HIV/AIDS has been transformed into a manageable, chronic condition and the life expectancy of patients living with human immunodeficiency virus (HIV) is now comparable to those without the disease. This is mainly due to the emergence of combination antiretroviral (cARV) therapy. This situation poses many new problems and challenges: persistent inflammation leading to immune activation, multi-morbidities, accumulation of toxicity of antiretroviral treatments, ageing and, finally, overloading of health systems especially in low resource countries. In this article we discuss many of these challenges.
Quentin Binet, Catherine Lambert, Laurine Sacre, Stéphane Eeckhoudt, Cédric HermansPublished in the journal : June 2017Category : Hématologie et Dermatologie
The differential diagnosis of isolated prolongation of the activated partial thromboplastin time (aPTT) is vast. An infrequent but severe cause is acquired hemophilia A (AHA) which is due to the spontaneous formation of neutralizing antibodies against endogenous factor VIII. About half the cases are associated with pregnancy, post-partum, auto-immune diseases, malignancies, or adverse drug reactions. Symptoms include severe and unexpected bleeding that may prove life-threatening. We report a case of AHA associated with bullous pemphigoid (BP), a chronic, autoimmune, subepidermal, blistering skin disease. AHA was completely cured and BP well-controlled with a short-term treatment consisting of methylprednisolone and rituximab.
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.
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
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
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
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.
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.
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.