Palliative care is recognized as a way to improve the quality of life and satisfaction of patients and their families, and even to optimize the use of health care services. However, it is implemented too little and too late for people with advanced chronic illnesses – and even more so for those suffering from non-cancer diseases. One of the main reasons for this is the “prognostic paralysis” that physicians face. Progressive chronic illnesses actually tend to have unpredictable trajectories, making it uncertain when the time is right to initiate end-of-life discussions. Various tools are available to help general practitioners identify patients who would benefit from a palliative approach, initiate such discussions, and assess potential unmet needs. Other tools exist to guide highly emotional conversations, to which physicians should add communication training to acquire the skills necessary to lead these complex discussions.
Pascale Jadoul (1,3), Fréderique Dessy (2), Jean Squifflet (1,3), Mathieu Luyckx (1,3), Amandine Gerday (1,3), Charlotte Maillard (1,3)Published in the journal : December 2024Category : Gynécologie
Physicians have an important role to play in the choice of a contraceptive method and in advising of their patients, who are strongly influenced by social media. They need to keep up to date with the latest developments in this area.
This article reviews the novelties in female and male contraceptives that have been commercialized these last five years and, to a limited extent, those expected in the future.
The progestogen-only pill containing drospirenone and the estro-progestogen pill containing estetrol are the main innovations in female contraception.
There has been a lot of research on male contraceptives for many years, which has not yet resulted in new products on the market. Thermal male contraception is not recognized, but is increasingly used by our patients.
Marine Wanlin (1), Jean-Louis Mariage (2), Pierre-Arnaud Rogghe (3), Marie-Odile Bleuzé (4), Stéphane Dechambre (5), Laurent Truffaut (6)Published in the journal : December 2024Category : Emergency
In developed countries, meningeal tuberculosis, with its non-specific clinical presentation, has a low incidence, and early diagnosis is challenging. Based on the clinical suspicion, which must be rapid, the work-up includes cerebrospinal fluid analysis showing hypoglycorrhachia and lymphocytosis features, and should be complemented by imaging studies (preferably magnetic resonance). The diagnostic gold standard remains direct microscopic examination, which requires specifically trained personnel, supplemented by mycobacterial culture, which implies long processing time. Nucleic acid amplification techniques (PCR), which are fast and specific, are not widely available in general practice settings and have poor sensitivity in non-respiratory samples. Skin test and IGRA test may be negative in cases of active and/or severe tuberculosis. To highlight the current challenges in managing extrapulmonary tuberculosis, we report a case of severe meningeal tuberculosis and delayed and difficult diagnosis despite the availability of modern molecular biology diagnostic tools.
Beryl Koener (1), Luc Vandecasteele (2), Caroline Eliacheff (3), Jacques Robert (4), Magali Pignard (5), Claudio Rubiliani (6), Patrick K. Hunter (7), Sophie F. Dechêne (8), Jean-Paul Leclercq (9), Jean-Pierre Lebrun (10), Céline Masson (11)Published in the journal : December 2024Category : Psychiatrie infanto-juvénile
There has been an exponential increase in the number of minors diagnosed with “gender dysphoria” over the past two decades. Specialized clinics in Ghent, Liège, and Antwerp treat them using the Dutch protocol, an approach described as “affirmative” of the desired gender, based on the administration of GnRH agonists followed by gender-affirming hormones.
Many clinicians are unaware of this protocol’s lack of evidence-based foundation, the many biases fostered by the World Professional Association for Transgender Health (WPATH) that promotes it, and the scandal that has erupted in various countries following its misuse. These have been revealed by the National Health Service (NHS) in the United Kingdom (UK) thanks to the Cass Review and by a report on the transidentification of minors in the French Senate. The European Society of Child and Adolescent Psychiatry (ESCAP) recently called for a halt to the routine use of the Dutch protocol for gender-dysphoric minors.
The aim of the present article is to outline the origins and foundations of this protocol, to document the drifts and biases that have occurred worldwide, and to present the current recommendations.
Lucile Breyne (1), Jean-Emile Dubuc (2-3), Olivier Cornu (2-3), Gaëtan Opsomer (4)Published in the journal : December 2024Category : Orthopedics
Frozen shoulder, also known as adhesive capsulitis, is a common condition encountered in clinical practice among patients complaining of shoulder problems. It manifests itself in three distinct phases, initially causing severe pain, followed by stiffness and functional impairment, and ultimately gradual recovery. The diagnosis of frozen shoulder is primarily clinical, with physical examination being the only method of diagnosis, and is characterized by loss of both active and passive shoulder mobility. While the majority of cases are idiopathic, some risk factors have been identified, such as diabetes, thyroid disorders, and immobilization. Initial treatment is predominantly conservative and includes analgesics, corticosteroid injections, and physical therapy, depending on the disease phase. Surgery is reserved for exceptional cases and avoided especially in the early stages. Although many aspects of this condition remain mysterious, this article is intended to inform general practitioners about the existence of frozen shoulder, so that they can provide early information to patients, initiate appropriate additional investigations, and begin initial therapeutic measures as soon as possible.
Ilektra Iakovidou (1), Grégoire Desimpel (1), Damien Hoolans (1), Marco Gizzi (2), Julien Van Damme (3), Bertrand Tombal (3), Emmanuel Seront (1)Published in the journal : December 2024Category : Oncologie médicale
Metastatic clear cell renal cell carcinoma (ccRCC) is a major challenge for clinicians. Although immunotherapy has revolutionized the management of patients with ccRCC, responses remain inconsistent and often transient, ultimately leading to therapeutic resistance. As a result, new strategies have been developed involving novel molecules with innovative mechanisms of action. This review sheds light on the pathogenic mechanisms and the advances in therapeutic strategies for metastatic ccRCC.
Catherine Verhellen (1), Valentine Gillion (1,2), Elliott Van Regemorter (1,2), Sandy Van Nieuwenhove (2,3), Karin Dahan (4), Nathalie Demoulin (1,2)Published in the journal : December 2024Category : Nephrology
In this article, we discuss the differential diagnosis of cystic kidney diseases based on a case of oro-facio-digital syndrome type 1. Establishing the correct diagnosis requires a multidisciplinary approach that includes clinical, radiologic, and genetic evaluations to better understand the prognosis, renal and extra-renal management, and specific genetic implications of each disease. Our case illustrates the importance of a detailed personal and family history taking and the significant diagnostic input provided by new genetic sequencing techniques.
Mohammad F Pirbuccus, Elliott Van Regemorter, Michel Jadoul, Nathalie DemoulinPublished in the journal : October 2024Category : Nephrology
Despite being a major public health problem, chronic kidney disease is often underdiagnosed. Measurement of glomerular filtration rate and albuminuria should be offered regularly to patients with comorbidities such as diabetes, hypertension, and/or cardiovascular disease. Early diagnosis of chronic kidney disease is essential for optimal management, especially given the availability of new therapies aimed at reducing the risk of progression and the occurrence of cardiovascular complications.
Véronique Deneys (1,3), Christine Pirlet (1), Jean Stoefs (2), Youssra Khaouch (1), Edith Rubin Winkler (3), Corentin Streel (1)Published in the journal : October 2024Category : Banque de sang
Patient identification is an essential step in hospital risk management and a key factor in transfusion safety. When taking a blood sample, the probability of mistaking a person’s identity is estimated at around 1/2,000. This can lead to diagnostic errors and/or inappropriate therapeutic patient management. In addition, the impact in terms of transfusion safety is major because mistaken identity can lead to ABO incompatibility, which can be fatal, as will be explained below. The causes of identitovigilance errors are diverse, but human factors are predominant. As part of the risk management process, various measures can be implemented to reduce the risk of WBIT (Wrong Blood in Tube): determining a patient’s blood group using two samples taken at different times plays a very important role. Staff training, adherence to procedures, and incident analysis are also essential and valuable tools. Finally, patient involvement in the safety of their care must become a “standard of care”.
Florence Fares (1), Nancy Laval (1), Jana Assy (2), André Mulder (3)Published in the journal : October 2024Category : Neonatology
Congenital nephrotic syndrome (CNS) is a rare and severe disorder that manifests in utero or during the first 3 months of life and is amenable to prenatal diagnosis. We report a case of CNS of the Finnish-type, the most common form of the disease, in a Lebanese newborn admitted to the neonatal intensive care unit for generalized edema. The diagnosis was confirmed by the presence of two compound heterozygous mutations in the NPHS1 gene. Despite optimal conservative treatment, the course of the disease was characterized by numerous complications resulting from massive protein loss. This case report illustrates the complexity of managing severe forms of CNS, especially in the neonatal period. We discuss its diagnostic, evolutionary, and therapeutic aspects, as well as the importance of genetic testing.