Blood glucose sensors for continuous interstitial glucose monitoring are reimbursed in Belgium for certain categories of type 2 diabetics treated with basal-prandial insulin regimens under the Diabetes Convention. They provide a better assessment of glycemic exposure, allowing finer tuning of insulin doses and adjustment of non-insulin glucose-lowering medications. As with type 1 diabetes, their use requires reevaluation of dietary practices and guided dietary counseling based on ambulatory measurements as a result of improved assessment of glycemic exposure, including postprandial excursions and nocturnal glucose.
Type 2 diabetes treatment in older adults presents a clinical challenge due to a benefit-risk balance that is increasingly compromised by ageing and comorbidities. This review explores the concepts of overtreatment and deprescribing of glucose-lowering treatments, which are essential for optimizing the management of this heterogeneous population. Beyond highlighting their relevance, it underlines current knowledge gaps and the need for further research to develop a more individualized, effective, and safe therapeutic approach for older adults living with type 2 diabetes.
Severe thyroid dysfunction can lead to subfertility via different pathways like altered menstruations, changes in reproductive hormone levels and through a direct impact on the ovaries. Fertility problems may persist even after thyroid function normalization, and require surgery and/or an assisted reproductive technology (ART). Several studies showed that women with polycystic ovarian syndrome and idiopathic subfertility have a higher prevalence of thyroid autoimmunity (TAI) compared with fertile women or women with other subfertility causes.
Prior to ART treatment, ovarian stimulation (OS) is performed, leading to high estradiol levels, in turn potentially resulting in (subclinical) hypothyroidism in women with TAI, requiring thyroid hormone supplements (LT4) before pregnancy. Women with (subclinical) hypothyroidism prior to OS and treated with LT4 should target a serum TSH level <2.5mIU/L.
In meta-analyses including women with TSH levels >4.0mIU//L, LT4 increased live birth rates, but this was not the case in euthyroid women with TAI. However, the use of intracytoplasmic sperm injection seems to be promising in those women.
Based on the above-mentioned reasons, routinely screening for thyroid disorders in women of subfertile couples is strongly advised.
Thyroid nodules are a very common issue in the adult population. Thyroid scintigraphy is the only method available to assess the functional characteristics of thyroid nodules. Hyperfunctional nodules, also known as hot or autonomous nodules, are characterized by an increased isotope uptake compared to the adjacent thyroid parenchyma. They present activating somatic mutations in the TSHR and GNAS genes, are rarely malignant, and their prevalence increases in iodine-deficient regions. Cytological examination of these nodules frequently shows indeterminate results, which can lead to unnecessary therapeutic procedures.
Although recommendations limit scintigraphy use to thyroid nodule assessment in cases of low serum TSH, many European studies have shown that a subnormal TSH level does not effectively exclude the presence of a hyperfunctional nodule. In our prospective study conducted between 2018 and 2021, among the 67 hyperfunctional nodules evaluated, 50% of patients presented with normal serum TSH levels, 70% had a EU-TIRADS 4 ultrasound score suggesting an intermediate malignancy risk, and 50% of the nodules submitted to cytology yielded indeterminate results. No malignancy was detected upon histological examination of the hyperfunctional nodules submitted to surgical excision.
Scintigraphy may still be relevant in the initial assessment of thyroid nodules in selected populations, namely patients with a TSH level <2mU/L in regions with past or current iodine deficiency, in order to avoid unnecessary diagnostic and surgical procedures.
Thyroid nodules in children, although relatively rare, have become more frequently diagnosed due to progress in imaging techniques, such as ultrasound. These nodules can either be benign or malignant, with a significant difference in prognosis. This article reviews the clinical, diagnostic, and therapeutic aspects of thyroid nodules in children, emphasizing the importance of a careful and individualized approach. The clinical evaluation includes consideration of risk factors such as radiation exposure and family history, along with physical signs like nodule palpability and lymphadenopathy. Ultrasound is the primary diagnostic tool, with high-frequency probes (≥12MHz) providing detailed information on nodule size, structure, and suspicious features. The TIRADS classification system is used to stratify malignancy risk, guiding decisions regarding biopsy or monitoring. Fine needle aspiration (FNA) is recommended for nodules with suspicious ultrasound features and has a sensitivity of 86-100% and specificity of 65-98.5%. If FNA results are inconclusive, further imaging and FNA procedures are indicated. Regular follow-up is essential, with a new ultrasound recommended every 6 to 12 months. Malignant cases require surgery and ongoing clinical monitoring. The article also highlights the management guidelines by the American Thyroid Association for pediatric thyroid nodules and differentiated thyroid cancer.
Julien Van Damme1, Bertrand Tombal1, Marco Gizzi2,3, Sandy Van Nieuwenhove4, Vassiliki Pasoglou4, Guillaume Grisay2,5, Emmanuel Seront2Published in the journal : February 2025Category : Urology
The standard treatment for non-metastatic muscle-invasive bladder cancer is neoadjuvant systemic chemotherapy followed by cystectomy or radiochemotherapy, regardless of the extent of tumor response. Recent studies have questioned the relevance of local treatment in cases of complete clinical response after systemic therapy. De-escalation strategies are limited by the poor correlation between clinical assessment of tumor response and the final pathology results from radical cystectomy specimens. Therefore, there is significant interest in developing and validating a multimodal signature to improve the prediction of response to systemic treatment using several available tools: cystoscopy with biopsies, multiparametric bladder MRI, quantification of circulating and urinary tumor DNA, and evaluation of urinary biomarkers. A more accurate assessment of tumor response to initial systemic treatment could help inform patients when choosing between standard treatment and a risk-adapted strategy: bladder-sparing procedures (clinical surveillance or intravesical treatments) for responders and immediate escalation of systemic therapy without local treatment for non-responders
Francesco Natalucci, Cecile Van Mullem, Stephanie Dierckx, Clément Triaille, Alexandra Avramovska, Tatiana Sokolova, Farah Tamirou, Frédéric Houssiau, Patrick DurezPublished in the journal : February 2025Category : Rheumatology
Recent advances in rheumatology reflect a shift toward early and personalized management of inflammatory and autoimmune diseases. In inflammatory rheumatic diseases, the advent of the ever-evolving Janus kinase (JAK) inhibitors represents a major breakthrough for 2024. By targeting the JAK-STAT pathway, these oral agents complement the current therapeutic armamentarium with a promising efficacy and tolerability profile.
In the field of systemic rheumatic diseases, particularly systemic lupus erythematosus, new recommendations encourage the early use of targeted therapies such as belimumab and anifrolumab, complemented by innovative approaches (CAR-T cells and bispecific antibodies) that offer promising prospects for deeper B-cell depletion and induce sustained remissions.
Finally, in rheumatoid arthritis, optimal patient management – from early to difficult-to-treat forms – relies on accurate identification of prognostic factors (seropositivity, bone erosions, comorbidities) and rapid therapeutic intervention aimed at reducing glucocorticoid exposure and improving treatment efficacy.
Taken together, these innovations illustrate the emergence of precision medicine in rheumatology, with the potential to sustainably improve patient prognosis and quality of life.
Ad Vandermeulen, Julien Pierrard, Sofie Heylen, Geneviève Van OoteghemPublished in the journal : February 2025Category : Radiothérapie
Innovations in radiotherapy have led to the optimization of oncology treatments by improving precision and exploring new therapeutic strategies. Three major advances illustrate this evolution in 2024.
First, online adaptive radiotherapy for rectal cancer allows treatment to be adjusted in real-time based on the patient’s daily anatomical variations. This technology, which has been available at the Cliniques universitaires Saint-Luc since 2021, reduces safety margins and enhances tumor boost delivery, thereby increasing complete response rates while minimizing toxicity.
Second, stereotactic ablative radiotherapy for kidney cancer offers a non-invasive alternative for patients who are ineligible for surgery. Thanks to high, precise radiation doses, this approach ensures optimal local control with minimal impact on renal function. The results of the FASTRACK II study confirm the efficacy and safety of this technique, which is now an integral part of clinical practice at the Cliniques universitaires Saint-Luc.
Finally, preoperative immunomodulatory radiotherapy in colorectal cancer aims to modify the tumor microenvironment to improve the response to immunotherapy. An experimental protocol initiated in 2023 is evaluating the impact of specific doses of radiotherapy on tumor immunity and the feasibility of surgical resection.
Bastien Camiola1,4, Viviana-Elena Tesinschi1,4, Sami Bou Saba1,4, Selena Toma1,4, Elin Malek2,4, Alexander Gerdom3,4Published in the journal : February 2025Category : Orthodontie et parodontologie
Cleft lip and palate are frequent congenital malformations, posing a surgical challenge, particularly for the correction of nasal deformity. Nasoalveolar Molding (NAM) is a pre-surgical orthopedic technique designed to improve anatomical relationships prior to surgery. By progressively realigning the labial and maxillary segments while reshaping the nasal cartilage, NAM reduces cleft width and optimizes primary surgery. This approach improves nasolabial esthetics, reduces tissue tension, and minimizes the need for secondary corrections. However, it remains demanding for clinicians and families. The emergence of digital technologies and artificial intelligence opens up new prospects for optimizing and facilitating this treatment.
Eléonore Longton1,5, Rachel Galot2,5, Jean-Pascal Machiels2,5, Michèle Magremanne3,5, Sandra Schmitz4,5Published in the journal : February 2025Category : Oncologie
Head and neck cancer requires multidisciplinary management, involving physicians and paramedical professionals. In 2024, the Department of Head and Neck Oncology introduced monthly meetings that bring together these different experts to ensure comprehensive, personalized care for each patient. This approach promotes better treatment adherence while improving patients' quality of life.