Revue medicale de Liege最新文献

Prevention of cardiovascular disease remains a key-objective from a health care point of view. The present article focuses on primary prevention, i.e. to prevent a first cardiovascular event among at-risk people. The first step is to evaluate the cardiovascular risk level (low to moderate, high, very high), which allows to fix target goals. It is especially the case regarding the management of dyslipidaemias. Lipid abnormalities are considered as a major coronary risk factor (especially, LDL or even better non-HDL cholesterol according to recent guidelines). Theoretically, it is quite easy to control this risk factor thanks to available lipid-lowering drugs, yet this goal remains insufficiently reached in clinical practice. The second step is to prescribe, in addition to life-style measures, the best pharmacological treatment. In most cases, it is a statin that should be well titrated, eventually combined with ezetimibe and/or bempedoic acid, to reach the set objectives. Finally, it is important to convince the at-risk individual by providing the valuable information regarding the benefits/risks ratio of the therapy and to verify a good drug compliance in the long run. Indeed, as dyslipidaemia is asymptomatic, people in primary prevention too easily tend to neglect (and eventually stop) the valuable therapy, also because statins have been widely (yet unfairly) criticized by some people in recent years.

This brief article focuses on vaccines targeted against five infectious agents that are linked to an increased cardiovascular risk in adults: COVID-19, influenza, pneumococcus, respiratory syncytial virus, and varicella-zoster virus. The article is divided into three parts. Firstly, it outlines the mechanisms responsible for cardiovascular events that occur during and after infections. Secondly, it discusses the principles of vaccine protection in this context. The third part is dedicated to clinical studies that specifically demonstrate the cardiovascular protection afforded by the vaccines. Vaccines targeting the five aforementioned infectious agents should undoubtedly be considered key elements in the prevention of cardiovascular risk.

Despite screening programmes, numerous clinical studies and new breast imaging techniques, breast cancer incidence for women continues to rise. The arrival of predictive and personalized medicine could clearly redefine our screening recommendations. One promising approach to improving screening would be to use tools to predict the risk of developing breast cancer, including polygenic risk scores (PRS). This approach will enable us to offer women risk-based screening by adapting the frequency, type and age of screening. This article reviews some definitions of the PRS and breast cancer screening. We also explain the risk assessment models that have been developed and the various studies underway on personalized screening.

The observation is unequivocal: nearly half of cancer deaths could be avoided ! This statement, both alarming and hopeful, underscores the crucial importance of preventive measures in the fight against the scourge that is cancer. Indeed, if nearly half of cancer deaths are preventable, it means that it is possible to act on certain modifiable risk factors. Smoking and alcohol consumption are among the most influential behaviours in the risk of death from cancer. Similarly, overweight and obesity, considered a true pandemic, contribute significantly to the increase in the number of cancer cases over the past decade. Environmental and occupational exposure to various physical, chemical, and biological carcinogens constitutes another set of largely avoidable factors. Now, more than ever, it is imperative to intensify efforts in implementing effective prevention strategies to counter the growing burden of this disease.

It's easy to imagine using medicines to treat or even cure an illness. For most people, however, the idea of taking one or more medicines to prevent or delay the onset of an illness or its complications seems less obvious. However, there is indeed a place for using medicines in the field of prevention. Knowing the definition of a medicine means you can immediately understand the role it can play in the field of prevention. What's more, the use of medicines should be based not only on evidence-based medicine, but also on an approach that integrates a collegial discussion with the patient, which will make it possible to discuss the expected benefits of such an approach, as well as explaining any possible side-effects. Only in this way can we expect better compliance of a person still without a disease. This article briefly summarizes the role that medicines can play in a prevention strategy.

Allergen immunotherapy is still the only curative treatment for respiratory allergies. It is based on repeated administration of allergenic extracts to sensitized patients. It can be administered either by subcutaneous or by sublingual route. The purpose of the treatment is to modulate the immune response to a specific allergen and to alter the course of the disease over a long-term period. Numerous studies and meta-analyses have demonstrated its efficacy in terms of symptoms and quality of life improvement as well as reduction of the allergic march. Indication of allergen immunotherapy includes moderate to severe allergic rhinitis and mild to moderate allergic asthma from GINA step 3. Early intervention in sensitized patients is nowadays promoted.

Responsible for a significant morbidity and mortality, smoking remains a major public health issue. Smoking cessation clinics are an integral part of the fight against smoking. This retrospective study, carried out between January 2022 and January 2023 on 106 patients who attended the smoking cessation clinics in the Respiratory Department of the University Hospital of Liège, was designed to assess patient cessation rates at 6 months and 1 year, and to identify any factors predicting success or failure. Our data showed a cessation rate of 25 % at 6 months and 19 % at 1 year. Age was slightly more advanced in those who succeeded in smoking cessation at one year (p = 0.05). The obtained cessation rate strongly supports the utility of our smoking cessation clinic for patients wishing to quit smoking.

Suicide is a public health problem that affects people throughout their lives: from childhood to adolescence, and from adulthood to old age. Numerous risk factors for suicide have been identified, not only at the level of the individual, but also at the level of the family, the community and society as a whole. These factors include the existence of a mental health problem, in particular depression and substance abuse. At the clinical level, it is important to try to spot the signs of impending suicide and organize an appropriate care strategy. But there are also protective factors against suicide at individual, societal and cultural levels. There are many strategies for preventing suicide. These approaches range from raising awareness of the problem of suicide among the general population and destigmatizing mental illnesses, to more targeted measures for people at risk of suicide: actively treating depression, training healthcare professionals to identify individuals at risk, developing telephone helplines, setting up peer-help programs and developing post-hospitalisation follow-up programs.

In order to improve our healthcare system, it is undeniable that the future of modern medicine must focus on a more preventive and personalized approach, notably based on the individual characteristics specific to each patient. In this perspective, clinical metabolomics, which focuses on metabolites, emerges as a particularly interesting and promising approach. Indeed, this science reflects the internal and external stimuli received by an individual, thus capturing their physiological and/or pathological state. Close to the phenotype, it represents the interface between the patient, their genes, and their environment in the broadest sense. Its translational nature requires the conjunction of several expertise areas, both in analytical, biostatistical, and clinical levels. Combined with other data, it allows the generation of predictive or diagnostic models useful for early detection and monitoring of pathologies, taking into account notably the individual characteristics of patients. There are, of course, many obstacles and challenges to overcome for metabolomics to transition into clinical practice, but it is evident that this innovative approach will, in the years to come, find its place among the tools available to clinicians in a more personalized vision of patient care.

Contrast-induced nephropathy (CIN) is a renal complication occurring after the administration of iodinated contrast agents routinely used in medical imaging. CIN causes acute renal failure of varying severity. The pathophysiology of CIN is probably multifactorial: it involves (i) renal vasoconstriction inducing tissue hypoxia, and (ii) a possible direct toxicity of iodine derivatives leading to tubular inflammation and necrosis. Several risk factors are associated with CIN, some related to the procedure itself, others to the patient's co-morbid profile. In particular, the pre-existence of chronic renal failure, dehydration, congestive heart failure, diabetes or hypotension has been associated with an increased risk of CIN, as summarized in the Mehran score. Prevention of CIN relies essentially on adequate i.v. hydration before and after the procedure, and on the administration of the lowest possible volumes of contrast. In patients at high risk of CIN, the use of metformin and non-steroidal anti-inflammatory drugs is contraindicated at the time of contrast medium i.v. injection. In these patients, renal function assessment after 3-7 days post imaging is required.