Revue medicale de Liege最新文献

Finerenone is a selective non-steroidal antagonist of the mineralocorticoid receptor. This molecule significantly reduces cardiovascular morbidity and mortality and slows the progression of kidney disease in people with type 2 diabetes (T2D) and chronic kidney disease as demonstrated in two huge randomised controlled trials versus placebo (FIDELIO-DKD and FIGARO-DKD). Recent data provide additional information about both the efficacy and safety of this molecule in patients with or without T2D presenting heart failure (FINEARTS-HF). These results obtained in controlled trials are being confirmed in observational real-life studies (FINE-REAL) and several other studies devoted to heart failure. Also, finerenone is currently being tested among various special populations outside T2D. Several international recommendations in nephrology, cardiology, and diabetology support the use of finerenone in patients with T2D considered at high and very high cardiovascular and renal risk.

Pelvic organ prolapse is a frequent condition among women. The lack of information and knowledge about this pathology is a major obstacle in its management. However, there are multiple therapeutic options, both conservative and surgical, which have proven their symptomatic and clinical effectiveness.

Among the pediatric pathologies that are encountered by health care professionals, there is one that particularly shakes us up, questions us and puts us in difficulty: child abuse. Clinically complex, a disease with a heavy morbidity and mortality factors, it also brings up the notions of danger and protection of the child but also the role that we as doctors have to play. Therefore, the announcement of the diagnosis with its clinical and protective issues remains a key moment in care but, given its sensitive nature, can put those involved in difficulties. This is why there are guidelines and interview techniques that make it possible to guarantee an announcement that is both transparent and caring, the main objective of which being the protection of the child.

Venous thromboembolism disease complicated by pulmonary embolism is a common cause of admission to emergencies and critical care unit. It is burdened by high mortality in the absence of early and appropriate treatment. Rapid diagnosis, anticoagulation to avoid recurrence and, in case of hemodynamic instability, use of systemic fibrinolysis are the corner stones of its management. For several years, interventional radiology techniques have been developed to treat the most critical patients in addition to or instead of systemic fibrinolysis. Among these techniques, mechanical thrombectomy deserves to be integrated into our therapeutic arsenal. We propose here an original decision-making algorithm integrating this technique based on a review of the literature, with the support of multidisciplinary team for the management of pulmonary embolism in our department.

The patent ductus arteriosus is a vascular structure that connects the proximal descending aorta to the main pulmonary artery near the origin of the left pulmonary artery. The persistence of ductal patency after the first weeks of life is abnormal. In adults, it is most often an isolated finding but it may be associated with other congenital anomalies. Its repercussions depend on the size of the duct, varying from the absence of signs and symptoms to Eisenmenger's syndrome. Echocardiography is the keystone of diagnosis. Multimodal imaging allows precise anatomical characterization. Treatment with percutaneous placement of a closure device is recommended based on ultrasound parameters and right heart catheterization.

Since January 2020, neonatal screening for cystic fibrosis (CF-NBS) has been implemented in the Wallonia-Brussels Federation. It's based on the immunoreactive trypsin (IRT1) assay between day 2 and day 4, associated with a 12 CFTR pathogenic variants analysis and with an IRT control on day 21. The aim of this study is to evaluate the performance of our CF-NBS in Liège according to the quality criteria defined by the European Cystic Fibrosis Society's working group on neonatal screening. After four years, 58.762 newborns have been screened. Nineteen children with cystic fibrosis were diagnosed : 14 by NBS, 3 following a meconium ileus, 1 by family history and 1 false negative diagnosed on clinical basis. Furthermore, 39 healthy carriers and 2 uncertain diagnosis (CFSPID) were identified. The sensitivity of CF NBS is 93,3 % (target ≥ 95 %), the positive predictive value (PPV) 17,7 % (target ≥ 30 %). Increasing the TIR1 threshold by 0,1 in 0,1 from P99 to P99,5, would be associated with a lower sensitivity and a non-significant improvement of PPV. A national assessment of CF NBS needs to be carried out.

Introduction: Cannabis is the third most commonly used substance by students. The aim of this study is to describe cannabis use among medical students and understand their motivations. It seeks to establish the link between cannabis and higher education, especially in medicine.

Materials and methods: 202 students from the UMons and ULB universities (Belgium) took part in the study. They completed an anonymous online questionnaire. Their answers were cleaned before analysis.

Results: 52% of the students declared they had never used cannabis. The time of first use was most often secondary school. Evenings out with friends and improvement falling asleep were the two most common reasons for using cannabis. The participants attributed little benefit to cannabis use in terms of managing their studies. Medical studies may have an impact on cannabis use.

Conclusion: The prevalence of cannabis use appears to be higher among medical students than in the general population, yet few measures are in place to raise their awareness. This study aims to open up the debate on cannabis use among students, especially in the medical school.

The lack of physical activity is widespread among our populations affecting all age groups from youngsters to older adults, heavily impacting health in general (physical as well as mental health). The main objective of serious gaming is not simply providing entertainment and fun. It aims at achieving specific health-related goals in an efficient and pleasant way. This article will take stock of the general interest of this approach in physical medicine and rehabilitation, while trying to illustrate the barriers and limits. Even if the concept seems effective, more efforts are required based on scientific sound and rational approaches, using standardized methods, to answer multiple existing and persistent questions.

The placement of central venous catheters is a common procedure in various hospital settings, such as emergency departments, intensive care units, and operating rooms. These catheters are essential for monitoring hemodynamic variables, administering vasoactive amines, and providing nutritional support, crucial functions that cannot be performed by peripheral catheters. However, this invasive procedure is associated with a significant complication rate, exceeding 15 %, which may be sometimes severe, even fatal. In this article, we will present the case of a 34-year-old patient who experienced a mechanical complication following the placement of a central venous line in the right jugular vein. We will discuss the various complications specific to central lines and possible solutions to reduce the risk.

Injectable semaglutide at a dose of 1 mg once weekly has been shown to be the most efficacious glucagon-like peptide-1 receptor agonist when considering both the improvement in blood glucose control and the reduction in body weight in patients with type 2 diabetes (T2D). After the SUSTAIN-6 study, published in 2016, which demonstrated not only the good safety but also already the cardiovascular (CV) efficacy of semaglutide in patients with T2D and high CV risk, several large placebo-controlled randomised trials have confirmed improved prognosis with semaglutide in different at risk populations : patients with T2D and chronic kidney disease (FLOW trial), subjects with obesity and heart failure with preserved ejection fraction, with or without T2D (STEP-HFpEF trial) and people with overweight or obesity (but without T2D) and a confirmed atheromatous cardiovascular disease (SELECT trial). Studies performed in patients with obesity used a higher dose of 2.4 mg/week. These positive results, based upon major clinically relevant outcomes, extend the therapeutic possibilities with semaglutide among at high risk patients of cardiovascular and/or renal diseases.