Jelena Hubrechts¹, Stéphane Moniotte¹Published in the journal : December 2022Category : Pediatrics
Since 2019, the SARS-CoV-2 has been associated with the occurrence of myocarditis. Moreover, specifically in the pediatric population, this virus can cause an exaggerated inflammatory response several weeks after the acute infection. This new entity is called “multisystem inflammatory syndrome in children” (MIS-C). Cardiovascular involvement is very common in this syndrome, particularly in the form of ventricular dysfunction with increased cardiac enzymes. As myocardial damage is one of the causes of sudden cardiac death in young athletes, resumption of sporting activities must be undertaken with caution. Depending on initial symptoms, a focused history taking and meticulous physical examination may be sufficient to permit resumption of sports after the legal duration of quarantine in case of simple COVID-19 infection. In other cases, the patient should be referred to a pediatric cardiologist for a more comprehensive workup. For patients with MIS-C, sport remains contraindicated for a period of 3 to 6 months. Sport should in any case be resumed gradually, with the patient, his parents, and trainers being made aware of the possible appearance of cardiorespiratory symptoms.
Sarah Brilot (1), Esther Calvo Lasso De La Vega (2), Christian Michaux (2), Leïla Belkhir (1), Lucie Pothen (1)Published in the journal : December 2022Category : Clinical Report
Fulminant hepatitis is a rare and fatal complication of Herpes simplex virus 1 (HSV1) infection, which can affect both immunocompetent and immunodeficient adults. The diagnosis is often delayed due to the rapid evolution of the infection, hence the importance of initiating rapid treatment with aciclovir. We report the case of a 36-year-old patient with no medical history who consulted for sudden asthenia after two days of fever and myalgia. The initial laboratory workup revealed hepatic cytolysis and bicytopenia (thrombocytopenia and leukopenia). The evolution was rapidly unfavorable, with the development of acute hepatic failure and a reactive hemophagocytic syndrome. The etiological workup then revealed an HSV1 infection. Treatment with aciclovir resulted in clinical and biological improvement, and the patient fully recovered.
Guy De Backer (1), Fabian Demeure (2), Olivier Descamps (3), Dirk De Bacquer (1)Published in the journal : October 2022Category : Cardiology
Primary prevention of cardiovascular disease (CVD) is actually needed, though poorly implemented as yet. The choice of the most optimal preventive strategy depends on the total cardiovascular (CV) risk of a given person. Several models have been developed to estimate total CV risk. Until recently, the SCORE model, calibrated for Belgium (SCORE-Belgium), has been recommended for that purpose.
A new model has now been developed and validated (SCORE 2), with certain advantages. Four systems have been advocated, and the ‘SCORE 2 low-risk’ system has been recommended for implementation in Belgium. This easy-to-use model allows for the stratification of the apparently healthy adult population into subgroups at low-to-moderate, high, and very-high total CV risk, so that preventive strategies can then be adapted accordingly. A recalibration of this ‘SCORE 2 low-risk’ model for Belgium seems unnecessary. The international model likely underestimates slightly the total CV risk in the population, which is in accordance with the position of Belgium as one of the countries with the highest CV mortality rates among the 10 countries considered being at ‘low CV risk’. Indeed, this only marginal difference does not justify a recalibration of the international model.
Charline Bronchain (1), Thérèse Leroy (2), Ségolène de Rouffignac (3)Published in the journal : October 2022Category : Médecine Générale
Due to the increasing prevalence of obesity, bariatric surgery has become an effective treatment option, resulting in a significant weight loss and reduction in associated comorbidities. Nevertheless, this procedure is an invasive therapeutic act, inducing rapid physical and psychological changes and requiring serious post-operative discipline. Seven patients who had undergone bariatric surgery were interviewed via individual semi-structured interviews. These were aimed to better understand their experiences and clarify the role that the general practitioner could play in managing obesity through bariatric surgery. The qualitative analysis of the testimonies reveals different emotional phases that patients may go through once the surgical process has been performed. The general practitioner (GP), present on the front line, exerts a crucial role in accompanying the patients through the associated changes and identifying the early signs of psychological suffering, provided that the GP is continuously attentive to the patient’s emotional evolution. In addition, the GP could be a relay contact concerning the help that is available by informing the patient about it.
Coagulation disorders, both thrombotic and haemorrhagic, affect many women throughout their lives. We provide a summary of a Webinar on the risks of thrombosis favoured by hormonal treatments, the relevance of thrombophilic assessments and finally the diagnosis and management of haemorrhagic diseases, the presence of which should be suspected in any woman presenting unusual haemorrhages, particularly from haematological reasons.
Camille Desender (1), Pascal Fajardo (2), Nicolas Eppe (3), Fleur André-Mathieu (4), Ludivine Hougardy (5)Published in the journal : October 2022Category : Clinical Report
The antiphospholipid syndrome is an acquired autoimmune thrombotic disorder that has been known since 1906, with an incidence of 40 to 50/100,000 people. Its complex pathophysiology remains poorly understood at present, with all organs potentially affected. Symptoms are very variable and most commonly associated with multiple thrombotic or thromboembolic events. If such manifestations including obstetric events occur in young patients, we should consider the diagnosis of antiphospholipid syndrome. Owing to its morbidity and mortality, this syndrome constitutes a diagnostic and therapeutic emergency.
The purpose of this study was to evaluate the medium-term survival of a dual mobility (D.M.) new generation cup: Polarcup® (Smith&Nephew, Fort Worth, Texas) in primary hip arthroplasty, in a population over the age of 70 (mean in our study: 80 years old). In comparison with other studies, our results are similar in terms of medium-term implant survival (100% after 9 years of follow-up, with the occurrence of nine periprosthetic femur fractures long after the operation). This type of cup is indicated for patients with a high risk of dislocation, aged between 70 and 75 years old, with neurological pathologies, alcoholism, low muscle trophicity and prosthesis revision, as well as tumor pathology requiring cementing of the cup in a Kerboull cross-type reconstruction ring. Wear problems occurred at the beginning of the first-generation DM cups use because the surface condition and the geometry of the prosthetic neck are involved in these wear phenomena. This led to the current preference for stems with smooth necks without extraction notches and highly cross-linked polyethylene. Currently, despite a wear and survival rate comparable to that of fixed polyethylene, the risk of intra-prosthetic dislocation (2%) specific to this type of implant should make their use cautious, especially in young and active patients (1). A more widespread use in patients over 70 years of age, supported by the significant reduction in the dislocation risk, as well as the very favorable medium-term survival results of new generation D.M. implants demonstrated by the Australian 2021 registry, could lead to a significant economic advantage (2).
Laurent Levecq, Margot D’Affnay, Alice BughinPublished in the journal : October 2022Category : Ophtalmology
The physician’s role is no longer limited to trying to make his patient aware of his physical or cognitive impairment, hoping that he will partially or fully give up on driving. The physician must support the patient and point out that there might be solutions, whether in the form of restrictions or conditions, likely to save him from financial and legal setbacks. In rare cases, it may happen that the dialogue is not possible anymore, the incapacity is proven and puts at risk both the patient and the third parties. In this specific situation, the physician might free himself from medical confidentiality without risk of ethical or criminal penalties, provided progressive and proportional actions.
How are our Belgian hospitals, including the physicians who work in them, being funded? How are these funds calculated and allocated? Herein, the article’s author has presented his book covering this topic. In brief, he has further explained the components of Belgian hospital financing, comparing it to what is done abroad, exposing both its strengths and weaknesses, and discussing the ambitious reform that is being scheduled by Minister Vandenbroucke.
Islet transplantation holds great promise for the treatment of type 1 diabetes (T1DM), as it offers the potential to restore euglycaemia in a reliable manner, protects against hypoglycaemia and glycaemic lability in a way that exogenous insulin administration has thus far been unable to achieve, and is associated with far fewer risks than whole-pancreas transplantation. Moreover, for patients requiring total pancreatectomy for benign disease, isolation of islets from the diseased pancreas with intrahepatic transplantation of autologous islets can prevent or ameliorate postsurgical diabetes and improve quality of life. We, therefore, seek to add this alternative treatment to the therapeutic modalities proposed within our institution.