Arrhythmias are common in elderly patients, and particularly atrial fibrillation, whose prevalence exceeds 15% in subjects aged over 75 years. In these patients, atrial fibrillation has been shown to be associated with a high risk of thromboembolic events. It is therefore paramount to accurately diagnose atrial fibrillation and promptly initiate anticoagulation therapy that has been shown to reduce mortality, even among frail elderly patients.
Cardiovascular complaints and symptoms of elderly patients are difficult to interpret, given the patients' decreased physical activity, differing experience of pain, and impaired memory. It is therefore our duty to pay close attention to their complaints in order to provide them with optimal treatment.
The common cardiovascular patient has now become older and more frail while suffering from multimorbidity. Such disease complexity requires different skills to be deployed by the cardiologist. Patient-centered care appears crucial and relies on a global assessment of patient health including frailty. The therapeutic objectives must be defined according to the patients’ priorities while maximizing their functioning and independence.
This is a case report describing an ectopic pregnancy occurring in the remnant stump following salpingectomy. A pregnancy implanted in this location appears very uncommon, thereby rendering the correct diagnosis challenging. This contribution comprises a case description, a presentation of the different diagnostic and therapeutic methods available to date, as well as a succinct literature review. We have also highlighted the requirement of performing salpingectomy by sectioning the isthmus of the uterine tube at the uterine horn, then coagulating the horn's intramural portion. Lastly, we have taken into consideration a series of practical recommendations.
C. Peeters, C. Francès, F. Houssiau, M. BaeckPublished in the journal : December 2016Category : Dermatology
We report herein on the «PEAU’se dermatologique» meeting of the Cliniques Universitaires Saint-Luc held on February 15, 2016, and focused on dermatological and rheumatologic pathologies. Professor Camille Francès, head of the Dermatology department at Hôpital Tenon in Paris, presented the dermatological manifestations of lupus erythematosus and dermatomyositis. Professor Frédéric Houssiau, head of the Rheumatology department at the Cliniques Universitaires Saint-Luc, enlightened us on the brainteaser constituted by the auto-antibodies occurring in systemic rheumatisms.
Primary hyperparathyroidism (PHPT) and vitamin D deficiency are two common diseases. Their combination seems also to be common and might influence the clinical and biological expression of PHPT. Forty two patients with PHPT in whom vitamin D (25OHD) was measured at diagnosis were studied retrospectively. Vitamin D deficiency (plasma 25OHD<10ng/ml) was observed in 40,5% of PHPT patients. Osteopenia and osteoporosis were more frequent (p=0,01) and PTH level was higher (567,9±697,0 µg/l vs 259,8±198,8 µg/l p=0.04) in patients with vitamin D deficiency. Low plasma 25OHD levels may contribute to the severity of PHPT. Measurement of 25OHD should be routinely performed in PHPT patients to better assess the severity of the disease and to consider possibly vitamin supplementation.
Christophe ScavéePublished in the journal : November 2016Category : GRAPA
Cardiovascular diseases remain the principal cause of natural death worldwide. Besides the standard risk factors, there is also stress, an undervalued source of cardiac events. Among the underlying causes of stress, there are natural disasters, as well as terrorism, with the latter having now reached Europe. A recent study revealed that, following the attacks at Charlie Hebdo in Paris, the number of both sudden deaths and hospitalizations for cardiovascular events abruptly rose. Similar statistics were observed in the US after the 2001 attacks in New-York, or in the aftermath of a major earthquake in Los Angeles. As a result, the harmful effects of stress must be better assessed in order to enable us to minimize its impact on the individuals’ health.
Véronique GoddingPublished in the journal : November 2016Category : GRAPA
Smoking cessation is the most efficient step for reducing cardiovascular risk in smokers. Stopping smoking is associated with a decreased risk of stroke and hypertension, in addition to improving patients' lipid and inflammatory profiles. It also lowers the risk of developing Type 2 diabetes, along with improved diabetes control and lowered risk of complications. Smoking cessation has been shown to improve physical fitness, in association with a more balanced diet. It is therefore crucial to pay attention to active and passive smoking in cardiovascular risk factor management by means of the 5A rule.
Véronique MaindiauxPublished in the journal : November 2016Category : GRAPA
LDL-cholesterol is the major therapeutic target in the management of cardiovascular risk factors. Several dietary interventions showed significant improvements whilst lowering blood LDL-C levels, such as replacing atherogenic fats by unsaturated fats, eating plant sterols from enriched foods, increasing soluble fiber consumption, consuming unsalted nuts, and, at times reducing dietary cholesterol. When considered separately, each result seems modest. If we however associate the proposed dietary interventions, the results are cumulative, resulting in a greater impact on LDL-C levels that decrease by 20 to 30%. This is relevant for primary prevention and for target groups at the highest cardiovascular risk, thereby increasing the nutritional quality of the diet.
Michel P. HermansPublished in the journal : November 2016Category : GRAPA
For any diabetes type, glucose control aims to prevent microvascular complications. The speed of the β-cells' functional decline will guide the progressive or rapid initiation of lifestyle changes, supplemented by oral monotherapy, combination therapy, triple therapy (oral or injectable), and eventually basal or basal-prandial insulin administration. All currently marketed therapeutic classes can be used either alone or in combination, preference being given to medications with weight neutrality, free of hypoglycemic episodes, without deleterious effects on β-cells, and possibly with additional macrovascular benefits.