This article describes several advances made in the dyslipidemia and cardiovascular prevention fields. These novelties pertain to the three steps of prevention: prediction including screening for two common, but often ignored, genetic abnormalities, namely familial hypercholesterolemia and elevated lipoprotein(a) levels, planning with the emergence in recommendations of a new target called "non-HDL cholesterol or non-HDL-C" in addition to the conventional "LDL-cholesterol or LDL-C" target, and prescription with the possible option of combining statins with other therapeutic classes.
The mechanism of action of the most commonly prescribed immunosuppressive drugs, as well as their dosage and adverse effects, are highligted in this article, with particular emphasis on toxicity prevention and treatment monitoring by general practitioners.
M Mousny, A RendersPublished in the journal : May 2016Category : Pediatrics
Nowadays, pediatric orthopedics is considered a fully-fledged specialty, which differs from adult orthopedics in terms of both the pathologies encountered and the clinical approach. This article describes the “general” orthopedic clinical evaluation as performed by the authors in their daily practice. A particular emphasis is placed on the clinical aspects that may help general practitioners distinguish the normal from the pathological. Of note is that this article only addresses clinical assessment of walking-age children, in a timely fashion that is believed to progressively favor patient compliance.
Familial hypercholesterolemia (FH ) is one of the most common fatal genetic diseases, affecting over 25,000 Belgians. it is responsible for very high cholesterol levels (> 300mg/dL) from birth, along with an increased risk of early vascular, cardiac, and cerebral complications, such as myocardial infarction and stroke, from the age of 30 years onwards in men and 40 in women. Cardiovascular complications may, however, be prevented by means of early diagnosis and proper treatment, ideally started in childhood.
The 2003 discovery of a new protein called PCSK9 (proprotein convertase subtilisin/kexin type 9), involved in LDL particle metabolism, resulted in the development of a new class of highly potent cholesterol-lowering agents. Given this context, several monthly or bimonthly subcutaneously administered monoclonal antibodies that inhibit PCSK9 (evolocumab, Amgen; alirocumab, Sanofi/Regeneron; bococizumab, Pfizer) were shown to reduce LDL cholesterol by 45-75%, with a very good tolerance and safety profile. This paved the way for a new therapeutic strategy aimed at helping patients achieve their LDL-cholesterol targets while compensating the statins' limitations of use.
A. DeltourPublished in the journal : May 2016Category : Le Genou
Clinical assessment allows determining the type of technical investigation that will facilitate establishing the diagnosis. It must be performed systematically and be guided by the patient’s history. When well conducted, clinical examination contributes to 90% of the final diagnosis.
A. Hartman, D. Leonard, R. Bachmann, N. Abbes Orabi , Ch. Remue, A. Kartheuser, Au nom du groupe intermétiers Fast-TrackPublished in the journal : May 2016Category : Sortie de l'hôpital
The concept of enhanced recovery, also termed "Fast-Track", was introduced in Denmark in the 1990’s by Henrik Kehlet with the aim to improve post-surgery recovery. This multimodal approach seeks to reduce surgical stress through optimized patient care in the pre-, intra-, and postoperative periods. In light of the most recent literature, this article provides a review of the different enhanced recovery program items that we have been using for the past 10 years in our colorectal surgery unit.
This article focuses on several fundamental links between basic respiratory physiology and clinical medicine practice during consultation, when a patient complaints about symptoms of pulmonary origin or seeks explanations for the proper functioning of his/ her lungs and breathing.
Headache is a common complaint that may be associated with a variety of clinical conditions. Most patients suffer from primary headache, whose diagnosis can be made based on clinical history, with no additional test required. Some patients have secondary headache that may be life-threatening, and further tests must be performed, at times under emergency conditions. Red flags include sudden onset of headache, new-onset headache, headache increasing in frequency and severity, advanced age, and abnormal neurological examination.
Chronic obstructive pulmonary disease (COPD) is a common condition, which is burdened with significant morbidity and mortality. The Global initiative for Obstructive Lung Disease (GOLD) international guidelines have recently proposed a new classification based not only on the degree of airflow limitation, but also on symptoms and risk of exacerbations.