Insulin degludec (Tresiba®) is an ultra-long acting basal insulin analog recently marketed in Belgium. Controlled clinical trials have demonstrated that insulin degludec provides similar reductions in HbA1c compared to the basal analogs glargine or detemir in Type 1 and Type 2 diabetes, with superior fasting glucose control in the majority of studies. The data additionally show a clinically relevant reduction in the incidence of hypoglycemia episodes, especially at night. The results of controlled and observational studies point towards the therapeutic added value of degludec in the management of Type 1 and Type 2 diabetes.
The CREDENCE study sought to compare the efficacy of canagliflozin vs. placebo in preventing clinically-relevant kidney and cardiovascular events in patients with diabetes and established kidney disease. With regard to the primary endpoint (terminal kidney failure; doubling of creatinine; renal or cardiovascular death), the authors reported a 30% reduction in the relative risk (hazard ratio [HR]: 0.70; 95% CI: 0.59-0.82, p=0.00001) after 2.6 years of follow-up. The risk was reduced by 17-39% with regard to secondary cardiovascular or renal endpoints. These results should be integrated in our therapeutic approach for Type 2 diabetes patients, in terms of both nephro- and cardioprotection.
Brain cysticercosis, or neuro-cysticercosis, is an infection involving the central nervous system caused by larvae of a flat worm called Taenia solium. This infection may give rise to numerous different medical presentations, complicating its diagnosis.
The interest of this clinical case assessment describe in this article lies in the rarity of its diagnosis, its non-specific infectious manifestation, as well as the fact that the patient had not recently travelled to a cysticercosis-endemic area.
Flu-like symptoms with cough may be the manifestation of many differential diagnoses. This article sought to demonstrate the relevance of a complete clinical examination, along with the need to look for underlying etiologies when faced to an unusual evolution of a flu-like syndrome
The adult-onset Still’s disease is a rare cause of fever of unknown origin. The clinical presentation and biological signs are rather polymorphous and non-specific. We herein emphasize the usefulness of measuring serum ferritin and glycosylated ferritin (GF) levels. The diagnosis of adult-onset Still’s disease is based on the Yamaguchi criteria, with three major criteria (high fever for more than 1 week, neutrophilic leucocytosis, and diffuse arthralgia) and three minor criteria (liver enzyme elevation of neither toxic nor drug-related origin, lymphadenopathy identified on PET imaging, and negativity of rheumatoid factors and antinuclear antibodies) to be present. The disease’s pathophysiology is still uncertain, and treatment essentially relies on systemic glucocorticoids. In this paper, we have discussed the usefulness of biotherapies, comprising primarily the monoclonal antibodies directed against the IL-6 receptor.
Omar El-Mourad (1), Fabien Roodhans (1,2), Valérie Huyge (3), Bruno Guetcho( 4)Published in the journal : April 2019Category : Observations cliniques
Horton's disease, also termed giant cell arteritis, mainly affects large-caliber vessels within the territories of the external carotid branches. Of note is that this condition can also involve the eye, central nervous system, digestive tract, respiratory system, as well as the arterial system of the lower limbs, and the heart. The diagnosis is confirmed based on the biopsy of the temporal artery, which is not positive in all cases. PET imaging takes an increasingly relevant place in the diagnostic tree, revealing metabolic hyperfixation of large and medium vessels. Treatment is mainly based on systemic glucocorticoids. Of note is the progressively increasing place of biotherapies in the condition’s management, primarily comprising specific antagonists of the IL-6 receptor.
Geoffrey Jacqmin (1), Jean-Philippe Stalens (2), Jean-Luc Dutrieux (3), Philippe Malvaux (4)Published in the journal : April 2019Category : Observations cliniques
Acute appendicitis is very rare in the neonatal period. The diagnosis may be delayed due to the lack of specific clinical symptoms, and because of its rarity in the patient population considered, leading to increased peritonitis and mortality rates. Despite neonatal appendicitis possibly manifesting as an isolated event, in many cases, it proves to be a complication of an underlying disease. While surgical treatment remains the gold standard in this pathological setting, conservative management may be considered in selected patients.
Mouhamadou Habib Diagne, Evariste Keyanina Nyumbandogo (1), Pol Vincent (2), Xavier Muschart (3)Published in the journal : April 2019Category : Observations cliniques
We herein present a case of methanol poisoning, promptly treated in an emergency setting. In this report, we have discussed its physiopathology, clinical presentation, and diagnostic methods, in addition to the therapeutic options currently available to manage methanol intoxication.
The occurrence of atrio-ventricular conduction disorders calls for further investigations. Differential diagnoses comprise infections, infiltrative diseases, and neoplasiae. Primary cardiac lymphoma is a rare condition, often associated with delayed diagnosis. Nevertheless, complete tumor response and, therefore, disappearance of the conduction disorder may be achieved through an appropriate treatment.
This article sought to present a rare iatrogenic complication occurring after a relatively common drug injection in medical practice. We have reported a "Nicolau syndrome" following a glucocorticoid injection. This term refers to a syndrome manifested by painful livedoid dermatitis, potentially associated with serious complications. This article aims to emphasize the relevance of preventing this syndrome, by providing technical recommendations for injections, along with the correct indications of glucocorticoid use. This paper ends by emphasizing the need of promptly diagnosing this syndrome, as accurately as possible, in order to limit its complications.