Anticoagulation in antiphospholipid syndrome

Catherine Lambert Published in the journal : April 2022 Category : Hematology/Oncology

Antiphospholipid syndrome is a severe thrombotic disorder with a high risk of recurrence. For many years, the standard treatment for thrombotic complications of antiphospholipid syndrome has been anticoagulation with anti-vitamin K drugs. Over the past decade, direct oral anticoagulants have emerged as the anticoagulant treatment of choice for venous thromboembolic disease in the general population. The purpose of this article has been to review the modalities and objectives of anticoagulant therapy in antiphospholipid syndrome and to discuss the potential place of direct oral anticoagulants in this indication

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VEXAS syndrome: a new entity at the crossroads of rheumatology and hematology

Séverine Wautier*, Hélène Houssiau*, Nicole Straetmans (1) Published in the journal : April 2022 Category : Hematology/Oncology

VEXAS (Vacuoles, Enzyme E1, X-linked, Autoinflammatory, Somatic) syndrome has been recently described as a late-onset inflammatory disease caused by a somatic mutation in UBA1 in myeloid cells. It mostly affects men over 40 years of age with inflammatory symptoms (recurrent fever, dermatitis), rheumatologic disorders (arthritis, chrondritis), or hematologic abnormalities for several years. The presence of vacuoles in bone marrow myeloid cells is a characteristic (yet non-specific) sign of the disease. VEXAS syndrome may be associated with hematologic diseases, such as myelodysplasia and multiple myeloma, as well as an increased risk of thromboembolic event. The mortality is about 25-35% at 5 years. The disease is usually steroid-resistant. Studies with JAK2 inhibitors have shown promising results and are currently ongoing. Allogeneic stem cell transplantation is currently the only curative option for young, otherwise healthy patients.

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An intense sports effort not so harmless in pediatric patients?

Emmy Hoornaert¹, Jean-Luc Hennecker¹, Simon Vandergugten², Nathalie Blavier¹, Véronique Maes¹ Published in the journal : March 2022 Category : Clinical Report

Pyomyositis is an acute bacterial infection of skeletal muscles arising from transient bacteremia, commonly associated with Staphylococcus aureus. Owing to its higher frequency in tropical regions, the infection has earned itself the title of “tropical pyomyositis”. However, it must be mentioned that the disease is no longer restricted to tropical regions, and its frequency is increasing worldwide. Obturator pyomyositis mimics other common infections involving this area like septic arthritis. Indeed lack of awareness of pyomyositis commonly leads to delays in both diagnosis and adequate treatment. Magnetic resonance imaging (MRI) is the best tool for diagnosing pyomyositis. Treatment consists of bed rest, antibiotics, percutaneous drainage, as well as surgical intervention, depending on diagnostic delay and extension of the infection.

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What is the value of understanding the properties of the endothelial glycocalyx in the management of COVID-19-affected patients?

Alexandre Boulanger1, Anne-Sophie Dincq1, Benoit Rondelet2, Maximilien Gourdin1 Published in the journal : March 2022 Category : Anesthesiology

COVID-19 is an emerging viral infection caused by SARS-CoV-2 coronavirus strain. Following the two-year pandemic, clinicians have made significant progress in their understanding of the clinical disease manifestations, particularly by highlighting the primary role of the endothelial glycocalyx. This micro-fibrillar complex structure is located at the apical pole of the endothelial cell. It constitutes the histological barrier between cell and vascular lumen; in many ways, this structure behaves as an organ in its own way. The pathophysiological study of the endothelial glycocalyx has highlighted its usefulness in understanding both the COVID-19 and its complications. This article thus sought to look at the disease from a different angle, while summarizing the relevant data we have learned over the past two years for the clinicians.

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Bempedoic acid: a new therapeutic option to improve the lipid profile of patients at high cardiovascular risk

Olivier S. Descamps1, Fabian Demeure2, Ann Mertens3, Ann Verhaegen4, Jean-Luc Balligand5, Michel Langlois6, Caroline Wallemacq7, Johan De Sutter8, Nathalie Cals,9 Ernst Rietzschel10 ***On behalf of the Belgian Society of Atherosclerosis/Belgian Lipid Club Published in the journal : March 2022 Category : Actualité thérapeutique

Low-density lipoprotein cholesterol (LDL-C) is now unequivocally considered a causal factor in atherosclerotic cardiovascular disease (ASCVD), and its reduction significantly contributes to preventing the risk of ASCVD.

Statins, ezetimibe, and proprotein convertase subtilisin/kexin Type 9 (PCSK9) inhibitors are the main treatment options available to date, but these drugs’ tolerability, adherence, and reimbursement remain problematic. Furthermore, despite these treatments, a large number of patients with high- and very high cardiovascular risk, are often unable to achieve the recommended LDL-C target levels. Hence, additional new treatments, whether given alone or in combination, are urgently required.

Owing to its mode of action that differs from that of other lipid-lowering therapies, along with its good safety profile, bempedoic acid constitutes the first candidate of a new and interesting therapeutic class for managing hypercholesterolemia. We have herein reviewed the currently available data relating to this drug’s efficacy and safety profile and similarly discussed its potential place in clinical practice, particularly in patients at high and very high cardiovascular risk who are insufficiently treated under ezetimibe along with a maximally tolerated statin or in those who display statin intolerance or contraindications.

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Clinical work-up of adenopathy in general medicine : when should we reassure the patient and when refer the patient for further evaluation?

Inès Dufour1, Géraldine Verstraete1, Juliette Raedemaeker1, Fabio Andreozzi1, Sarah Bailly1, Eric Van Den Neste1, Cédric Hermans1, Marie-Christiane Vekemans1 Published in the journal : March 2022 Category : Hematology/Oncology

Adenopathy investigation requires a systematic approach in order to determine the benign or malignant character of the adenopathy. It is essential to be able to recognize severity signs, which should orientate towards additional assessments, usually consisting of a biopsy. The article was aimed to help the general practitioner in the adenopathy work-up, as well as to review the main differential diagnoses in this setting.

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The role of immunotherapy in urothelial cancers

Hélène Houssiau MD1, Emmanuel Seront MD PhD1 Published in the journal : March 2022 Category : Oncologie médicale

Immune checkpoint inhibitors (ICIs) have significantly improved the outcome of patients with urothelial cancer. Several ICIs are currently approved in Belgium, such as pembrolizumab, avelumab, atezolizumab, and nivolumab. These ICIs were first evaluated in the metastatic setting, following failure of platinum-based chemotherapy. New strategies have been evaluated over the last years, including ICI plus chemotherapy, ICI monotherapy, or maintenance therapy, referring to introducing ICI after chemotherapy without waiting for disease progression. Other clinical trials are currently ongoing, which evaluate ICI in perioperative setting, be it neoadjuvant or adjuvant. This paper sought to review the current knowledge concerning ICIs in urothelial carcinoma, in addition to the new indications of these agents in this specific domain.

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Diabetes in the age of connected medicine

Philippe Coucke (1), Christophe Coucke (2) Published in the journal : March 2022 Category : Médecine et intelligence artificielle

Recently, the use of connected health has exponentially increased, especially during the crisis linked to COVID-19. For patients with chronic disease, such as diabetes, a continuous and regular remote follow-up on their health care status is mandatory so as to gain subjective and objective information. Artificial intelligence has a central role to play within an ecosystem that is characterized by a continuous flux of data. In this article, we have highlighted four examples of its use, including automatic screening of microvascular retinal changes, decision support for treatments like closed loop pancreas, predictive stratification using risk calculators, as well as individualized patient support.

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A socially accountable competition test of general practice? Exploratory study of its acceptability by students and examiners

Ségolène de Rouffignac1, Thérèse Leroy2, Michel De Jonghe3, Jean-François Denef4 Published in the journal : March 2022 Category : Médecine générale et formation

Background: In Belgium, access to specialist training in general medicine is limited by a competitive examination. Students’ personal reflections on their role as physicians and on their adequacy with society’s needs are not encouraged. Being aware of its social accountability in health, our department has developed a competitive examination based not on the students’ knowledge, but rather on their motivation, capacity for reflexivity and flexibility, and awareness of general practitioners’ societal role in the future.

Objective(s): To evaluate the acceptability of the competition test created with regard to objectives of social accoutability.

Method: At the end of the examination, a questionnaire was distributed to students and examiners on a voluntary basis. The answers were analyzed using a qualitative inductive method.

Results: Overall, 637 students participated in the competition, while 215 students (34%) and 21 of 30 examiners (70%) completed the questionnaire. Both examiners and students seemed to be satisfied with the competition. However, the lack of theoretical background raised several questions concerning the quality of the competition and its credibility. The test produced a distortion revealing the student's capacity for mental flexibility. The examination thereby becomes a rite of passage, enabling a transition from student life to professional life.

Conclusion: In addition to its selection role, the general medicine examination has become a rite of passage from student life to the professional world, which is likely accompanied by future general practitioners’ awareness of their social accountability in the health landscape.

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2021 innovations in endocrinology and diabetology

Maria-Cristina Burlacu, Raluca-Maria Furnica, Stefan Matei Constantinescu, Orsalia Alexopoulou, Dominique Maiter, Michel P Hermans, Jean-Paul Thissen Published in the journal : February 2022 Category : Endocrinologie et Nutrition

The 2021 year in endocrinology, diabetology, and metabolic diseases saw the arrival of new medical treatments, notably for Cushing's syndrome and hypercholesterolemia, in addition to the revival of treatments that were already known, yet without finding their correct place within our therapeutic arsenal.

All these treatments were likely promising, because of being effective and well tolerated. Although some of them are not yet available in Belgium, we thought it useful to actually discuss them, as they well illustrate the continuing dynamism of clinical research within this sector, whereas our activities have been somewhat thwarted by the current pandemic. We sincerely hope you enjoy the reading!

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