Dominique Piette, Catherine MagnettePublished in the journal : October 2021Category : Geriatry
This article describes the case of two elderly patients suffering from COVID-19 and admitted to a geriatric ward. It refers to the physical but, above all, psychological suffering that affects both the patients and their geriatricians at their bedside. Based on international literature, we analyze the severity of COVID-19 consequences on mental health. Moreover, we also add recommendations to be implemented so as to limit the impact of this long-term suffering.
Cécile Habran (1), Marie Laterre (2), Julie Fudvoye (3), Michelle Nisolle (4)Published in the journal : October 2021Category : Clinical Report
Disorders of sex development (DSD) represent a diagnostic challenge. The complexity and variability of DSD and their psychosocial consequences require multidisciplinary care, including obstetricians, endocrino-pediatricians, clinical geneticists, pediatric urologists, neonatologists, psychologists, as well as child psychiatrists. The clinical case described herein is a genotypic-phenotypic discordance. Indeed, the non-invasive prenatal test argued in favor of a male chromosomal sex, whereas the fetal ultrasound was rather in favor of a female phenotype. The antenatal biological explorations will likely enable us to review both the mechanisms and genes involved in sex determination and sexual differentiation. Currently, a molecular diagnosis is found in only 30-50% of cases pertaining to 46, XY. In the event of an unusual external genitalia appearance, 75% of the reported cases are related to 46, XY, the most commonly encountered being hypospadias. The etiology retained in this foetal case is idiopathic DSD, with normal testicular function and severe intrauterine growth restriction (IUGR). Despite the improved etiological and genetic knowledge of sexual differentiation, the understanding of the underlying physiopathology is still incomplete, and some clinical situations remain unresolved.
Stéphanie Jasienski (1), Bénédicte Van Grambezen (1) , Renaud Menten (2), Olivier Danhaive (1)Published in the journal : September 2021Category : Clinical Report
Necrotizing enterocolitis remains the leading intestinal cause of morbidity and mortality in preterm infants. Given that this clinical condition can be unpredictable and fulminant, it is paramount to recognize this disease quickly and initiate appropriate treatment promptly so as to achieve better clinical outcomes. The condition’s management is multidisciplinary. Therefore, transferring the patient to a tertiary hospital with pediatric surgery must be considered in advanced cases. The condition’s physiopathology is still incompletely understood, with several factors considered to be involved, including the intestinal mucosa’s immaturity with innate immunity dysregulation, vascular immaturity, as well as microbiota imbalance that may be of iatrogenic origin. Complications may arise early or later in the disease course. Human milk and probiotics are the most established preventive measures.
Justine Malvaux (1), Asmae Belhaj (2), Philippe Eucher (3)Published in the journal : September 2021Category : Clinical Report
Right proximal subclavian artery traumatism is rare, but it may be associated with pseudo-aneurysm formation. Currently, its treatment consists of an endovascular procedure using covered stenting. Indeed, open surgery can be quite challenging due to the subclavian artery’s anatomical; therefore, such an intervention is associated with a high morbidity and mortality rate. We report the case of a 71-year-old man presenting with a right proximal subclavian artery pseudo-aneurysm following a car injury having occurred 11 years prior. Several endovascular procedures were performed, but they all failed to exclude the aneurysm. This report sought to demonstrate that an open surgical approach is still possible following failure of less invasive interventions. A right aorto-carotido-subclavian bypass was carried out using an approach combining a median sternotomy and right cervicotomy. The patient’s postoperative course was uneventful. The first follow-up at 6 weeks post-intervention confirmed both the exclusion of the pseudo-aneurysm and vascular permeability. Yet, the 1-year-follow-up is mandatory to confirm this favorable outcome.
The presence of psychological sequelae among women that have undergone induced abortion is still a controversial issue in the scientific literature. In order to clarify this further, we first constructed a questionnaire and then analyzed the answers from 100 women, at more than one year following the abortion. The results revealed that a quarter of these women still presented signs of major distress. However, it must also be stressed that another quarter declared they went serenely through this interruption, without any adverse outcome. These observations could be of interest to all those who take care of women experiencing unwanted pregnancy.
"Burn victims" represent a specific population that requires complex care. A brief description of the burns and their healing process is given herein.
Clinical burn symptoms are patient-dependent, given that they may be associated with numerous and various skin lesions, including burns, hypertrophic scars, keloids, as well as skin retractions; joint lesions consisting of mobility reductions and heterotopic ossifications, in addition to various associated pathologies, such as nerve compressions, amputations, as well as perineal lesions.
The care of these patients requires a multidisciplinary approach, enabling the management of various purely medical problems, along with a bio-psycho-social approach allowing for the various difficulties the patient is inevitably confronted with to be addressed.
On 19 May, the Health Sciences Sector of UCLouvain awarded its highest distinction to 3 personalities of the medical community for their major contribution, Professor Bruno Crestani (University of Paris and Hôpital Bichat, France); Professor Amit Nathwani (University College London and Royal Free Hospital, UK) and Professor Marc Pfeffer (Harvard University and Brigham and Women's Hospital, USA). At this virtual ceremony, the contributions of these renowned researchers in understanding the pathophysiology of pulmonary fibrosis, the development of gene therapy for the treatment of haemophilia and the role of enzyme conversion inhibition in myocardial infarction were presented and honoured. This is a summary of these scientific achievements by exceptional doctors written by the sponsors from the pneumology and haematology division and the cardiovascular department of the Cliniques universitaires Saint-Luc.
Lara Lunelli, Camelia Rossi, Nathalie Demeulenaere, Marc Léon, Xavier CollardPublished in the journal : July 2021Category : Clinical Report
Infectious spondylodiscitis is a rare disease in children, generally of hematogenic origin. In the reported case, the clinical presentation was non-specific, whereas the usual symptom consisting of severe low back pain was present.
The responsible agent, which is not always found, is usually detected using blood cultures. The most commonly implicated germs are Staphylococcus aureus, Streptococcus α-hemolytic, Streptococcus pneumoniae bacteria, and gram-negative bacilli
Evidence of Streptococcus pyogenes is anecdotical.
Léa Frisson, Cédric Mahiat, Pauline Richez, Liliane Marot, Henri Colin, Philippe D’Abadie, Julie Lelotte, Jean Cyr Yombi, Halil YildizPublished in the journal : July 2021Category : Clinical Report
Dermatomyositis (DM) is an autoimmune inflammatory disorder affecting the skin and muscles, whose etiology is often unknown. While DM induced by biological agents like anti-tumor necrosis factor-alpha agents is uncommon, this disorder is mainly seen in patients with autoimmune disorders or underlying neoplasms. We report the case of a 57-year-old female patient who developed DM with anti-small ubiquitin-like modifier-1 activating enzyme (anti-SAE 1/2) antibodies following an adalimumab treatment on account of refractory hidradenitis suppurativa. Our patient presented typical cutaneous findings consisting of heliotrope rash, Gottron papule, arthralgia, joint swelling, proximal muscle weakness, and dysphagia. Laboratory studies showed mild inflammatory syndrome, polyclonal hypergammaglobulinemia, hypoalbuminemia, high LDH levels, yet normal CK, AST, and ALT levels. Myositis-specific antibody assay was found to be positive for anti-SAE 1/2 antibodies. The electromyogram (EMG) and muscle biopsy revealed inflammatory myopathy. Systemic corticosteroid therapy was initiated. As a result, the patient’s joint pain and muscle strength both improved following 7 days of treatment. A clinical recurrence of the pathology occurred during the gradual regression of corticosteroid therapy, requiring the initiation of azathioprine with both good clinical and biological responses.
Nathalie Bilem, Marie-Noelle Vogeleer, Julien Mergen, Samuel BalbeurPublished in the journal : July 2021Category : Clinical Report
Cold urticaria is a physical urticaria induced by contact with cold environments like water or air, but also by contact with cold objects, food, or beverages. The severity of the reaction can vary widely, ranging from a simple urticaria up to an anaphylaxis with cardiovascular collapse. The cardiovascular and respiratory systems are mostly involved in severe anaphylaxis cases. Severe anaphylaxis occurs most often following aquatic activities in cold water. The diagnosis is based on the clinical history together with an ice cube challenge test. The treatment is based on antihistamines, as well as on using an epinephrine auto-injector in anaphylaxis cases. Awareness on how to avoid risk factors is also crucial, particularly including a warning against immersion in water colder than 25°C and against the ingestion of very cold food. Differential diagnosis includes the different forms of chronic physical urticaria.