Notes

Impact along with Problems of Adding Synthetic Brains and Telemedicine directly into Specialized medical Ophthalmology.
The pharmaceutical industry faces, as many other public and private sectors, a significant deficit in trust (medication considered too expensive, not always readily available, even if it is deemed essential, lack of financial transparency). Immunology inhibitor Moreover, we are more than very surprised by the lack of efficiency (colossal investments, compared to the modest final output). Not a single human activity sector can afford the luxury of such a situation. In these moments of doubts, industrial leaders are pushed to reinvent the whole sector, starting from research and development, through production and commercialization, to finish with retail. They are massively investing in new disruptive technologies (artificial intelligence, connected health, big data), redesigning the way clinical trials are elaborated and performed.Pulmonary embolism (PE) is the third cause of cardiovascular death in industrialized countries. The difficulty lies on the diagnosis and is linked to the clinical pre-sentation which is often non-specific. The use of diagnostic scores and paraclinical examinations help the clinician in the management and assessment of the risk of death. This article aims to optimize knowledge and management of pulmonary embolism by revising the latest recommendations from the European Society of Cardiology 2019.In cystic fibrosis, lung disease is early and insidious. It almost always conditions the prognosis. A pragmatic way of looking at prognostic factors is to distinguish those on which care management has little (environmental factors) or no grip (genetic factors) and those related to the quality of care, the latter being crucial. Recently, a triple-combination CFTR («Cystic Fibrosis Transmembrane conductance Regulator») modulator regimen has been shown a highly effective therapy. Ultimately, at least 90 % of Belgian patients with cystic fibrosis should benefit from this drug. However, its official price is extremely high (712 €/day), lacks transparency and illustrates problematic aspects of current orphan legislations. For the majority of citizens in Western Europe, a social ideal still prevails that healthcare should be accessible to all in an equitable fashion. Somewhere between this price and the necessity for national health systems based on solidarity to keep the costs of orphan drugs at a sustainable level, patients are looking like hostages.Paedophilia is a paraphilia characterised by behaviour, drives or sexual fantasies that are intense and recurring and that involve children, in a general sense. This sexual deviation is often linked to personal distress, to a significant alteration of personal, family, professional and social life, in a general sense. In our modern Western societies, paedophilia and the perversions associated with it are punishable by law. Paedophilia is a concept that is very ancient, complex and particularly diverse in its many clinical presentations. Its societal impact is very important and contrasts with the real knowledge of this issue among non-specialists, or even among specialists. Based on expert clinical experience gathered at the courts and on an exhaustive review of current literature on the subject, the authors propose an update of the concept of paedophilia. In the first part of this work, the authors will discuss several aspects such as the historical background and the clinical aspects and nosography of paedophilia. This literature review will be accompanied by short clinical vignettes, based on the authors' clinical experience.Sodium-glucose cotransporter type 2 inhibitors (iSGLT2 or gliflozins) exert their antidiabetic action through a specific renal mechanism, by inhibiting tubular glucose reabsorption. These agents have proven their efficacy to reduce major cardiovascular events and hospitalisation for heart failure, but also the progression of chronic kidney disease (CKD), in patients with type 2 diabetes (T2DM) at high risk, independently of glucose control. While the glucose-lowering effect of iSGLT2 is decreasing with the decline of estimated glomerular filtration rate (eGFR), both cardiovascular and renal protections remain present until an eGFR as low as 30 ml/min/1,73 m². These effects were demonstrated in several meta-analyses and in two trials specifically dedicated to renal outcomes in patients with CKD and macroalbuminuria CREDENCE with canagliflozin and Dapa-CKD with dapagliflozin. link2 In addition, Dapa-CKD showed similar positive results whatever the presence or absence of T2DM. Safety profile of SGLT2is among patients with CKD is good and similar to that of patients with normal renal function. These favourable findings led to a privileged place of SGLT2i in recent international guidelines promoted by diabetologists, cardiologists and nephrologists. Current restrictive criteria for the prescription and reimbursement of SGLT2i in Belgium according to eGFR level (initiation only if eGFR superior to 60 and interruption if eGFR inferior to 45 ml/min/1.73 m²) should be enlarged very soon owing to convincing results of published controlled trials.Anesthesia remains a high-risk specialty, even though the discipline has evolved considerably over the last few decades. link3 Independently of postoperative complications, some risks are inherent to the perioperative period itself. In this narrative review of the literature, we describe these risks and the predictive scores, allowing an assessment of these complications. All these scores are designed to detect high-risk patients and to promote personalized medicine and individualized anesthesia. They also increase the objectivity of the preoperative assessment. Finally, using these scores, the practitioner can more accurately respond to the patient who presents anxiety regarding the perioperative period.The aim of this study was to analyse retrospectively the profile of female victims of intimate partner violence (IPV) within the population of victims of assault and battery seen in expertise at the Forensic Institute of Liège. Overall, 678 files were analysed. The proportion, nature and type of IPV were determined, as well as the profile of the victims. The link between the socio-economic profile and the seriousness of the sequelae was analysed on the basis of the Chi-square test. 8,4 % of the files concerned IPV, of which 93,0 % were female victims. All the victims had suffered physical domestic violence and 55,5 % of the victims cumulated at least two forms of violence. According to Johnson's typology, 56,6 % of IPV cases may be considered as «Situational Couple Violence» and 43,4 % as «Intimate Terrorism». There are differences between the profile of victims of IPV according to the literature and the profile of victims seen at the IML. Subject to these differences, we have not found a link between the socio-economic status and the severity of the sequelae of IPV victims.Pulmonary fibrosis is a pathological entity still too little understood today, burdened with significant morbidity and mortality. Idiopathic pulmonary fibrosis is a complex diagnostic disease requiring a multidisciplinary approach and in some cases the performance of a lung biopsy. In addition, the early identification of the pathology remains the key in order to preserve lung function as much as possible. In this context and in view of the diagnostic difficulty, it seems essential to identify new biomarkers to help with the differential diagnosis, the evaluation of the prognosis and the response to treatment. In addition, the evolution of the pathology remaining inexorable despite anti-fibrotic treatments, it appears critical to be able to identify new potential therapeutic routes.Diffuse bilateral uveal melanocytic proliferation is a rare paraneoplastic ophthalmologic syndrome. The increase in life expectancy in oncology partly explains the gradual increase in its incidence. In almost half of the cases, the syndrome manifests itself before the diagnosis of primary neoplasia. It should be suspected in cases of bilateral uveal pigmented lesions that do not meet the clinical criteria for other known eye pathologies. Legal blindness occurs for the majority of patients during the first year after the initial clinical presentation. Death, due to the severity of the underlying pathology, occurs statistically within three years. Here we display the case of such a diffuse bilateral uveal melanocytic proliferation in a patient with relapsed colonic adenocarcinoma, initially treated for age-related macular degeneration.POEMS syndrome is a rare and invalidating entity characterized by polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and dermatoses. The diagnosis of this condition is often late and challenging due to the heterogeneity of clinical forms. The light chains secreted by the clonal plasmocytes cause overproduction of VEGF (Vascular Endothelial Growth Factor) responsible for the appearance of the clinical manifestations of POEMS. The diagnostic approach is based on different clinical and biological criteria. Patients with a solitary plasmacytoma are candidates for radiotherapy treatment. Patients with diffuse bone involvement or bone marrow infiltration are best treated by systemic drugs. The response to treatment may take several months before clinical and biological improvement. Early diagnosis and dedicated management limit the clinico-functional impact of POEMS.Both obesity and type 2 diabetes (T2D) are recognized risk factors for developing a more severe form of COVID-19, with a higher death rate. Metformin is considered as the first-line medication for the treatment of T2D, especially in obese patients. Beyond its glucose-lowering activity, metformin exerts pleiotropic effects, among which an anti-inflammatory effect that could be beneficial. However, metformin is contraindicated in case of severe renal insufficiency, liver failure and/or unstable heart failure, because of a risk of lactic acidosis. Yet, COVID-19, besides the well-known pneumonia that can be responsible for severe hypoxemia, may be associated with multisystemic organ failure, among which kidneys, liver and heart. Thus, the question arises whether metformin, which represents the background therapy in above 80 % of patients with T2D, should be continued in patients exposed to SARS-CoV-2 or instead be stopped. This article summarizes the most important results of observational studies, which all argue for a beneficial effect of metformin therapy that is associated with a significant reduction in mortality among hospitalized patients with T2D due to COVID-19. Finally, some practical advices will be given.Tracheomalacia (TM) is characterized by tracheal collapse due to an intrinsic anomaly resulting in a lack of rigidity of the cartilaginous rings and/or the posterior membrane during expiration, coughing or crying. It may also be secondary to external compression or acquired during endobronchial diseases. TM is commonly associated with other syndromes or airway abnormalities. Tracheomalacia can be localized or diffused and if the main bronchi are involved, the term of tracheobronchomalacia (TBM) is used. The most common symptoms include expiratory stridor, barking cough and recurrent respiratory tract infections. If tracheal weakness is severe, Acute Life Threating Events (ALTE) or Brief Resolved Unexplained Event (BRUE) can occur. While mild forms usually do not require any treatment, severe TBM may require medical and/or surgical management. Amongst several possible treatments, including tracheostomy, noninvasive ventilation and airway stenting, the pexy surgical approach (posterior, anterior tracheopexy or aortopexy) is currently the favoured option.
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