncelet (3), Karlien Carbonez (4), Stéphane Moniotte (4)Published in the journal : April 2017Category : Pediatrics
A 2-month-old baby is admitted to our unit for bronchiolitis. Due to the infant's prolonged symptoms with predominant feeding difficulties and because of a heart murmur noted on auscultation, cardiac ultrasound is performed, resulting in the diagnosis of ALCAPA syndrome (Anomalous Left Coronary Artery from Pulmonary Artery). ALCAPA is a rare but severe cardiac malformation, with early diagnosis and treatment being key to a good prognosis. Bronchiolitis can provoke heart failure, whereas clinical features of heart failure may mimic bronchiolitis. This clinical case underlines the need for performing a complete clinical examination, along with oriented diagnostic investigations, when confronted with a baby suffering from a respiratory condition whose severity or evolution appears unusual.