Charlotte d’Odémont (1), Michel Henry (2), Pascale Grandjean (1)Published in the journal : January 2017Category : Cardiology
Peripartum cardiomyopathy (PPCM) is defined as a non-familial form of peripartum heart failure and described as an “idiopathic cardiomyopathy presenting with heart failure secondary to left-ventricular systolic dysfunction towards the end of pregnancy or in the months following delivery”. We have here reported the case of a young woman suffering from peripartum cardiomyopathy 2 months after delivery. This case provided us the opportunity to review etiology, diagnosis, and treatment of this little-known medical condition with occasionally serious outcome.
Yves Pirson¹, Thien-Anh Ho¹, Nathalie Demoulin¹, Nathalie Godefroid², Valérie Dekeuleneer³, Kenou van Rijckevorsel⁴, Marie-Cécile Nassogne⁵, Riëm El Tahry⁴, Yves Sznajer⁶Published in the journal : January 2017Category : Rare Diseases
Tuberous sclerosis complex (TSC) is a genetic disease characterized by the development of hamartomas in several organs, including the brain, kidney, and skin.
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.
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.
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.
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.
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.
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.
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.
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.