Familial hypercholesterolemia : some « tips » to facilite the diagnosis and its treatment

Olivier S. Descamps Published in the journal : May 2017 Category : Internal Medicine

Familial Hypercholesterolemia (HF) affects more than 25,000 Belgians and leads, due to its severely elevated levels of LDL cholesterol since birth, to premature risk of cardiovascular disease. Currently, diagnostic tools, effective treatments and preferential reimbursement give the Belgian doctors the opportunity to achieve the early diagnosis and the intense treatment necessary to stop the dramatic prognosis of this disease.

Key Words

Familial hypercholesterolemia, cardiovascular diseases, cardiovascular prevention, lipoproteins, LDL cholesterol, genetics, atherosclerosis

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Benefits, risks and indications of COX-2 selective NSAIDS revisited: focus on Celecoxib

Cédric Hermans Published in the journal : May 2017 Category : Actualité thérapeutique

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

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Are SGLT -2 inhibitors an holistic approach for treating patients with type 2 diabetes? A state of the art after the EMPA-REG OUTCOME Trial

Martin Buysschaert Published in the journal : May 2017 Category : Diabétologie

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

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Bacteria to treat type 2 diabetes ?

Patrice Cani Published in the journal : May 2017 Category : Congrès UCL de Médecine Générale

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

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Burnout is often misdiagnosed

Published in the journal : May 2017 Category : Congrès UCL de Médecine Générale

In this manuscript we explore how the history of psychiatry shed light on its differential diagnosis.

Key Words

Depressive disorder, panic disorder, burn out

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The non-traumatic shoulder physical examination

Henri Nielens Published in the journal : May 2017 Category : Congrès UCL de Médecine Générale

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.

Key Words

Shoulder examination, mobility, specific tests

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Current medical therapies of breast cancer

François Duhoux Published in the journal : May 2017 Category : Congrès UCL de Médecine Générale

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.

Key Words

Breast cancer, CDK4/6 inhibitors, genomic tests

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Hereditary breast cancer: role of the general practitioners

Anne De Leener Published in the journal : May 2017 Category : Congrès UCL de Médecine Générale

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.

Key Words

Breast, Cancer, heredity, syndrome, HBOC

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Atypical back pain as a manifestation of granulomatosis with polyangiitis (GPA)

Alexandre Jacquerie ¹, Elodie Georges¹, Charlotte Van Ende², Gabriela Migali², Benoit Ghaye³, Michel Lambert¹ Published in the journal : April 2017 Category : 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

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Melanoma diagnosis and treatment

Laurine Sacré (1), Isabelle Tromme (1), Jean-François Baurain (2), Benoit Lengelé (3), Marie Baeck (1) Published in the journal : April 2017 Category : 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

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