[Alcohol dependence in primary care : a clinical approach by the GP]. / Prise en charge du mésusage de l'alcool avec dépendance par le médecin généraliste.

Clinical care to patients with alcohol dependence by GP's is described in this article. First, we have to destigmatize these patients and their illness. Diagnosis approach is specified. Therapeutic approach is first a motivational approach; subsequently it's like pedagogy : it's coping. Care is both physical and psychological. Empathy all along therapeutic relationship is a priority and how establishing a therapeutic alliance is described. A psychiatrist, a psychologist, a care network, self-help associations have also to be called on when needed. Physicians education creates new opportunities since 2016-2017 : in particular SSMG (Scientific Society of Primary Care) and three Belgian universities (UCL, ULB and ULiège) introduced a special study program called «?certificat interuniversitaire d'alcoologie?¼. Let's hope this new clinical rewarding approach for GP's contribute to reduce the treatment gap as far as clinical care of patients with alcohol dependence is concerned.

La prise en charge clinique du mésusage d'alcool avec dépendance par le médecin généraliste est décrite dans cet article. Il s'agit, d'abord, de déstigmatiser ces patients et leur pathologie. La démarche diagnostique est précisée. L'approche thérapeutique est, d'abord, motivationnelle; elle prendra, ensuite, des allures pédagogiques : il s'agit de coping. Les soins sont physiques et psychologiques. L'empathie, tout au long de la relation thérapeutique, est fondamentale et les techniques pour créer l'alliance thérapeutique sont décrites. Savoir référer au psychologue, faire appel au réseau, collaborer avec le psychiatre, conseiller l'entraide sont des initiatives nécessaires. La formation des médecins généralistes connaît de nouvelles opportunités : notamment, grâce à un certificat interuniversitaire d'alcoologie mis sur pied à la rentrée académique 2016-2017 à l'initiative de la Société Scientifique de Médecine Générale (SSMG) et de trois universités francophones (UCL, ULB et ULiège). On peut espérer que ces nouvelles pratiques cliniques, valorisantes pour le médecin généraliste, contribueront à réduire le «?treatment gap?¼ dans la prise en charge du mésusage d'alcool avec dépendance, un véritable défi de santé publique.

[Psychiatric complications associated with alcoholism]. / Complications psychiatriques liées à l'alcoolisme.

Psychiatric complications are commonly associated with alcoholism. Psychological symptoms appear during intoxication or in patients with concomitant psychiatric disorders or substance-induced psychiatric disorders. Moreover, the assessment of the psychiatric symptomatology is particularly challenging in patients who express difficulties to accept that the disorder is due to alcoholism. Psychotic reactions, affective disorders and anxiety disorders are the main psychiatric complications of alcoholism.

L'abus d'alcool peut être à l'origine de complications psychiatriques. Les symptômes psychiques peuvent apparaître lors des phases d'intoxication ou être présents chez des patients souffrant de troubles psychiatriques pré-existants ou induits par l'alcool. En outre, l'évaluation de la symptomatologie psychiatrique induite ou exacerbée par l'alcool est rendue particulièrement difficile par les réti-cences qu'ont les patients à accepter que la décompensation puisse être favorisée par la prise de substance. Les décompensations psychotiques, les troubles de l'humeur et les réactions anxieuses sont les manifestations psychopathologiques les plus fréquentes chez les sujets alcooliques.

Alcohol-induced hypertension: an important healthcare target in Belgium.

Excessive alcohol intake is one of the leading causes of premature death in Europe and particularly in Belgium. Belgian people are consuming more alcohol per year than the European average. It is well established that excessive alcohol consumption is a significant predictor of the development of hypertension (HTN). Two million adults in Belgium suffer from HTN and this number will increase to three million by 2025. Less than 50% of Belgian people treated for HTN are well-controlled. Alcohol reduction in patients with HTN can significantly lower systolic and diastolic blood pressure. After reviewing the epidemiology of HTN and alcohol disorders in Belgium, this paper will focus on the rationale for alcohol screening and brief intervention in primary care. It will also describe the barriers to alcohol screening, and what could be the benefits of alcohol screening for our healthcare system. The authors believe that early identification through alcohol screening and brief intervention in general practice can help to improve the management of patients with HTN, to reach the targets of the WHO Global Action Plan, i.e., a 25% relative reduction in the risk of premature mortality from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases. They are also convinced that this would allow achieving major healthcare savings.

Enhanced levels of free and protein-bound threonine in transgenic alfalfa (Medicago sativa L.) expressing a bacterial feedback-insensitive aspartate kinase gene.

Threonine, lysine, methionine, and tryptophan are essential amino acids for humans and monogastric animals. Many of the commonly used diet formulations, particularly for pigs and poultry, contain limiting amounts of these amino acids. One approach for raising the level of essential amino acids is based on altering the regulation of their biosynthetic pathways in transgenic plants. Here we describe the first production of a transgenic forage plant, alfalfa (Medicago sativa L.) with modified regulation of the aspartate-family amino acid biosynthetic pathway. This was achieved by over-expressing the Escherichia coli feedback-insensitive aspartate kinase (AK) in transgenic plants. These plants showed enhanced levels of both free and protein-bound threonine. In many transgenic plants the rise in free threonine was accompanied by a significant reduction both in aspartate and in glutamate. Our data suggest that in alfalfa, AK might not be the only limiting factor for threonine biosynthesis, and that the free threonine pool in this plant limits its incorporation into plant proteins.