[Infantile hemangioma: a new indication for propranolol? Retrospective study: a case-series of 25 infants]. / Hémangiome infantile du nourrisson: une nouvelle indication du propranolol? Etude retrospective: série de 25 cas.

BACKGROUND: In 2008, the New England Journal of Medicine reported a new indication for propranolol: treatment of complicated infantile hemangioma (IH). The objective of this study is to identify any adverse events and to measure the efficacy of propranolol in children with complicated IH, through a retrospective, observational, case-series study of 25 patients treated with propranolol at the Hôpital Universitaire des Enfants Reine Fabiola in Belgium. OBSERVATIONS: 25 patients were submitted to this therapy. The treatment was stopped prematurely for two of them, by parental fear of side effects and 48 % presented one or more adverse events; all of which were transient and rapidly controlled by adjusting the doses administered. Mean age at the start of treatment was 4,8 months. A clearly favorable response was observed in 100 % of patients at their first visit after treatment initiation ; a total response was seen in 9 patients, with subtotal and partial responses observed in 9 and 3 patients, respectively, by the end of treatment. CONCLUSION: The real efficacy of propranolol for complicated IH was confirmed by the clearly evident improvement observed in all patients and the absence of non-responders. As global tolerance was also good, propranolol can therefore be considered to be an appropriate first- line treatment for complicated IH.

Feasibility and acceptability of HIV screening through the use of rapid tests by general practitioners in a Brussels area with a substantial African community.

OBJECTIVES: To assess:1) if HIV screening with rapid tests in neighbourhoods with a substantial African community is feasible and acceptable among GPs and patients; 2) HIV seroprevalence. METHODS: Multicenter prospective study with 10 trained physicians. Use of HIV standard test and INSTI Ultrarapid test. INCLUSION CRITERIA: MSM, sex worker, multiple sexual partners, having returned or coming from a country with high HIV prevalence, IVDU, Indicator conditions as defined by HIV Indicator Diseases across Europe Study, having an AIDS-defining illness, having had a recent pregnancy or abortion; or presenting other risks. RESULTS: From August 2010 to August 2011, 10 trained GPs offered an HIV test to 224 patients: 51% ♀, 48% ♂, 43% Caucasians, 45% Africans. INCLUSION CRITERIA: 32% "high risk group", 9% returning from an endemic country, 29% with an indicator condition; 12 patients (6%) refused the standard test. The INSTI was offered to 217(97%), 197 performed with 2 reactive rapid tests confirmed. The seroprevalence according to ethnic origin was 0% among Caucasians and 2.2% among Africans and was 1.5% among patients with an indicator condition. 1087 consecutive consultations of the same GPs were recorded: 42% patients had ≥ 1 inclusion criteria among which 41% of offered tests, that is to say 59% of "missed opportunities". The reasons for not offering the test as recorded for 55% of patients:"not indicated" 44.5%, "no time" 33%, "impossible to propose" 15%, test completed previously 11%, known HIV-positive 4%. CONCLUSIONS: Standard and rapid tests are well received by patients but were usually not offered by doctors who have been trained.

[Infantile hemangioma and propranolol: a therapeutic "revolution". Literature review]. / Hémangiome infantile du nourrisson et propranolol: une "révolution" thérapeutique. Revue de la littérature.

Infantile hemangioma (IH) is the most common benign vascular tumour affecting children. Most infantile hemangiomas are self-limiting, but some require specific treatment. Propranolol has been proposed for the treatment of infantile hemangiomas. The aim of this study is to explore the mechanism of action of propranolol for the treatment of infantile hemangiomas and to demonstrate its safety and efficacy through a review of the literature. The non cardioselective bêta-blocker propranolol has been used in a pediatric setting for 40 years and, since 2008, has a new indication. A clearly significant improvement has been observed in the condition of children with complicated IH (10%) treated with propranolol. This new indication has been widely described in the international literature. Various explanations have been put forward for the mechanism of action including a vasoconstrictor, antiangiogenic and apoptotic effect of propranolol on the different cells making up an IH. Overall tolerance is good and the efficacy markedly superior to that of any other treatments used for this purpose. In conclusion, with its good tolerance profile and superior efficacy versus all the other available therapies, propranolol can be considered to be a first-line treatment for complicated IH.

[Management of patients with HIV/AIDS by the general practitioner]. / Prise en charge en médecine générale du patient atteint par le VIH.

Dealing with HIV/AIDS in primary care encompasses preventive, curative, social and psychological aspects within a framework of a person-centred approach. Antiretroviral treatments enable the control of HIV infection, prevent opportunistic infections, reduce the risk of the sexual transmission and allow patients to "live their life" with an increased life expectancy, active sexuality and need to procreate. The holistic care of patients should always be the primary concern. An increased involvement of GP's in HIV care can raise the quality of care, reduce the stigma and prejudice surrounding HIV. Medical care providers can substantially affect HIV transmission by positively reinforcing changes to safe behavior, by referring patients for specialized services and working in direct collaboration with them, by facilitating partner counselling and testing. It might be considered to create a "path of HIV care" in the perspective of an optimal collaboration between primary care and specialists. However, providers must interweave the" half-baked "science about drug therapies, side effects and drug interactions with the psychosocial and lifestyle factors of the patient. Sometimes it's not easy to find adequate and relevant information about HIV in primary care. This document will provide primary care givers the keys for improvement, increase their basic HIV-related skills (and strengthen their role in HIV/AIDS prevention and follow-up) and make them more confident in their assessments.

[The new types of addiction]. / Les nouvelles formes d'addiction.

Addiction is characterized by the inability to control his consumption of product or control certain behaviors, and the continuation of the behavior despite knowledge of its adverse effects. Addictions to substances like heroin, cocaine, etc., are well known. But other substances potentially addictive are getting more common in Belgium: MDMA, GHB / GBL, Cristal, etc. The existence of addictions without substance (called also behavioral addiction) is well recognized now: gambling addiction seems to be the most common and has been recognized as a disease by WHO, but we can also observe cyberaddiction, addiction to sex, workalholic, addiction to shopping, etc. The screening of poly-addiction or to one substance or one behavior should be systematized in the history of every patient. This screening should be facilitated through the development and validation of a cross scale. Particular attention will be paid to certain groups, both in primary prevention and screening: men, adolescents and young adults, university students or high schools, clubbers, sporting people, prisoners, ethnic minorities, people with mental disorders like depression. Primary care workers, and especially general practitioners, are at the first place to detect those different forms of addiction, can affort appropriate care according to patient's characteristics and type addiction, and to identify high-risk situations for relapse.

[Antibiotics in current infections]. / Antibiothérapie dans les infections les plus courantes.

Our principal concerns about the antibiotic regulation is the emergence and the increase in bacterial resistances to antibiotics. This article discusses the various factors influencing this resistance and the various indications of antibiotics in current infections in general practice. In our singular conference with the patient, we have to integrate the characteristics of the patient, the clinical exams and the evidence of the literature to reach a clinical expertise allowing us to better prescription of antibiotics and thus to reduce the pressure of selection exerted on the bacteria.

[Evaluation of the vaccine coverage of the general practitioners in the French Community]. / Evaluation de la couverture vaccinale des médecins généralistes en Communauté Française et en Région de Bruxelles-Capitale.

The present inter-University study aims to analyze the vaccine statute of the Belgian French-speaking general practionners and the reasons of their possible non-vaccination. A questionnaire with an exhaustive list of vaccines was sent by postal way to a random sample of thousand two hundred and twenty general practitioners. The results were analyzed via SPSS 13. The rate of answer is 60.83%. Two thirds of the doctors (67%) considered themselves in order of vaccination anti-influenza. A majority of doctors (59.7%) is vaccinated systematically each year. The majority of the doctors (83%) considered themselves in antitetanus order of vaccination. Two thirds (67%) think that the vaccine protects from 5 to 10 years. Nearly 73% of the doctors considered themselves in order of vaccination against hepatitis B. More than 50% of the doctors received a vaccine HBV since less than 10 years. The majority of the doctors (79.2%) made a blood control of their protection after vaccination HBV Almost half of the doctors thinks that the vaccine protect for life, 23% from 10 to 20 years and 14% from 5 to 10 years. Two thirds (67%) of the doctors did not make a vaccine against rubella. In 80% of the cases vaccination dated from more than 20 years. In nearly two thirds of the cases the doctors did not make blood control of their protection. Nearly 60% of the questioned doctors think that vaccination offers a protection to life. About half of the doctors did not consider themselves in order of vaccination against the whooping-cough. In three quarter of the cases last vaccination dated from more than 20 years. The two principal durations of protection of the vaccine are with life and between 10 and 20 years. Three quarters of the questioned doctors are considered in order of vaccination against the poliomyelitis. However in 62% of the cases the last vaccine goes up with more than 20 years. More two thirds of the doctors think than the vaccine protects with life or from 10 to 20 years. Two thirds of doctors considered themselves in order of vaccination against the diphteria. For a third of the doctors the vaccine dated from less than 5 years, in more than one quarter of the cases to more than 20 years like between 5 and 10 years. About half of the doctors said they were vaccinated against other pathologies: hepatitis A (34.5%), the yellow fever (21.1%), the thyphoid fever (12.5%), the BCG (8.9%), the pneumococcus (6.6%), meningitis and variola (5%). In the French Community, the vaccine coverage of the general practitioners against the influenza (67%), tetanus (83%) and hepatitis B (73%) is, in this study, higher or equal to the other Belgian and international studies but remains insufficient. A bad vaccine coverage is observed concerning rubella, the whooping-cough, the poliomyelitis. The answers over the durations of protection of the vaccines are rather disparate and show a bad knowledge of these durations and diagrams of vaccination. An update of this knowledge could be carried out during the continuous medical trainings.

[Global HIV care in general/family practice]. / La prise en charge en médecine générale du patient atteint par le VIH.

Dealing with HIV/AIDS in primary care encompasses preventive, curative, social and psychological aspects within a framework of a person-centred approach. Antiretroviral treatments enable the control of HIV infection, prevent opportunistic infections and allow patients to "live their life" with an increased life expectancy, active sexuality and need to procreate. The holistic care of patients should always be the primary concern. An increased involvement of GP's in HIV care can raise the quality of care, reduce the stigma and prejudice surrounding HIV Medical care providers can substantially affect HIV transmission by positively reinforcing changes to safe behavior, by referring patients for specialized services and working in direct collaboration with them, by facilitating partner counseling and testing. However, providers must interweave the "half-baked "science about drug therapies, side effects and drug interactions with the psychosocial and lifestyle factors of the patient. Sometimes it's not easy to find adequate and relevant information about HIV in primary care. This document will provide primary care givers the keys for improvement, increase their basic HIV-related skills (and strengthen their role in HIV/AIDS prevention and follow-up) and make them more confident in their assessments.

[Vaccination of general practitioners]. / La vaccination des médecins généralistes.

The vaccination of general practitioners represents significant problems for two reasons: they can be a reservoir of infectious diseases for the patients they are in contact with and their attitudes towards vaccination can influence their preventative acts and consequently the vaccination coverage of the population. The anti-influenza vaccination of the care providers is associated with a decrease of mortality amongst patients. Hepatitis B is one of the most frequent professional occupational infectious diseases and vaccination is necessary for all the professionals at risk. Concerning the whooping-cough we can observe at the present time an increase in the number of cases. The "Conseil Supérieur d'Hygiène" advises to propose vaccination of the people in contact with infants and people who have not HAD vaccination supplements in childhood. The rubella vaccination for unprotected women is also recommended for the care providers, to avoid the risk of infection and the possible implications for the foetus. The existing data in Belgium on the vaccination coverage of general practitioners is poor, but leads us to believe there is an insufficient vaccination coverage against these diseases. A study will shortly be undertaken to analyze the vaccination status of the Belgian French-speaking doctors and to further analyse their reasoning for any possible non-vaccination.

Rheumatic manifestations due to human parvovirus B19. A report of four cases.

Human parvovirus B19 has been incriminated in the genesis of hematologic, dermatologic, neurologic, and rheumatic disorders. We report four cases in which inflammatory rheumatic manifestations developed during the course of human parvovirus B19 infection documented by the presence of IgM and IgG antibodies. There was one case each of monoarthritis, oligoarthritis, polyarthritis, and enthesitis. Three patients had a favorable outcome under nonsteroidal antiinflammatory drug therapy, and one developed reflex sympathetic dystrophy syndrome. In patients with inflammatory rheumatic manifestations that do not fit any specific diagnosis, a careful family history can provide evidence suggesting human parvovirus B19 infection, which should be confirmed by tests for IgM and IgG antibodies.