M. Baeck, A. Herman, V. Dekeuleneer, A.-C. Deswysen, P.-D. Ghislain, B. Leroy, L. de Montjoye, I. TrommePublished in the journal : February 2016Category : Dermatology
2015 was an important year in dermatology, especially in the therapeutic area. New treatments are available for chronic urticaria, psoriasis and angiofibromas of the face in the tubrous sclerosis complex context. In dermato-oncology, treatments of advanced cases of basal cell carcinomas and metastatic melanomas have significally improved. Finally, methylisothiazolinone remains a major allergen, responsible for contact allergy epidemic and for which it is urgent to establish a limitation of its use at European level.
Your money or your life? - Kalydeco®: a milestone towards the “cure” of cystic fibrosis From February 1st 2016 on, Ivacaftor (KALYDECO™) will be reimbursed in Belgium for the treatment of cystic fibrosis (CF) in patients aged 6 years and older carrying at least one of nine well characterized gating (Class III) cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations, which account for approximately 3% of Belgian CF patients. In most of these patients, this very expensive oral drug (248,000 €/year) substantially improves lung function, lowers sweat chloride levels, and improves body weight by targeting the primary defect, thus representing a fundamental shift in the way the disease is managed. However, clinicians should be aware of the drug's potential for numerous drug interactions.
ATOZET ® contains two active agents, atorvastatin and ezetimibe, which inhibit the pathways pertaining to hepatic synthesis and intestinal absorption of cholesterol, thereby reducing the LDL levels by 50 to 65%. Each active ingredient has proven its effectiveness to significantly reduce the incidence of cardiovascular disease. From a practical point of view, the reimbursement conditions (INAMI/ RIZIV) for this combination pack have been rightly adjusted to the latest European and Belgian recommendations, allowing patients at very high risk to be optimally treated. The combination 'two in one' is also likely to facilitate therapeutic adherence. ATOZET ® is particularly indicated in secondary prevention, in primary prevention, and in patients with a very high SCORE (≥10%), patients with diabetes, or those with familial hypercholesterolemia whose LDL cholesterol levels remain inadequately controlled by statin monotherapy alone.
N. Feller, J.-B. Le Polain de Waroux, S. Marchandise, C. Barbraud, Ch. ScavéePublished in the journal : September 2015Category : Cardiology
We report two cases of patients receiving inappropriate shocks delivered by an implantable cardioverter-defibrillator (ICD). The device malfunction was related to rapid atrial tachycardia in one patient and defibrillation lead defect in the other. With the expansion of ICD implantation, this inappropriate shock problem has increased gradually over the past years and has thus become a noticeable concern today. Inappropriate shocks usually cause psychological distress in the patient and are associated with increased mortality and morbidity. Furthermore, the majority of lead defects may be detected on ICD control before inappropriate shocks occur. Lead defect problems can hardly ever be resolved conservatively, usually requiring an invasive approach.
Diabetes mellitus is a major health problem for at least two main reasons: the disease's epidemic evolution and the risk of chronic, hyperglycemia-related complications. This article aims at emphasizing the worldwide health problem of (pre)diabetes, while presenting approaches in order to better control the disease and its consequences.
Many conditions may cause painful edema of one or more extremities. Eosinophilic fasciitis (EF), also called Shulman syndrome, is an uncommon one, evolving into sclerodermoid cutaneous infiltration, associated with peripheral blood eosinophilia. EF is a fibrotic disease of muscle fascia and skin, whose etiology remains unclear. Several pathophysiological mechanisms have nevertheless been proposed, the major component being an imbalance between extracellular matrix production and degradation. Visceral involvement is uncommon. EF may be associated with blood disorders, which determine its prognosis. The diagnosis is confirmed by elliptical full-thickness incisional biopsy of skin and subcutaneous tissues down to the muscle surface. EF is most likely underdiagnosed due to its rarity and its similarities with other conditions, such as systemic sclerosis. The typical first-line treatment is systemic corticosteroid therapy tapered over several months. Cortico-resistant and severe-onset forms require adding another immunomodulatory agent. In this case report, we describe a typical presentation of EF, highlighting the diagnostic difficulties posed by this uncommon pathology. Based on a literature review, we also recall its underlying pathophysiological mechanisms, along with the diagnostic and therapeutic steps.
A. Josset, Ch. ReynaertPublished in the journal : January 2016Category : Ethics
Mrs. H., aged 44 years, was unaware of her pregnancy when giving birth to a child in her bathroom, all by herself. She panicked and pressed the newborn against her chest just before fainting. When she regained consciousness shortly thereafter, her baby had died. The court sentenced her to prison for 10 years. This case is rather rare, yet far from being exceptional. Similar incidents have been reported in the past, some of these neonaticide mothers being found not guilty at trial. The vast majority of mothers did not have any apparent psychiatric disorder. The literature is inconsistent as to whether these women share similar characteristics or not.