Gonarthrosis in obese patients: practical recommendations

Barbora Bocankova, Stéphanie Meirlaen, Emmanuel Thienpont Published in the journal : March 2023 Category : Orthopédie et Traumatologie

Obesity prevalence is rapidly growing and becoming a critical health issue, especially in developed countries. Obesity and life expectancy increase are the main reasons for the rising incidence of osteoarthritis (OA). Obese patients greatly benefit from surgical OA treatment and should therefore not be denied any intervention, including knee arthroplasty, regardless of their body mass index.

Conservative measures, such as lifestyle modification, exercise, and pharmacological treatment with systematic slow-acting drugs for OA (SYSADOA) like glucosamine sulphate, chondroitine sulphate or curcumine, topical or oral non-steroidal anti-inflammatory drugs, and intra-articular steroids or hyaluronic acid injections should be tried before resorting to knee surgery. Minimally invasive knee prosthesis, respecting soft tissue as much as possible, might be particularly beneficial for obese patients, reducing complication rates and improving outcome. However, further studies are needed to confirm this trend.

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Hallux valgus: What to tell the patient in the first line?

Maxime Fasseaux, Olivier Cornu, Dan Putineanu, Karim Tribak Published in the journal : March 2023 Category : Orthopédie et Traumatologie

Hallux valgus is the most common disease of the forefoot. Its etiology remains unclear, but is influenced by genetics. This condition can cause incapacitating and even disabling problems. It can have several presentations, the clinical and radiological severity of which will guide the treatment.

The level of evidence regarding first-line management remains poor. This article aims to explore the conservative treatment possibilities and their limits, and attempts to provide answers to the questions most frequently asked by patients.

Patients with mild to moderate hallux valgus, or severe hallux valgus, can have their pain relieved without surgical management. It is not yet established that conservative treatment can actually slow down disease progression, but future studies could explore this possibility.

Conservative treatment is based on adapting the footwear, wearing insoles or orthoses, physiotherapy, level I analgesics, as well as lifestyle and dietary adaptations.

In patients who do not respond to conservative treatment and have significant deformity, surgical treatment can be proposed. This treatment yields a satisfaction rate of approximately 80%

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Innovations 2022 in rheumatology

Frédéric A. Houssiau, Farah Tamirou Published in the journal : February 2023 Category : Rheumatology

Rheumatologists are internists who specialize in the treatment of systemic diseases. The Rheumatology Department of the Cliniques universitaires Saint-Luc has gained an international reputation in this field, particularly in the management of systemic lupus erythematosus (SLE), systemic sclerosis (scleroderma), and idiopathic inflammatory myopathies. The department is officially recognized in Europe through the European Reference Network ReCONNET. We would like to summarize herein some of the recent therapeutic innovations in our fields of excellence

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Innovations 2022 in the field of Child and Youth Psychiatry

Stéphanie Mazzone1, Anne Wintgens2, Valentine d’Aspremont3, Adeline Hanzir4, Estelle Mousset5, Sophie Vanhalewyn6, Emmanuel de Becker7 Published in the journal : February 2023 Category : Psychiatrie infanto-juvénile

Two clinical aspects are discussed this year for the Child and Adolescent Psychiatry Service of the Cliniques universitaires Saint-Luc. They describe the help and care offers implemented to cope with the increase of mental distress situations of children, adolescents, and their families. The first part concerns the deployment of the reference center for Autism Spectrum Disorder, namely the establishment of an early stimulation group for young children awaiting diagnosis and a “parent training” group after diagnosis. The second part encompasses the consolidation of legal time within the SOS-Children team of the Clinics; where we will show the merits and contributions of this specific function in complex cases of child abuse.

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Innovations during 2022 in pulmonology

Charlotte Smetcoren, Gimbada Benny Mwenge, Thierry Pieters, Françoise Pirson, Gregory Reychler, Giuseppe Liistro, Sophie Gohy, Antoine Froidure, Charles Pilette Published in the journal : February 2023 Category : Pneumology

Respiratory medicine is progressively becoming a personalized care due to a better understanding of the pathophysiological mechanisms underlying the endotypes of pulmonary diseases, either frequent (sleep apnea syndrome, lung cancer, chronic obstructive pulmonary disease, asthma, and allergies) or rarer (interstitial lung diseases, cystic fibrosis), in addition to more generic care benefiting to most patients (e.g., environmental avoidance measures, physical exercise). This article describes those inspiring concepts applied to major respiratory diseases by presenting major advances made in 2022.

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Innovations 2022 in Otorhinolaryngology

Valerie Hox, Caroline Huart, Philippe Rombaux, Caroline de Toeuf, Sandra Schmitz, Alexandre Biermans, William Renwart, Marc Hamoir, Monique Decat, Daniele Desiati, Anaïs Gregoire Published in the journal : February 2023 Category : Otorhinolaryngology

During 2022, the ENT department focused on the well-being of the patients in all sub-disciplines of our specialty. First, we were pleased to obtain reimbursement of long-awaited biological products for the treatment of patients with chronic rhinosinusitis with nasal polyps. These new therapies are able to help a significant number of patients whose disease cannot be controlled by standard medical and surgical treatments. Second, we were able to review a series of more than 250 patients who underwent parotidectomy with intraoperative neuromonitoring. We found that preservation of facial nerve function was significantly better compared with previously reported data on parotidectomies without neuromonitoring. Finally, in the field of cochlear implantation for patients with severe hearing loss, we are currently preparing for the future. New techniques have been developed in order to maintain residual hearing during the implant’s insertion into the cochlea, such as robotic surgery and intraoperative electrocochleography. These techniques will allow us to increase the indications for implantation, which will lead to more patients being able to benefit from this life-changing technology.

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Innovations 2022 in neurochirurgy

Vincent Joris, Patrice Finet, Christian Raftopoulos Published in the journal : February 2023 Category : Neurochirurgie

The year 2022 was the year of the acquisition of a neuronavigated robotic arm (Stealth Autoguide from Medtronic) for invasive electroencephalography implantation. As estimated, this robotic arm has allowed us to greatly improve the accuracy of our implantations and ensure better safety for our patients

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Innovations 2022 in Nephrology

Guillaume Fernandes, Yassin Akachar, Laura Labriola, Michel Jadoul, Nathalie Demoulin, Johann Morelle Published in the journal : February 2023 Category : Nephrology

We discuss the negative results of a randomized controlled trial of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers cessation in G4 or G5 stage chronic kidney disease. We next review the initiation modalities of dapagliflozine and finerenone in chronic kidney disease patients. Lastly, we review the recent therapeutic advances in IgA nephropathy treatment.

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Innovations 2022 in Hemostasis and thrombosis

Cédric Hermans, Catherine Lambert Published in the journal : February 2023 Category : Hémostase – Thrombose

what’s new ?

We summarize hereafter five topics that caught our attention in 2022, related to anticoagulants and hemophilia. First, we will address rivaroxaban treatment of atrial fibrillation (AF) associated with rheumatic valve disease. We then discuss the role of new anticoagulants targeting Factor XI in both the prevention of AF-related thromboembolic events and recurrent ischemic stroke. With respect to hemophilia, we detail the results of the largest ever conducted gene therapy study in patients with severe Factor VIII (FVIII) deficiency. We conclude with the therapeutic successes of emicizumab, a bispecific antibody mimicking FVIII, which has been shown to be effective in patients with non-severe hemophilia A (Haven 6) and in newborn with severe hemophilia A (Haven 7).

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Innovations 2022 in the field of hemostasis-thrombosis

Sarah Bailly1,2, Eric Van Den Neste1, Stefan N. Constantinescu1,2,3,4 Published in the journal : February 2023 Category : Hematology/Oncology

The specific characteristics of the CD19 cell marker make it an ideal therapeutic target in the treatment of B-cell lymphoma. Several molecules targeting CD19 have recently been made available, or are currently being developed, and show promising results for this therapeutic indication. This seems to be particularly true in the management of relapsing or refractory diffuse large B-cell lymphoma, as demonstrated by the results of the different studies described in this article. The choice of the right molecule and the best sequence for these treatments is still to be defined.

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